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Scot: Do you take time just to reflect on things in your life, Troy? Do you have any knowledge about the act of reflection, the art of reflection, if you will?

Troy: All I know is what Dr. Chan told us before. He told us, "We think about the past and it makes us depressed. We think about the future and it makes us anxious." Those were his words, so maybe reflection isn't always a good thing. Sometimes it does, and we can, I think, become a little bit nostalgic and think the past was so much better than maybe it was, which was interesting to hear him say that. But as he said that, I thought, "Oh, that makes sense."

But I think there's value in reflection, certainly, in terms of appreciating what has happened and appreciating the experiences, and taking it in a positive way, while also recognizing that sometimes it can be a little depressing to reflect.

Scot: Mitch, do you take time to reflect?

Mitch: That is a complicated question because . . .

Scot: I love it.

Mitch: It's the opposite of what Troy was just saying, where as someone who has struggled with mental health for a lot of their life, who is just barely starting to learn a lot about myself and about how I can manage and cope with things, my therapist says that I need to not self-reflect, but instead be introspective.

So it's this idea that, for me, I do remember the bad stuff and I do focus on the terrible things that have happened, and I replay them over and over and over again. It's like bizarro nostalgia where things were terrible and things will probably always be terrible, etc.

So instead, introspection, or at least the way that it has been taught in this particular definition when it comes to my mental health work, is taking an intentional look back on things that have happened, and having this kind of approach and mindset of, "What did I feel when that thing happened? What was it that made me feel that way? How can I prevent it in the future?"

Rather than just like, "Oh, man, that was a great time," or, "Oh, man, that really, really sucked," actually going through in a very active process to kind of stop the potential of . . . I don't know another word for it, but just this negative despair-based nostalgia from kicking in.

Troy: Interesting.

Mitch: Yeah. It's an exercise I do.

Scot: Let me tell you, I think maybe you're doing a deeper reflection than I am.

Mitch: Sure.

Scot: Which is part of the reason why I think this is a good show to do, because that word is thrown around a lot, right? Reflection. It's time for a reflection. When we get to this time of year, at the end of the year, we reflect on whatever. But what does that really even mean? And that's why we're doing this episode today, to work on this notion of reflection.

This is "Who Cares About Men's Health," offering information, inspiration, and a different interpretation of men's health. My name is Scot Singpiel. I bring the BS to the podcast. The MD to my BS is Dr. Troy Madsen.

Troy: I'm here, Scot, and I'm ready to reflect.

Scot: Mitch Sears is in the mix.

Mitch: Hey, I'm going to reflect too, I guess.

Scot: And psychiatrist Dr. Benjamin Chan is going to talk about the power of reflection with us as well. How are you doing, Ben?

Dr. Chan: Doing great. Happy to be here.

Scot: Do you take time to reflect, Dr. Chan? Is that something you do?

Dr. Chan: All the time. Incredibly powerful. Incredibly needed.

Scot: So we're really looking forward to hearing about the benefits of this exercise of reflection. I mean, we've talked about other things that have benefits that you might not think have them, like gratitude, for example. So reflection, this is going to be a lot of fun.

Are you guys ready for a quote drop to start this thing? I'm going to drop a quote on you. Are you ready for this?

Troy: Let's do it.

Scot: All right. Here it comes. "We don't learn from experience. We learn from reflecting on our experience." That's John Dewey. He was a philosopher and a psychologist and an educational reformer. And he was the guy . . . his form of learning is "we learn by doing." So he's saying, "You get that experience, you do things, and then it's not truly learning until you pause and actively reflect on what just happened."

So, Dr. Chan, I have a question for you. Reflection seems like kind of a big concept. What is reflection when it comes to your practice of mental health?

Dr. Chan: Great question, Scot, and happy to tackle that one right off the gate. We're going deep right at the beginning. I love it.

So, from a mental health perspective, reflection is essential. And I love that quote by John Dewey. I think the first step is to look back at the situation or experience. We're all creatures of habit. We have built in patterns into our thoughts and behavior, so taking a pause and looking back at a specific situation or experience, I think, is the first step of reflection.

And I don't know, Mitch or Troy, can you think . . . I'm going to turn the tables on one of you. Can you think back to a situation or experience that you really thought about and pondered?

Scot: Generally, it's at a party and generally it's the day after and I'm like, "I was too loud and obnoxious." That's usually my reflection. And I think, "I'm a little over the top. I need to cool my crap a little bit."

Troy: I mean, mine often comes down . . . I certainly reflect on personal events. I have spent a lot of time reflecting on some events that have happened in the ER. Sometimes I think that's been a little detrimental because I've probably dwelt on it and maybe have even beaten myself up over it. But yeah, no doubt I definitely reflect.

Mitch: Yeah. Like I had mentioned a little earlier, for me, especially as I'm going down this long road of mental health and dealing with past trauma and dealing with all this other stuff, I have been practicing and learning strategies to reflect in such a way that it is productive and not mentally exhausting or retriggering or whatever. So, yeah, I reflect on a lot of things, but learning how to do it in a way that doesn't impact me has been a journey.

Dr. Chan: I think that's beautiful. And I think that's the first step, is to look and recognize. And then, Troy, and Mitch, and Scot, as you all mentioned, I think Step 2 is to think about it, reflect upon it. And then Step 3 is to learn. So look, think, and learn.

I think this is where we kind of break past behaviors, past thoughts. And you can do this either talking about it with someone, and that's the role of mental health. A lot of people, that's what we do. We talk about these past experiences or these past situations.

I really like journaling. I'm big into journaling now, and I think this is linked to what we discussed previously about gratitude, but just to actually write about these different experiences and what you learned about it.

Troy: I wonder though, Ben, is there danger in spending too much time in reflection? When we had an episode on anxiety, I remember you said, "We think about the past, it makes us depressed. We think about the future, it makes us anxious." Is there danger in just spending too much time thinking about the past?

And also, does that encourage just . . . Let's say if we already have some neurotic tendencies, does it encourage further neuroticism, where we are just overanalyzing situations and dwelling on them and thinking through them? I'm curious about your thoughts on that balance there.

Dr. Chan: Yeah, you used the word I was going to use, Troy. Balance. Moderation in all things. And the last step I was going to advocate for is to plan. What can you do next? What could you do differently?

Yes, if we're caught up, if we start perseverating, if we start just fixating on past behaviors, past traumas, past experiences, and we don't come up with a plan, we don't come up with a new way to approach it, yes, it would increase neuroticism or anxiety.

It's really difficult. It's extremely hard. And I don't know if anyone would feel comfortable in sharing something that happened in their past, but I think we're all experiencing and navigating life. And again, we're creatures of habits. I think life just gives us the same learning experiences again and again until we actually learn from them.

Mitch: Sure.

Troy: I like, though, what you said about looking at it as more of a looking to, "How can I act? How can I do things differently?" rather than just dwelling on it, which can definitely be a problem, I think.

We just dwell on maybe . . . Like you said, Scot. "Wow, I just talked way too much last night and I just feel stupid." And you think over and over, "What did I say? Okay, these guys must think I'm an idiot," versus just saying, "Hey, I had a good time there. Maybe I did talk a little too much. I'll try and talk less next time." I don't know.

Scot: Or maybe I could come to the conclusion that, "No, I'm fine with that, and I just need to make my peace with that." I think that seems to be the difference, using these remembrances of these experiences or reflecting on these experiences. And I love that you said plan, because that's kind of the thing then that gives it closure to me. You come up with, "All right. Well, what am I going to do about this going forward if I choose to do anything about that going forward?"

And one of the benefits I saw when I did some reading on reflection is it can help improve sleep because of that. A lot of times, the act of reflecting can give closure to things that otherwise we might dwell on. Does that sound accurate, Dr. Chan? Have you heard that?

Dr. Chan: Yeah. Again, Scot, I love your examples. Yes, I think all of us to a certain degree, when we lie down in bed at night, we start replaying a lot of those experiences and situations from our days. And we're our own worst critics. We tend to focus on the negative, not so much the positive, like, "Oh, I should have said that in that meeting," or, "When that person interacted with me, I should have said that," or, "I was quiet in that moment, and I should have spoken up," or, "This happened at the grocery store," or, "This interaction happened with a family member."

That is reflection, but also, like what Troy said earlier, if you perseverate on it, if you can't let it go, that could cause you to have insomnia. That could cause people to have difficulty falling asleep. Totally accurate.

Scot: Some of the other benefits I saw of reflection, in addition to better sleep, is it can reduce stress and anxiety levels. Why would that be, Dr. Chan?

Dr. Chan: Again, we're going to have the same situations presented to us again and again and again. And we can't control how other people think or feel or act. We can only control how we think and feel and act. And if that is sparking a reaction inside of us, that causes anxiety. That causes stress. So that's why I love doing this podcast, because to me, this is essential for high-quality mental health.

Scot: I also saw some of the benefits. Gives clarity to thoughts, which I think we've all experienced that. When we've reflected on something, we get some clarity maybe we didn't before. It creates self-awareness, and it can also create room for growth. So those are some of the benefits I came across.

Has anybody else, when they've reflected, noticed benefits that they'd like to share at this point?

Mitch: So through the work that I've been doing with my mental health specialist, the process of kind of an active reflection has allowed for me just very much that room for growth. It allows me to kind of put all the thoughts and memories and all these things that are kicking around in my head all the time to be able to say, "I don't need to worry about this anymore. I don't need to think about this anymore. I have an understanding about it. I've acknowledged the feelings that I had. I've come up with a plan to prevent any negative thing from the future." Or if it's a positive thing, how I'll get more of that in my life, whatever.

And when you don't have so much mental . . . Or myself at least, when I don't have so much mental processing power being completely devoted to the past, to just thinking about that reflection and re-feeling and reliving those things over and over and over again, it allows me to think about new stuff, and to figure out what I do and don't like in life, and how to make sure I get more of it.

Troy: I don't know if you mentioned, Scot, I didn't hear specifically, but we had our gratitude episode, and I do think that reflection does also help us to reflect on . . . Certainly we reflected on a lot of things we were grateful for, but just on a daily basis, I think it helps us in terms of reflection to experience gratitude for the positive things. And I think there's value in that too, just because it kind of helps you reframe things in your mind rather than reflecting on the negative things.

And then as new things happen, seeing negative in that, I think it then helps to potentially carry that reflective attitude of gratitude forward into the day. Certainly, there's value in that as well.

Dr. Chan: And something that I've seen again and again and again, especially during the pandemic, just to make it real world, is emails. All of us have received emails that seem upsetting or have what we perceive as a negative tone. And to me, this power of reflection is not to immediately fire back an email and reply.

Scot: But it feels so good, Dr. Chan.

Dr. Chan: I know. It feels terrific. Again, reflection. Did that person really mean to say that? Taking a pause, going for a walk, or reflect upon the intent.

I tell everyone I work with that if you get an email that causes this negative reaction inside of you, don't respond right away. Sleep on it. Revisit it the next day. Maybe type up a rough draft. Kind of process your thoughts, going back to the journaling, and then really think about pushing send.

I always feel it's better to pick up the phone and just talk to people. And unfortunately, I think with the pandemic, a lot of our communication has been altered in many ways, and sometimes we over-rely on technology. So that's just a real-world example that I've seen of reflecting about the intent and the tone of people's emails.

Troy: That's so true. I wish you could have told me this 20 years ago, Ben. And I wish there was something you could implement in your email that would just not allow you to respond for 24 hours. I will tell you, 90% of the things I've said in the course of my life that I've regretted, I've said via email. Because you don't say those things in person. You just fire off a response. You misinterpret the tone. It's so impersonal, it's easy to say things you would not say otherwise.

It's so true. Definitely power of reflection. I agree. If you can take time just to reflect on an email and let it sit and sleep on it and continue to reflect on it, there's huge value in that.

Scot: So reflection is this really broad thing, but it seems like it kind of breaks down to this. It just breaks down to if you're experiencing something or if you're thinking about a memory or if you are wondering how to move forward, it's just taking a pause and thinking about it and trying to break it down and analyze it. 

For me, at the end of the year, I tend to reflect on the goals that I set for myself that year, or the things that I wanted to try to accomplish for that year. And reflection in that instance is like a plateau when you're hiking. You can stand at that plateau, and you can look down and see how far you've come, and you can look up and see where you still want to go. You can celebrate the victory of making it to that plateau while still admitting, "I would like to continue on my journey."

So let's bring this back to the Core Four and health for a little bit. Do you guys reflect on your activity, your nutrition, your sleep, your emotional health? And what does that process look like?

Really, our whole show is based on this notion of a turning point, and reflection is required for those turning points. Things happen, we do things, we think about them, then we create this new thought that sometimes puts us in a new direction. And it might make things a lot better or just even a little bit better.

Dr. Chan: I love that, Scot. And I don't know if you're teeing this up for New Year's, but what is our plan? What are our goals for 2023? And this, to me, is where reflection comes in. We're coming out of the pandemic, there have been a lot of changes, and we all have different goals, personal goals, professional goals. Where does that growth occur?

Because if you're not actively reflecting, or as Troy and Mitch have talked about, expressing gratitude for where you've come from, how do you know where you're going?

And to me, this is a perfect segue into what is going to happen next year for us? What is the plan? And you need to reflect upon where you've come from. So I think of 2023. When you talked about that hiking analogy, Scot, that's what came to my mind.

Troy: And I would say, Scot, too, I certainly do that as well. I can't say I have a formal process in terms of that reflection on the Core Four, but what I often find is when things just kind of feel off, like just, "Something is off," it often comes back to thinking, "Okay, how's my sleep? How are things going there? How's my mental health?"

Just kind of checking in on a lot of those things and then finding, "Great, I've made these changes recently. Maybe this I didn't implement as well as I could have." Maybe we can revisit that and potentially refocusing, and then moving forward with that in mind.

Scot: As I was doing some reading, I came to the conclusion that there are some rules for good reflection. We've talked a little bit earlier, that Dr. Chan brought up, which I loved, that you've got to look, think, learn, and plan. And it's that planning part that helps give you closure.

But some of the rules I found for reflection . . . Feel free to add to these or tell me it's a bunch of crap if you want to, Ben. I think the first thing you have to do is you have to stop and make space for reflection. We're so busy and we occupy our brains all the time, even in downtime with our phone or whatever, that you actually kind of have to stop and be . . . What am I looking for here? You have to be . . .

Troy: You have to be still.

Scot: Yeah, you have to be still, but you have to . . .

Troy: Your mind has to be open and still.

Scot: You have to be intentional about stopping and making space for reflection. And I've read some stuff that said even maybe do a little meditation first to kind of get your brain in the place to do that.

Is that something you've heard of, Dr. Chan? When you talk to patients, is there a bunch of steps that you have them go through to prepare themselves to reflect and then to reflect properly?

Dr. Chan: Totally. It's almost like an adult homework assignment. You need to literally carve out time. For a lot of us, we're all working professionals and we have very busy lives, and our Outlook or Google Calendars rule our lives. So you need to go in and set aside a couple of hours a week and block those out so people can't schedule something in there.

I don't know if you use the word reflection, but executive time or personal time. You can do that during the day. A lot of people do that during the lunch hour. This is time for not just sitting at your desk and returning emails, but just go for a walk, or go out to eat by yourself or with friends. I mean, there are ways to carve out time.

So it's like an adult homework assignment, and it works extremely well. There are a lot of demands on our time and you need to prioritize this reflection time. If not, you never reflect. And that's unfortunately the cycle you get into.

Scot: And as the quote earlier said, "You don't learn from that experience. You learn from the act of reflecting." So if you're not scheduling time to do that, then you're not learning. You're not progressing.

Not only just at the end of the year or beginning of the year, I think a lot of times reflection happens during maybe vacation when we do have a little downtime or when our routine is broken up. So you've got to make that space.

And then something else I read said, "Don't beat yourself up." It's an honest evaluation based on what's working and what's not compared to your values and your priorities. And you're just honest and just very straightforward about it. Try not to be emotional about it if at all possible.

And then also be kind, because change can take time as well. So you reflect and you want to make some changes, but that doesn't necessarily always happen overnight.

Troy: Yeah, I like that. And being kind to yourself I think is essential. A lot of it gets back to what Ben said about just using it as a time you can plan, and plan your next steps. I think you can do that, you can reflect, be kind to yourself. Say, "Hey, should I do anything differently?" If not, no. Forget it. Forget about it. Don't reflect on it anymore. And if so, great. Take the lessons you can learn and move forward.

I think that's the biggest risk for me personally. I do have a tendency at times to reflect way too much on things and beat myself up and I think that's problematic. So I think if you can take from it what you can and move forward, that's the best approach.

Dr. Chan: That's beautiful, Troy. I love that.

Scot: I found some questions from a paper from Halloran 2016 called "The Value of Self-reflection." And I wanted to share some of these questions and see what you think.

This notion of reflecting, some of us might have things we want to reflect on or that come to our mind, but maybe this would be some thought starters for you if you want to take time to reflect.

And it doesn't always have to be at the beginning of the year. It could be during the workday. I often will make myself a cup of tea and take 15, 20 minutes. The rule is no social media, no work, no email, and I just sit there and I sip my tea and I just think about things. I give myself that space to reflect.

So here are some of the questions that I found interesting, and see how these resonate with you. Am I using my time wisely? Am I taking anything for granted? Am I employing a healthy perspective and not letting matters that are out of my control stress me out? Am I living true to myself? Am I still passionate about my career? Where am I feeling stuck? What do my finances look like? How have I allowed fear of failure to hold me back? When have I felt the most alive? How can I improve my relationships? Am I taking care of myself physically? What old habits would I like to release? What new habits would I like to cultivate? How can I be kind to myself? And finally, what is it time to let go of?

Mitch: Can I . . .

Troy: Yeah, can I get that list? Those are some great questions to reflect on.

Mitch: So side story here, one of the things that I started doing with my friends in college when we were struggling with anxieties, depressions, whatever, is we started doing an adaptation of a kind of witchy ritual called "Candle in the Wreath."

And with "Candle in the Wreath," everyone gets a single candle that they hold, and you light it up and you have a wreath of dead bows from the winter, and you have a big candle in the middle. And everyone, either aloud or to themselves, stands with their candle lit and lets the wax drip and they're supposed to say what the things are you are letting go of this year.

And everyone will say things and whatever, and then you have this big . . . when everyone blows their candle out, when they're done, when they feel they've given enough time, this wreath is so disgusting and covered in wax and just gnarly and gross. And you throw that on a bonfire and everyone lights their candle one more time and you say, "What am I saying yes to? What am I welcoming in the next year?" And it's supposed to let out bad energies, bring in good energies. And it's funny to see that those same questions are in a research article. That's all.

Troy: I love that you described that as kind of witchy.

Mitch: It is kind of witchy.

Scot: Troy, you want to get together and do that ritual?

Troy: Are you guys free tonight?

Mitch: Yeah. Well, you would be shocked . . .

Troy: I'll bring the branches.

Mitch: . . . how much catharsis . . .

Dr. Chan: Candles. I'll bring the candles. 

Mitch: Year in, year out, you have all these very high-functioning, super intense often, accelerated students for a while and things like that, and they just . . . It's like the only time that some of these people have ever done that kind of reflection or asked those types of questions to themselves, and it's shocking.

Troy: But I think there's incredible value in doing that regardless of how you go about doing it, if it's an actual physical act like that or some other process. But yeah, I think that's something that we need to do more of.

Scot: So, as we wrap up the episode, I was thinking about a couple of things I wanted to reflect on. One came to mind almost immediately, and I need to build in more time to actually think more deeply about this.

But as I was exercising the other day, my right shoulder used to be . . . I don't know what I've done to it over the years that I couldn't lift something over my head, but I've been working really hard to get that strength back in that shoulder.

And the other night as I was lifting, I'm like, "Wow, actually I've got strength back. I can do this again." It's not where I want it to be. It's not the same level as my left arm, but that was that plateau for me. I'm like, "I'm not where I want to be. I'm not where I was. I'm feeling pretty good about this."

And this has been something that I've been working on, or at least thinking about because I work out off and on, for over two or three years. So that comes back to that time thing.

Troy: Yeah. And it's nice because there you have a very physical manifestation of your progress. And for a lot of us maybe, it's just like, "Hey, I didn't react to that email like I might have reacted a year ago." And it's maybe something more like that where it's kind of our analogy being like, "Hey, I got my arm up higher than I did a year ago."

Scot: Well, gentlemen, I encourage you to take some time to reflect. I will get you a copy of those questions. Of course, we'll post that along with this podcast episode on our website. So, if that list of questions was useful for you, you can start asking yourself some of those questions and go through this process of reflection whether it's at the beginning of the year, which is kind of a natural time for a lot of people to do it, or like Dr. Chan recommended, maybe you need to carve out . . . Maybe you can't do two hours, but maybe you can do a half hour. Maybe it's 10 minutes before bed. You can pick something.

I like, Troy, you're just kind of doing a gut check and then going, "Well, how could I make this better? Why is it that I'm concerned about this? Is it something that I really do need to worry about?" and then putting some closure to that.

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

Dr. Chan: If this hypothetical person, if they're doing well and they don't think it's a problem and the people around them don't think it's a problem, well, it's not a problem. But if they're struggling and the people around them feel that they're struggling, I think this minimalism idea is a perfect way to start unpacking, uncluttering, and improve their mental health.

Scot: Here, we like to think about your health as a currency that enables you to do all the things you want to do. The podcast "Who Cares About Men's Health," giving you information, inspiration to better understand and engage in your health so you'll feel better today and in the future.

My name is Scot, I'm the manager of thescoperadio.com, and I'm a guy who cares about men's health.

Troy: I'm Dr. Troy Madsen. I am an emergency physician at the University of Utah, and I care about men's health.

Dr. Chan: I'm Dr. Benjamin Chan, a child psychiatrist here at the University of Utah, and I care about men's health.

Scot: So I saw a documentary at the first of the year called "The Minimalists." And I found this really, really fascinating because they make the claim in "The Minimalists" that I'm engaging in a minimal lifestyle can help with your mental health. So that is today's topic, mental health and minimalism.

Now, when they talk about minimalism, it's not about living with just the bare necessities. It's basically this philosophy that you ask yourself what things add value to your life and how might your life be better if you owned fewer material possessions.

So I wanted to go around the room, first of all, and find out everybody's philosophy on their possessions, if they've ever gone through like a purge of some sort. So let's go ahead and start with you, Mitch. Talk to us.

Mitch: Oh, hey. I'm here. I'm back.

Troy: We got Mitch back. We miss you, Mitch.

Dr. Chan: I missed you too, Mitch.

Mitch: I'm here. So I actually did a huge purge a couple of years ago. I was in between jobs. I was at kind of a low point in my life and I was reading self-help books because that's what you do. And one of the ones I came across was all about the joy of minimalist living. And I'm like, "Okay, sure." I looked around and I'm like, "Oh, I suddenly hate all my stuff."

And this particular book, she isn't like . . . I know Marie Kondo is really big right now, but she was not this one who was trying to find joy in your items. There was this seven-step process where you took everything out and there was a step where you took 10 to 15 minutes to look at all your stuff and question how did you get to this point? Why do you have these things in your life?

Scot: Wow.

Mitch: Oh my god. I'm like, "Why do I have 40 micro USB cables? What have I done in my life to need all of those?" And I got rid of maybe 75% of everything I owned. I donated it to local charities, Big Brothers Big Sisters stuff, gave away furniture, gave away everything, and I kind of cataloged my whole journey online and it was piles and piles and piles. It was almost a dumpster full of stuff by the time I was done. And since then, I've had a relationship with stuff where if it doesn't have a purpose, I get anxious that it's in my home.

It's interesting when you are in a relationship with someone else who likes to hold on to every cool box that something comes in and likes to have things up on their shelves and buys things that just fill up the house. And so there's always been this new kind of tension that I think may have swung the complete opposite way.

Scot: Troy, what's your relationship with stuff?

Troy: See, I'm not quite the polar opposite of Mitch, but probably close. I'm kind of a packrat. It's funny. Laura, my spouse, just said to me the other day, "We need to start clearing out some of your stuff. I don't know why you still have high school biology papers."

And I said, "These are important. This is part of my life and my training." And she's like, "You really don't need to look back at this, at the process of meiosis or whatever you have in here." And I was like, "Well, that's probably right, but still."/p>

So I'm kind of a packrat, and I'm struggling with this a little bit because I did go through a bit of a purge about three years ago. We did some remodeling as we were moving stuff out. Laura's like, "Hey, you've got to get rid of some of this stuff."

And just recently, I was looking for some suitcases and we had a couple of really big suitcases and I'd gotten rid of them because we never used them. You never take them as carry-on, and I needed the big suitcases. I was like, "Why did I do that purge?" Or I'm looking for a pair of pants like, "Oh, I got rid of the pair of that pair of pants." I've got to say I struggle with this a bit.

I tend to hold on to things, and maybe it is kind of more of that sentimental thing. Mitch, when you talk about Jonathan and how he holds on to things, I understand where he's coming from because I kind of do the same thing. And now, obviously, I have a spouse who is saying, "Why are you holding on to all of this?"

Scot: Dr. Chan, how about you? What's your relationship with stuff?

Dr. Chan: Oh, I can tell you about a purge fail. When I was a kid, I collected baseball cards and comic books. And I think this is perfect venue to talk about this, because this is a men's health podcast. I think there are a lot of men out there who collected baseball cards and comic books.

Mitch: Baseball cards, yeah.

Dr. Chan: And I just remember hours and hours of going to the local 7-Eleven, the comic book store, collecting all of these things.

And I liked what Troy said. I think there is a nostalgia there. When I really think about it, my dad collected baseball cards and comic books. And I still remember to this day when I was 8 or 9 years old, he produced all these comic books and baseball cards from the '50s and '60s and he gifted them to me. I just remember reading them with him, and so there's just this memory I have with these. Just the smell and certain issues, and I struggle to get rid of this.

Troy has talked about it causing problems with his spouse, and I can say the same thing because I have this . . . I just have boxes and boxes of these baseball cards and comic books and I can not make myself give them away. When I rationally think about it, they're just pictures on a piece of cardboard and they're just these stories and a little tiny book, and they mean so much more to me.

There's such an emotional value I attach to these baseball cards and I just have this image, "I'm going to give these to my son one day." I don't think kids nowadays are into baseball cards or comic books. They're more iPads and playing "Among Us" and all this other stuff. So yeah, that's a purge fail.

I don't know. Do any of you have baseball cards or comic books? I'd be curious . . .

Troy: Oh, yeah. Comic books. I loved "Garfield" growing up. Loved "Garfield." Got all the comic books. I mean, I can't get rid of those things. I totally agree. My brother collected baseball cards more than I did, but I've got like these old basketball cards and baseball cards in my stuff too. Same thing. Can't get rid of them.

Scot: It's amazing the story that you tie up in those. So I had comic books too I collected. I recently got rid of them. I just kind of let go of that whole thing. Part of what allowed me to do that is I learned that if you wanted to read them, you can do it all online now for like a monthly membership fee. When was the last time I ever took one out? I moved those comic books to five different cities and never opened the box.

A long time ago, I had a stuff rant. I called it my stuff rant, this urge to get stuff. And then this urge to get stuff makes us have a job so we can earn more money to get more stuff. And then we have to buy a house so we have a place to keep that stuff. And then pretty soon we've bought so much stuff we have to add on a garage to store more of that stuff. And then I have to buy insurance to insure my stuff. And then that kind of keeps me tacked down to I always have to have a job to earn money to keep and store my stuff and buy more stuff.

Dr. Chan: Scot, to add upon that, I think it's very unique in our society is then people buy storage facilities. Again, it just blows my mind. Again, no judging anyone on this call who owns a storage facility, but that I feel is uniquely Western and American that we own so much stuff we can't keep it in our house, we can't keep it in our garage. We have to buy space elsewhere and store stuff. It just blows my mind. So, yeah, I agree, Scot.

I was thinking about before this podcast what I could talk about. Pat Riley, he was a coach of the Lakers back in the '80s. He's still involved in basketball now. He called it the "disease of more." Scot, when you were talking about everything you've got to keep on adding, I just feel it's very applicable.

As humans, we tend to just want more and more and more, and we're never really satisfied with the status quo. We live in a very large consumer society, and it's so easy now with Amazon and everything is at our fingertips and we almost expect that . . . it's a hit. It's a dopamine hit, to bring in psychiatry.

Scot: Totally.

Dr. Chan: When buy it and then it shows up on our doorstep and then we unpack it, it's like Christmas morning 300 days of the year, and it's incredibly addictive.

Scot: And then just like Christmas morning, you play with it for an hour and then all of a sudden it's all gone and you're just left with the regret of the money you spent on it.

Troy: But it's such a dopamine hit. Ben, I usually forget what I've bought by the time it arrives. So it truly is a dopamine hit. I'm opening this package like, "What is this?" And there it is.

But speaking of storage units, that was the wake-up for me when we did our big purge. I was thinking about getting a storage unit and I said, "Wait a second. Your house is big enough. There are not a lot of people living here. Why do you need a storage unit? This is crazy." Yeah, that was a wake-up for me. I thought, "Wow, okay. We need to get rid of some stuff."

Scot: Let's talk about this notion of stuff then and the notion of minimalism and our mental health. There are a lot of different avenues we can go down about this, but, Dr. Chan, I'm going to go ahead and let you take the lead. When they say that getting rid of stuff can help you in your mental state, what do you think they mean by that?

Dr. Chan: It's a saying we have in psychiatry, that you think about the past too much and you get depressed, and you think about the future too much, you get anxious.

So the items can we kind of talked about, that anchors to the past, for better or worse they sometimes get in the way. And so by letting stuff go, it's a powerful symbol that you're turning away from the past and you're not thinking about those things as well.

Now, I don't think any of us on this call think we should get rid of everything in our life because all of us probably have something beautiful from the past that ties us to those really wonderful nostalgic memories. But if there is so much stuff and it's just cluttering your house, in a way it also clutters your mind. So that is what they talk about just letting go. Minimalism is just thinking and pivoting towards the future, not being tied down by all these items.

Mitch: One of the interesting things that the purge that I did talked about was letting go of the things that you thought you would do. And so there's this kind of . . . where they're like . . .

Scot: That's like what garage sale is. It's just a yard full of broken dreams and operations.

Dr. Chan: Well, that was kind of it. They have you do this mental health check. It was vaguely cult-y as I'm reading through this, and you go on the blogs and these people have given their lives over to it. But there were these ideas that it was like, "Did you decide you were going to get way into a hobby and then you bought all this stuff and then you found out you didn't actually enjoy it and it's not a part of your now, but you hold onto it because you might one day?"

This idea of, "Did you use to play guitar in high school and you haven't played it in 20-something years, but you keep the guitars and all of the amps and everything else? And how much of your now is being taken up by potential future?" And so at that point, that object becomes an object of anxiety and of guilt of regret and everything else.

And then same with even, "Why do you have 50 cables?" Why do you have 50 of the same charger? Well, I might have a device I need it one day. There is a potential I might need this thing one day, and then it gets into prepper behavior and things like that. It was really interesting to take a real look at the stuff and be like, "Oh, man, how much of the stuff I keep around is anxiety objects? How many of it is nostalgia and depression objects? How many of it is . . ."

Troy: Fascinating. I'm feeling super guilty. I'm sitting right now about five feet from a closet that has at least five phone cords in it, like old landline cords. When am I ever going to need a landline cord again? I've got old cell phones in there. When am I ever going to need those? For whatever reason I've held on to them. Maybe it is nostalgia. I don't know. But your point is well made, Ben. As you're saying that, that really hits home.

Part of my big purge when I did the purge was getting rid of a lot of things from my childhood: trophies, stuffed animals, and something called seed art. When I was in fifth grade, we had an art instructor who would cut out stuff in plywood, like my name and different basketball teams and stuff, and then we would use these little seeds and placed them on there one-by-one, colored seeds with glue. And I kept these things for 30 years and I finally got rid of them, but it was hard to get rid of them.

But looking at those, it was kind of anchoring in the past and maybe some good memories but also kind of holding onto the past. But again, it's kind of tough but as I look back now, it was all right to get rid of it

Scot: Did you take pictures of it? That was my strategy.

Troy: I did.

Scot: I took pictures of a few things because I figured it's more the image of the memories that it brought back. And if I wanted to ever go to that, then I could as opposed to actually keeping the thing.

Troy: Exactly. I did. I had read that, "Take pictures of it and then you've got that memory of it." So I did take pictures of it, but then I threw them in the trash. It was really hard to do.

Dr. Chan: I've also read too that sometimes people do ceremonies. There's a ceremonial goodbye. And again, just to kind of explore this to all of you because I feel that we're all similar, I get sometimes attached to cars that I've bought, like my 1990 Honda Civic. It got me through high school, college, and grad school. I loved that thing and it was just breaking down.

So I remember the last time I took it in because I knew I was trading it in and I was going to get $1,000 for it. I went on one last drive. One last drive, listened to my favorite songs, had the old CD player. Do all of you remember how the CD players used to be so important with the little album of CDs? And I just went for one last drive around the city before I turned it in, and it was hard. It was really hard.

Do any of you get connected to your vehicles? There are a lot of memories with vehicles.

Troy: You're killing me. This is a super emotional session for me.

Dr. Chan: I'm a psychiatrist. I'll send you my bill.

Troy: Exactly. I just said goodbye to my Mazda Miata.

Scot: You did?

Troy: I have taken so much heat for that car. A Mazda Miata. I bought this in residency and I've had it since then. A Mazda Miata is a completely impractical car when you live in a place where it snows for eight months of the year. So it would just sit in the garage forever.

And then I had it down at my parents' house and finally, my dad's like, "Well, what are you going to do with this car?" I said, "I haven't driven it in three years. It just isn't practical where we live," and gave it away. My dad has it. I think my sister is going to end up taking it. She's back East. But that was a hard thing to do. I get very attached to cars too. And I think it's inherited. My dad is very attached to cars. He keeps old cars around forever. So I think there's a certain inherited component to that, or maybe learned.

Scot: I had some identity stuff wrapped up. So I did a purge a couple years ago. And I was going to hold off on this because I'll tell you why in a second. But I had this realization I was creating identity with my things and that identity was I was trying to be my dad.

My dad was a rancher. Any time you needed a tool, he had the right tool at the right time. Any time you needed a piece of scrap iron, he'd go out to the scrap iron heap. So I kind of inherited those things.

And as I was getting rid of stuff because we moved and I had to downsize, the table saw, the power tools, the other tools that I hardly ever used, it dawned on me I was trying to be my dad. And that was particularly hard to let go of, that identity.

I found that identity tied up in a couple of things. I used to brew beer and I just kind of lost interest with that. I was a beer brewer. So that whole notion of losing your identity, I think, was something that played into it for me.

I just had an epiphany. I'm sorry. I'm going back to the creating my identity. I think that was powerful because it allowed me to go, "I'm not my dad. I am me," and it helped me kind of discover or allow me to then not always put myself down because I wasn't living up to some ideal in some way, shape, or form. Like, "I should be handy like my dad was." Well, I'm kind of not. I'm all right.

So it's kind of like letting go of the past, and when you let go of something, then you can replace it with something new. And that something new would be my own identity.

Dr. Chan: Scot, that's really profound. I love it. I don't know if we can top that. I think that was a precious moment.

Troy: It is.

Scot: Let's pivot for a second. So I want to know if you guys are up for an experiment. I want to do an experiment to see if minimalism, the process of getting rid of these things and then perhaps having fewer things, everything has its purpose, everything has its place . . . mental health and minimalism experiment. Are you guys game for getting rid of some stuff and tracking that journey and seeing how it makes you feel? So I don't know if Mitch has enough stuff to get rid of.

Troy: This isn't just a quiz. We have to take some action and actually get rid of some things.

Scot: Yeah. So here's my proposal. For the next 30 days . . . now this is what the minimalists proposed in their documentary. And you can find it on Netflix if you want to watch it. For every day for 30 days, you rid of something. But this is the trick. On Day 1, you get rid of one thing. On Day 2, it's two things. On Day 3, it's four things. On day 4, it's eight things. It doubles every day.

Troy: Scot, you're making me anxious. I was going to say one per day I think I could do, but this doubling . . .

Mitch: It's the 100 things challenge, isn't it?

Scot: This, actually, when you do the math comes up to 400 or 500 things.

Troy: Yeah. That's huge. I think I can do one per day.

Scot: Is a pair of socks two things? I mean, we'd have to set the rules, but then what I'd like to do is when we figure out what we're comfortable with purging as we do this journey, every episode we'll do just a little check-in and talk about what we experienced, what we went through, if it did impact our mental health, any observations we had.

Troy: Question. Does my biology paper count as one thing, or if it's 10 pages, does that count as 10 things?

Mitch: If you're holding on to all of those, I might count each one as one if it's going to help you move past them.

Dr. Chan: Troy, that's a deep question. I think we need to get IRB approval before we go.

Troy: Exactly. Yeah. That sounds like it needs a panel to review it and ponder it for about three months before they get back to me.

Dr. Chan: I think that's a great idea. I'm up for it.

Scot: All right. So Dr. Chan is in. Mitch, are you in?

Mitch: Absolutely.

Scot: All right. Troy, you in?

Troy: I don't know, Scot. Seriously, I don't know if I'm in. I can do one per day.

Scot: So we have to negotiate the number of things a day then for you it sounds like.

Troy: This is a huge number. I mean, this doubling every day is . . . wow.

Mitch: Well, maybe there's a point in which you stop, that you can't do it.

Troy: I think I would probably reach the end of the first week and I'd be like, "Okay, that's it." Because if we're doubling every day, that'd be . . . what? We'd be up to like 30 things by Day 7. That's a crazy number.

Scot: I think you'd be up to more than that because Day 5 you're to 16. Day 6, you're 32. Day 7 you'd be double 32, 64.

Troy: Sixty-four things by Day 7.

Dr. Chan: Scot, to be clear though, these are things that belong to us, not family members. Because I would love to go into my children's bedrooms and do a purge, because they have way too many toys.

Scot: I don't know. That's a good question, because Troy and I don't have families. You do.

Troy: I have dogs though and I can get rid of a lot of dog stuff. I wasn't going to say I'm going to get rid of dogs. I said dog stuff.

Scot: I mean, is that part of the problem? Is the stuff that other people in our lives own, like our kids, our pets, our roommates, part of the problem? Could you get away with getting rid of kids' toys, Dr. Chan, do you think?

Dr. Chan: If I pass this exam, I would love to get . . . let me share a dad hack with you right now. Then you can have me come back on another podcast and talk about dad hacks.

So something that we do is when they're asleep at night, we gather some of their toys and put them in a box and hide it downstairs. And then like a month later, we just rotate those toys back into the circulation and they're like, "Oh, these are new toys." Actually, these are toys that you had in your room like a month ago. But we have this circulation kind of.

Yeah, we have removed . . . if we don't remove the toys in front of them, they don't notice they're gone. If we remove them while they're in the room, then they start to kind of get upset.

Scot: The observation you made too is interesting. I've read before about this whole thing. Another benefit of getting rid of stuff is then you cherish the stuff that you have. Instead of having 86 things that have sentimental value back to your mom or dad, have one or two, and then you're able either put some . . . instead of them living in a box, maybe you can put them someplace in an area of prominence where you can see them and take them in and they just mean more to you.

And it sounds like the same thing with your kids. The toys mean more when there are fewer of them and when they're kind of new and novel. And in all of that clutter, I think a lot of times we lose track of the things that we have. We just don't see them anymore.

Dr. Chan: And technically, since my children are little and they don't work, I own all the toys. I feel really great about donating them because we just have a lot.

Scot: All right. Well, maybe the number of things is dependent on the person. Maybe Troy's not comfortable with that. Maybe he's more comfortable with whatever day number it is, that's how many things you have to get rid of. So on Day 8, you have to get rid of eight things. Maybe instead of the doubling, it just corresponds with the day. So you can start out with that first thing. Maybe Dr. Chan wants to do the doubling. I don't know.

Troy: It's tough. I'll give it a shot, Scot. And I'm not saying this just for radio drama. This is making me anxious, just thinking about this number of items. I'm just like, "What am I going to get rid of?" Yeah, I can start with the USB . . . or not the USB. The landline cables. Yeah, I can get rid of those.

Scot: There's four things right there.

Dr. Chan: Troy, in your kitchen, there are probably kitchen utensils or plates that you've not touched in a long time.

Troy: It's true. There are. They're definitely there.

Dr. Chan: Scot, you're not asking . . . I mean, ideally, if these items have some personal meaning to us . . . you're just talking about items throughout the house, right? I mean, they don't have to be from . . .

Scot: No, they don't have to have personal meeting. We're just talking about decluttering. If you choose an item with personal meaning that is just something you don't want to have in your life anymore, like the comic books or baseball cards, then that could definitely be part of it, but I'm not forcing you no.

All right. Here, let's do this. Troy, I'm going go ahead and let you take some time and think about what number you feel comfortable with, what framework you're willing to work within.

Troy: Thanks, Scot. I'm going to do one item per day. I feel comfortable with that. I feel like that's a good starting point, because I can say otherwise I probably would not have gotten rid of anything over the next 30 days. So that's a good starting point for me.

Scot: How about the number of items corresponding to the number of days that it is? Let's challenge yourself a little bit on this one. You're only getting rid of 30 things by the end of it. Come on.

Troy: I'll think about it.

Scot: Think about it. Dr. Chan, what's your structure going to be, do you think?

Dr. Chan: I think I can do it because I'm going to have a very broad definition. I'm already thinking of . . . and again, we're all there I feel like. There's stuff deep in my freezer that I have not touched in 30 years, and this is a great excuse. We all do this. I know we have stuff. We all each have stuff in our freezers that we can throw out.

Scot: I love how creative you're getting.

Dr. Chan: I'm going to have a broad definition. Children's toys, baseball cards, kitchen utensils, freezer items. We all have stuff. When was the last time you did a deep clean of your freezer?

Mitch: Two weeks ago.

Troy: That's a good one. Yeah, I like the freezer idea. I like the dog toys. We've got old shredded dog toys. I can definitely rotate some of those things out. So that'll be an easy start for me. And then some of these old cables and electronics. That's a good start.

Dr. Chan: I bet if I went to each of your houses and I tried to put something in your freezer, it's full.

Scot: You're still on the freezer thing.

Dr. Chan: It's a whole separate discussion. We go to Costco and we buy 500 blank, and we can't eat 500 blank, so we would put it in the freezer and it just sits there for months and months and months and years.

Scot: You gave me a great idea. I think there are four half-open bags of cauliflower rice in our freezer. I don't even know what this is.

Dr. Chan: Throw it out, man. And according to Troy's definition, you can count each of those . . . that's like 300 right there.

Troy: That's how I'm doing it. I'm counting every piece of rice I throw out, some old bag of rice.

Scot: All right. Mitch, what framework are you going to go with? Do you think you know yet?

Mitch: I'm actually going to have to think about it a little bit because you guys are catching me right after a big . . . actually, we purged our fridge just the other day.

Troy: Yeah, Mitch, you're not going to have anything left. You're going to be homeless after this.

Mitch: Or I will have a beautiful home with nothing in it. How wonderful would that be?

Troy: Yeah, you're going to be down to zero. No bed to sleep in. You're like, "Well, I said I'd do it."

Scot: I agree with you, Troy. I'm a little intimidated by the doubling every day. I don't know if that's possible. Maybe I'll stretch myself to try to do that. And I like Mitch's thing. Maybe you just get to a point where you can't anymore and that's part of the story.

One other thing I want everybody to do is take pictures of these things and think about if there are any stories with any of them. So let's document this to some extent as well. I think this will be fun and we'll see if it has any impact on our mental health at all during the process, after the process, and then we'll check in with ourselves six months later and see where we're at.

Cool. If you're listening and you want to participate, take pictures, make observations. You can go ahead and share those with us at facebook.com/whocaresmenhealth. We'd love to hear about your journey as well.

Dr. Chan, thank you for being on the show, and thank you for caring about men's health.

Dr. Chan: Thanks for having me. Great to see all of you.

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

Scot: All right. We're starting it over. I hit Record.

Dr. Chan: Rookie mistake. Sorry, Scot.

Scot: I swear to God. But you know what I didn't do? I didn't look to verify that numbers were moving. I did a rookie mistake. You're right. Here we go.

Dr. Chan: I'm just teasing you, Scot. I make that mistake still to this day.

Scot: Nope. I deserve it. I deserve it. That is as rook as it gets. Like I was born yesterday. Don't act new. All right. Here we go.

Your health is the currency that enables you to do all the things that you want to do, and that's why you should care about men's health. That's the name of this podcast, "Who Cares About Men's Health," giving you information and inspiration to better understand and engage in your health so you feel better today and in the future.

My name is Scot Singpiel. I'm the manager of thescoperadio.com, and I care about men's health.

Troy: I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Chan: I'm Dr. Benjamin Chan. I'm a child and adolescent psychiatrist here at the University of Utah, and I also care about men's health.

Scot: All right. We talk about the core four on the show of course. Troy, why don't you go ahead and remind our listeners what the core four plus one more is?

Troy: Don't make me do this, Scot. You know I can't remember the core.

Scot: That's why we made it the core four, to make it easy.

Troy: I know. Seriously

Dr. Chan: Troy, teach me about the core four.

Troy: Diet, exercise, sleep, mental health, and the fifth one, the one more besides the core four is know your genetics.

Scot: Yeah. Those are the things if you pay attention to will help you stay healthy now and in the future. Of course, mental health is a big one that us guys generally don't talk about or think about that often. That's why we have Dr. Chan on today. So even though you're a child psychiatrist, can you talk to us about adult manly things?

Dr. Chan: I can do it my best. And sure, yes, I'll try to talk about manly things today.

Scot: And for our women listeners, who I know that we have women listeners, no jokes about how having a child psychiatrist on a men's health show is just perfect, because we're not laughing at that joke that we have the psyche of children. Okay? We're not laughing at that.

All right. So, Dr. Chan, before we get to what I wanted to talk about today, which was the practice of showing gratitude . . . we're coming up on Thanksgiving. It's in the name of the holiday Thanksgiving. But a gratitude practice is actually just a really good way, from what I understand, to remain mentally healthy. And I want to get your take on that and talk about that a little bit.

But first, I want to talk about what are you seeing right now as a result of COVID? Have things changed in your practice from a mental health standpoint?

Dr. Chan: They definitely have, Scot. First of all, I just hope everyone is safe and healthy and doing the best they can out there, and I'm glad you're listening to this podcast as a way just to learn more. And yeah, we're about eight, nine months into this pandemic, and we're definitely in a marathon.

Going back to your question how this has impacted mental health, we're seeing higher rates of depression, anxiety, post-traumatic stress disorder across the board. And this has been incredibly taxing for men and women alike as well as for children and adolescents, because we're living in truly unprecedented, challenging times.

How we communicate, how we connect to others has been dramatically altered. Many of us who are used to working are now doing it through Zoom or teleconferencing. Children/adolescents who are going to school have had their school schedules disrupted. It is incredibly hard and difficult right now, and just the amount of stress and anxiety that is placed upon us during these times is just totally new and unexpected and it's just ongoing, going back to my marathon comment.

Troy: Ben, I'll tell you, Scot has run a marathon, I've run a marathon, and I would much rather run a marathon than do this. I'll tell you that. But you're right, it is a marathon. I think we thought that two-week shutdown in March that it was going to be a sprint and we would get through the two weeks and we'd emerge on the other side of that and everything would be back to normal. But I keep telling people, "Hey, circle 2022 on your calendar and maybe that's when things will be back to normal. Maybe."

Scot: Dr. Chan, question for you. So if there's a guy or a person listening and they're like, "Oh, this hasn't affected me. I'm fine," is that generally true, or are we just not in tune to the symptoms that are indicating that maybe we're not fine?

Dr. Chan: So if someone is thinking that they're fine, I would say that is probably true for a small minority of people. The vast majority of us are not fine. And I would argue that if someone feels that they're "fine," I'm not sure that is also true for their loved ones or their family members or the person they interact with at the grocery store or their local school or if they belong to a church.

This is impacting everyone everywhere. And when people are stressed or overwhelmed or feeling isolated around you, it's going to impact you eventually. So even if people feel fine right now, I don't think that's sustainable.

Troy: It is tough. And it's interesting you mention that about maybe thinking you're fine and maybe you're not fine. I've found it kind of interesting these studies that have shown how many people report increased anxiety, depression, etc. And for me, the most surprising thing out of these is that more people aren't reporting that, like it's doubled or . . . What's your take on that? Do you think people are under-reporting or maybe in denial over some of the symptoms they're having?

Dr. Chan: Yeah, there's definitely a denial piece to it and under-reporting symptoms. I think all of us manage our stress differently. I think people are kind of going to extremes, as it were.

Again, this is all very anecdotally because this is unfolding real-time. I've had a number of patients and colleagues tell me that they have children or adolescents who are just bingeing more video games or watching more Netflix or just kind of tuning out reality, turning more towards social media, reading the comment section on social media, commenting on social media. Anecdotally, I'm hearing higher rates of drug abuse or difficulty sleeping.

Right now, one thing that is thriving is all the drive-throughs. So, again, is it a positive coping skill to go to your favorite restaurant? I think it's normal to kind of go out to eat, but going multiple times a week is probably not as healthy, and I think that violates one of the core four as it were.

So I think all of us are running towards coping skills that are not really positive, especially in big doses such as social media, plugging in, eating out. These are all things that people are turning to and that, Troy, is maybe why it's being under-reported.

Troy: Yeah, I was going to say it's funny you mentioned that about eating out. Every night we look at doing something, my wife and I, we're like, "We'll go to a movie. Oh, there are no movies. What about shows? Oh, there are no shows. Let's go eat out again. Let's go to the drive-through." So yeah, I understand that.

Dr. Chan: I've got little kids and we've turned to Crown Burger because they give out free kiddie cones and my kids love those. Again, before the pandemic, maybe we would go on the weekend once and that's turning into more than once a week.

Troy: I know. It's like every other night.

Scot: So us guys can sometimes be notorious for not recognizing when we're stressed, when we're anxious. We just think it's part of life. We just kind of discount those feelings. It sounds like maybe one thing that might indicate that mentally you've got something going on is what you just described. Are you bingeing things? Are you doing some things to excess? I consider those distractions. I'm trying to distract myself from whatever it is going on. It sounds like that might be one indication. What are some other indications?

I mean, it manifests itself differently in everybody, right? So what are some other indications that somebody might be dealing with some mental issues and not even really be aware of it? I've heard getting angry could be one of them. Losing patience could be another. Is that true?

Dr. Chan: Yeah, I agree with that, Scot. That's all true. If you feel your temper, if you're just being short with people, if you're not being as patient, that is definitely a warning sign because that's not who you are. But I think everyone right now is stressed, and stress, again, as we talked about, manifests itself very differently.

Another one that came into my mind too, Scot, is just lack of concentration, the inability to focus. I don't know how many people I've talked to told me that projects that used to take a short amount of time now take a lot longer. That book you pick up at night to read, now people are tuning out after a couple of pages. It's just much more difficult to focus right now, and that is definitely a warning sign of stress, depression, and anxiety.

Troy: Maybe it's just me, but it seems like on the road people are just edgier, like more aggressive drivers. And there's certainly been an increase in traffic fatalities and they've said, "Well, it's because there aren't as many people on the road, so people are driving faster." But I wonder if that's a manifestation as well. People are just kind of edgier and more aggressive and maybe one other symptom of this we're seeing as well.

Scot: So if you notice some of these symptoms, of course that can impact your health, not only your emotional health but your physical health, as Dr. Chan said. Maybe if your outlet is drinking too much or eating the wrong kinds of foods too often, that might not necessarily be healthy. So what are some things that one could do to perhaps put themselves in a better mindset?

Dr. Chan: First of all, we cannot take care of people around us if we cannot take care of ourselves. So I've been more and more preaching self-kindness, self-awareness, taking breaks. I know we talked about a marathon earlier, but I really advocated exercise and going for walks just to start healing yourself. And that helps with sleep. That helps with body regulation.

I really believe that we just need to be less hard on ourselves, because going back to what I said about the projects . . . and I'm guilty of this too. I'm not responding to emails as quickly. I'm not as effective in a meeting because our brains aren't used to Zoom.

The cognitive load of trying to balance all these different things with my team across . . . everyone is working from home. Everyone is working remotely. Things just take longer. And so I'm just trying to be much more patient both with my family as well as the people I work with, just knowing that everyone is doing really the best job they can. And people's efficiency is not as strong as it once was.

Scot: Troy, do you have a gratitude practice in your life?

Troy: That's a great question, Scot. I know you've mentioned you do journaling and that's something I do as well. I think since we've talked about it, I've tried to do that more consistently on a daily basis. And as part of that, I do try and think through some of the things I'm grateful for.

It is sort of a process every morning of doing that. And so I've long believed that gratitude and expressing gratitude and feeling gratitude certainly makes a big difference, and it's probably become a lot more important to me during the pandemic and during what we're experiencing.

Scot: Yeah, you're right. I do journal and I try to come up with three things I'm grateful for every day. And some days it's really hard, but I find that just the act of looking for that makes me feel better about things. And sometimes that gratitude might be, "Hey, you know what? I learned a new skill today," or, "Hey, I got this major project done," and it gives me a chance to be grateful for something that I might not have necessarily thought about and then would have just let my mind go, "All right. What do you have to do next?" It's like a little party, a little celebration.

Dr. Chan, do you have a gratitude practice, and has it been proven to help people feel better and actually help their mental health?

Dr. Chan: I do have a gratitude practice. I like to send thank you notes. And especially in today's age of email and social media, I really feel like a handwritten letter of gratitude goes a long, long way. All of us on this call used to remember a time when we would run to the mailbox to look for mail. Now, email comes to us instantaneously, but I still think a really nice, well-written card or letter really can touch people in a positive way.

As I alluded to earlier, I think people are looking for a way to connect to others. And even if you can't meet with your loved ones, even if you can't meet with your team, your work colleagues, I still think there are other ways to express gratitude.

So the research has shown that people who express gratitude have lower rates of depression, increased rates of happiness. They feel connected to others. There's a warmth there. There's an ability to have empathy.

Again, all of us are working incredibly hard. Everyone is doing the best job they can. And to have a meaningful way to say thank you goes a long, long way to feeling that you were listened to and heard.

The research also talks about the ability to form alliances and building trust between people when you express gratitude. I know this is a men's podcast, and so I was looking up some other literature, and there's this old stereotype that I'm not sure if all of you have tackled, that men are a little bit less likely than women to express their emotions. I think this gratitude concept falls into that. Men are slightly less on average -- again, it's a very stereotypical comment -- to express gratitude to others as opposed to women. So I think there is something there.

Again, let's use this time as an opportunity to say things and have men thank the people around them for either the love or the jobs well done.

Troy: Ben, it sounds like it's not so much, like Scot and I are talking about, just writing it down. It's more that expression of gratitude and that connection that comes to others as we let them know we're thankful for what they do, we're thankful for their role in our lives, or whatever that may be.

Scot: Troy, I think we've been doing gratitude wrong. Dr. Chan, I thought the gratitude practice was finding two or three things every day that you were thankful for, but it sounds like truly it's reaching out and connecting to somebody. Or are they both gratitude practices that could give you benefits?

Dr. Chan: Well, Scot, I would say both the way you phrased that. The gratitude practice, yes, you can identify two or three things every day that you're grateful for. But again, we're in a pandemic. People feel isolated, people don't feel listened to or heard, people are feeling a little scared, so I think this is an opportunity to connect to others and give thanks for who they are and what they are in your life.

So if I asked all the listeners out there, "Who are the five people you're most thankful?" some of you will think about your wives, yours husbands, your partners. Some of you may think about your friends. Some of you may think about your coworkers. When is the last time you said thank you to them? When is the last time you took a break, took a pause, and connected with them, and just genuinely let them know you're appreciative of who they are and what they are to you?

To me, that's Thanksgiving. That's what we're trying to do. And so, yes, I would argue that there's a connection aspect to it.

Scot: Troy, I really appreciate that you're in my life.

Troy: Thanks, Scot. And I appreciate that you're in mine, and, Ben, I'm grateful you're on our podcast.

Dr. Chan: This is so cheesy. I love it.

Scot: What I'm getting at, though, is that feels weird. Even though I grew up on a ranch, which has its own stereotypes. My dad was as stereotypical of a rancher as you could get. I'm a little bit more sensitive, as my mom likes to describe it.

And sometimes when I do say things like that to other men, like, "I really appreciate that you did that for me. Thank you very much that . . ." and I maybe might give a specific reason why that made a difference to me, I feel like guys pull away from that, like I'm stepping over some line I shouldn't have stepped over, like I did too much.

Dr. Chan: Yeah, you don't need to do it on a podcast in front of hundreds of thousands of people who listen to this.

Troy: I think you underestimated our numbers, Ben, but go on.

Scot: We'll forgive you.

Troy: We'll forgive you.

Dr. Chan: But think about how hard you worked on a project, Scot, and if someone, your boss, your supervisor, we all have bosses, we all have supervisors, just that short little email, like, "Hey, Scot, that was a great job," how much that would mean to you.

So I'm not saying it has to be in person or over a podcast. Everyone accepts praise. Everyone accepts that ability to connect in different ways. And I think that's who we are. We as humans have different ways of communicating our emotions to others.

So I guess what I'm saying is this gratitude idea, this gratitude project, what are some ways you can express gratitude to those around you? And it might be a handwritten note, it might be an email, it might be a phone call, it might even be a text.

I mean, my best friend from high school I don't talk to very often, but I get really sweet texts from him every once in a while and it just makes the world to me, and I save all of those. So I think you just have to know your audience. Who are the people you're trying to connect with?

Troy: I'm feeling guilty now. I feel guilty. I'm thinking about my best friend from high school. I haven't been in touch with him in probably seven or eight years. Like you said, this is a time where I think we just need so much more connection and just a text or something to say thank you to someone. I'm sure it means a lot to that person, but just personally, to have that connection, I think, can help us out a lot as well.

Scot: Dr. Chan, I think you've given us all a really great idea as we head into Thanksgiving, especially a Thanksgiving unlike any Thanksgiving that we've had. It might be a Thanksgiving where we might decide as a family unit, each one of us, that perhaps getting together with other family units as we have in the past is not necessarily a great idea this year, but there are other ways, it sounds like, you can reach out and let somebody know that they matter to you and they mean something to you.

And it doesn't necessarily have to be a family member. It could be a friend, somebody you haven't talked to in seven years, and you don't have to go all Scot on them. You don't have to get all gushy. Maybe start with just a thank you and then see how they accept. You described your interaction with your friend as these sweet texts, which to hear a guy say that about a text from another guy is a little strange.

Dr. Chan: But as a psychiatrist, I like to feel that I'm in touch with my emotions. The people in your life, be it men or women who care about you, they'll communicate that to you in very profound, meaningful ways.

All of us have bad stuff happen in our lives. I mean, the thing that's impacting all of us right now is a pandemic, but all of us have had breakups, we've had loved ones pass away, we've received failing grades, we didn't get that promotion at work. And just those negative emotions are really difficult. How do you leave them when someone reaches out to you that cares about you and just lets you know they're thinking about you and you can share some of that burden with them?

So I say sweet texts. I can just think of moments in my life where I felt pretty down and my best friend reached out to me and just let me know he was thinking about me and he was thankful that I was his friend, and that just meant a lot to me. So that's what I meant by sweet texts.

Troy: Scot, I didn't even think twice. I thought Ben was just like, "Sweet, man. That was so sweet."

Scot: Sweet text.

Troy: "Sent me this link to this awesome ACDC video."

Scot: I love your challenge, Dr. Chan. Think of five people that mean something to you, reach out to them, let them know. Even if it's just reaching out to say hi it sounds like.

How many times have each of us or any of us just been like, "Wow, I haven't thought of that person in forever, and we were so close at one point"? Well, when they pop in your head, then sometimes you're like, "Well, maybe I'll reach out," and then you're like, "Nah, I don't want to interrupt him or anything." Maybe instead of going that path, you go the path of reaching out. That might be a good place to start.

Dr. Chan: I mean, the weird thing is, and I talked about this too, we exist in this culture right now where we spend hours Netflixing and bingeing or social media-ing. But compare that to how many times you've had like a real conversation with someone you care about in your life. I mean, the ratio is dramatic. That's why I'm just kind of recommending and talking about just connect with others.

Scot: Get out of Twitter. Maybe text or call a friend and show a little bit of gratitude this Thanksgiving. It could do wonders for your mental health.

Dr. Chan, thank you so much for being on the podcast, and thank you for caring about men's health.

Scot: Paging Dr. Troy Madsen to Scope Studio for "ER or Not."

"ER or Not," that's where we throw out a scenario for you, you decide whether or not it's something to go to the ER or not, and Dr. Troy Madsen is going to let us know whether or not you guessed correctly.

Today's "ER or Not," you have some food stuck in your throat. I'm talking about you're breathing fine, it's not obstructing your airway, which is definitely always a reason to go to the ER if that airway is blocked, but it's just there and it won't come up, it won't go down. It's uncomfortable. ER or not?

Troy: Well, this is one of those things, again, emphasis on it's not affecting your airway. It's just something you feel is stuck in your throat. People often point to the base of their neck. They can't swallow even their own saliva. They're just spitting it out.

It's something you very well may have to go to the ER for, but there's a trick you can try at home before you go to the ER. And that is take a soda, usually a Cola, and try and drink a little bit of it down or get some of it down where it's not coming back up and let it sit there. Now there's something about soda, and Cola in particular, where it can relax the esophagus. And it's a trick you can try to potentially get that food to pass and get down to the stomach.

So this is something that you may avoid a trip to the ER for because your only other option is to come to the ER. You can't go to an urgent care for this. You have to come to the ER, ideally a larger ER, a center that would have a gastroenterologist on call because they're going to have to come in and retrieve that piece of meat or whatever it is and either push it down to the stomach or pull it out.

Scot: The soda route sounds like a thing to try first before you do that.

Troy: Absolutely. If it were me, I would try and grab a soda. And again, the challenge is sometimes that it's obstructing things so much that you're even spitting up your own saliva. But if you just feel like something is stuck there, try and get some soda down there. Just let it sit there, five minutes, see how you feel. Give it another five minutes. For me, personally, I'd try three or four times, and if it's just not working and nothing is going down, then you've got to get to the ER.

Scot: And again, to stress, in this scenario, you've got something stuck in your throat like a piece of food, but it is not obstructing your breathing. It might be causing that you can't swallow your saliva, but you can breathe okay.

Troy: Right. Anything that's obstructing your breathing, that's something you need to get immediate help for. Even then, not just ER, but call 911.

But if you do this and it's not obstructing your breathing and you drink the Cola and it resolves, you probably still should get in to see your doctor. You may sometimes have these rings in the esophagus, little things that food get caught on, that it would be worth having an endoscopy done at some point to look to see if that's there to prevent future problems. But no rush to do anything once it resolves.

Scot: "Just Going To Leave This Here." It's a part of the show where we might talk about something having to do with health or something that's going on in our life, or it could be something completely random and fun hopefully.

Troy: Hopefully. It's always questionable.

Scot: It is questionable. We'll see. Here we go. Just going to leave this here. I've made an observation about myself and I want to know if other people have this same kind of issue. If you give me a decision, which line to choose in the grocery store or which lane of traffic to choose when I'm driving somewhere, I'm always going to make the one that takes longer. Always.

Troy: That's the rule. That's how it always works.

Scot: I'll be standing in a grocery store line or I'll choose between two of them and I'm like, "That one looks like it might be faster." And as soon as I get into it, inevitably that's going to be the one that takes longer.

Troy: Every time at the airport. You've got four lines to choose from and I always choose the wrong one.

Scot: I don't know why that is, but that's my "Just Going To Leave This Here."

Troy: I'm glad I'm not alone in that. I'm just going to leave this here. You said this could be interesting and fun, so now it's not because I'm talking about science fair. My nephew just competed in science fair.

Scot: That's awesome.

Troy: Did you ever do science fair?

Scot: I did. I got the people's choice award for my telegraph, which would have been a great science . . .

Troy: You invented the telegraph? Scot . . .

Scot: Which would have been a great science fair project in 1890.

Troy: A hundred and fifty years ago, it would have been awesome.

Scot: But I don't know.

Troy: You would have been a thousandaire by now.

Scot: Yeah. It was a study in magnetic because that's how old telegraphs worked. But that was what intrigued me. My friend, by the way, did a solar-powered engine, so he was way on the cutting edge of things.

Troy: Oh, wow. He was on it.

Scot: Before solar power.

Troy: So my nephew did a project. He looked at golf balls, and he had these golf balls soaking in water for various periods of time to see how it affected how far they would bounce and fly. The idea being that he would fish golf balls out of streams by golf courses and sell them to golfers. He found they don't work as well. It was a cool little project, just a fun kind of idea.

I'm just such a nerd. I did science fair when I was in high school and junior high. This is what I actually did. I actually took soda bottles and did swabs on those bottles to see how many bacteria are on soda bottles, and it was disgusting. This was the stuff you'd buy out of vending machines.

Scot: Oh, so a vending machine soda bottle?

Troy: A soda can. I shouldn't say a soda bottle. A can that you're putting your mouth on and drinking out of. So not a bottle.

Scot: That has not been opened. So you'd go to the store or vending machine, you'd buy one of these, and then you'd swab it, and then you'd see what's living on it.

Troy: Yeah. And this is what we're putting our mouths on. So that was my science fair project, was taking soda cans out of vending machines and from stores, doing a swab, and then growing it and seeing the stuff that grows there.

Scot: Nasty. Like stuff that could impact our health?

Troy: Potentially. I don't know. I never . . .

Scot: You didn't quite get that far.

Troy: I didn't quite get that far. I did not isolate the exact strain of E. coli that was on there.

Scot: There wasn't E. coli on there, was there? I don't want to start rumors on the show.

Troy: I'm going to have to go back to my science fair project, so don't quote me on saying there was E. coli.

Scot: We'll look at the data. I know people that wash off or wipe off the top part of their soda cans before they use it. So that might not be a bad idea.

Troy: I would. Even if it's coming from a box, it probably sat in some factory for a while, and there's a certain limit on the number of rat hairs and the amount of . . .

Scot: Oh, come on.

Troy: I'm not joking. You can have X number of rat hairs . . .

Scot: Oh, I see.

Troy: . . . and X amount of rat droppings and urine within some kind of facility that still meets health code. I know this is disgusting.

Scot: And we're not saying that's actually on there, but the potential . . .

Troy: I'm not saying there's rat urine on the . . .

Scot: There's an acceptable range as opposed to not an acceptable range, which I would think . . .

Troy: Exactly. Some is acceptable. Anyway, this is a long way of saying that science fair is great. I enjoyed the process of discovery, and it's fun that kids are getting into this. So that's my "Just Going To Leave This Here."

Scot: All right. There you go. That took a completely interesting path.

Troy: It sure did.

Scot: And that's sometimes what happens with "Just Going To Leave This Here."

Troy: Exactly.

Scot: Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, thank you so much for listening. It means a lot that you're taking ownership of your health and you're getting some information and inspiration here. If you haven't yet, please subscribe so we can be a part of your life every week.

Troy: Yeah. Subscribe through anywhere you get your podcasts. You can check us out on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. You can contact us, hello@thescoperadio.com. Thanks for listening and thanks for caring about men's health.

Interviewer: This Thanksgiving and Christmas, it's going to be very different than Thanksgivings and Christmases in the past. It used to be you would get together with family and friends, and now health officials are saying that perhaps you should reconsider that because of the spread of COVID-19, that you should maintain that family bubble.

However, even within families there are a lot of different opinions on how dangerous the virus is and what kind of safety precautions could be taken. So having those conversations with family members about whether or not to come to Thanksgiving or get the whole family together could be very, very challenging.

Dr. Benjamin Chan is a psychiatrist at University of Utah Health and in communication, communicating your thoughts and feelings is referred to as assertive communication, and it can be a very challenging thing to do. And I wanted to find out how somebody could be an assertive communicator, not aggressive, but an assertive communicator in talking about plans for Thanksgiving and Christmas. So is that what you call it? Is that what you call it, is assertive communication in your field?

Dr. Chan: Yes, Scot. And again, we're all in the middle of a pandemic. This is historic, unprecedented, and incredibly challenging. And in years past, Thanksgiving dinner would be a time that we get together, see and talk to long-lost cousins, aunts, uncles, grandmas, grandpas, maybe some neighbors, family friends. That is not safe this year.

And there's a lot of disagreement in the community about how to get together for Thanksgiving. A lot of people have different thoughts and feelings about COVID, and what social distancing is, and what masks are. And this time more than any other is the time for you to be assertive because you have to protect your own health. You have to protect your family and your loved ones. And COVID is silently transmitted. This is not the podcast that goes into it, but you can listen to many others. But there's a lot of different research and data out there that shows how pernicious and silent COVID can spread.

So assertiveness means behaving and communicating in a manner that equally values your rights and opinions on par with other people's rights and opinions. And the opposite of assertiveness is passiveness. And passiveness is when you put someone else's rights and opinions above your own. So now is the time to be assertive.

Interviewer: Have those assertive conversations beforehand. What does that look like? Because I mean, some people, myself included, we don't like conflict, right? So it's really difficult for us to know . . . I'm going to be talking to somebody in my family who thinks that COVID maybe isn't a big deal, that we should still get together, and it's going to be tough for me to express, "No, I disagree." How do you do that in an assertive way?

Dr. Chan: You do that in an assertive way by first recognizing that the other person has a different opinion and feeling than yourself. And then you segue into statements that start with, "I feel." So, "I feel scared for my own health because when I hear that you're going to host a Thanksgiving get-together and not everyone there is going to be wearing a mask or socially distancing, I feel scared that I might get COVID." And you frame things where you recognize the other person's belief or values, and then you maintain your own beliefs and values.

And people want to be heard, they want to be listened to. So my experience has been if you immediately start talking about what you believe and do not give the other person the recognition for what they believe, that's where conflict really starts escalating because the two parties don't feel like they're being listened to or heard. But if you can restate perhaps in their own words or maybe a summation of what you understand what their belief is and then give your belief, that gives an opportunity for that person to feel that you actually listened to them, an acknowledgement, and then you can present your belief.

Interviewer: I tell you what, I can see the spiraling for me pretty quickly, because I think people that do believe that COVID is a serious threat to the health, when they hear somebody that does not necessarily have that same belief, we just want to go, "Well, I understand you don't think this is a big of a threat impact as I do." Would that be the restating? Is that fair enough? Is that all I need to say? I mean, it's so hard not to do that judgmentally.

Dr. Chan: I agree, Scot. And it's credibly difficult. It might take practice. And I think when you, like, your example you just gave is a very quick response and people's responses tend to be much longer. So if you say, you know, "When I hear you, it sounds like you do not feel that the COVID pandemic is as serious as some of the public health officials have said or as serious as some of the hospital officials have said. I do believe those individuals, and this is why I believe them." I agree, it could start spiraling, but to me the key is to reframe it through core values. Just go back to values.

So people want to feel safe. They want to feel heard. They want to feel that they're being listened to. So if the core value is health, you can talk about like, "What is your value about the health," and they'll talk about the memories and the mental health of getting together for Thanksgiving. And you can use that as a springboard of, "Okay, this is my conceptualization of health. I'm worried about COVID. I'm worried about the fevers and the respiratory problems and everything else associated with COVID." If you have a discussion about values, the vast majority of people have core similar values, and then you can just explore those basic values together.

It's hard, Scot. It's incredibly difficult because people are drawing upon information from a wide variety of sources. Some of these sources might not have the same beliefs that you believe or might have different versions of facts. But you need to be assertive during this moment because if not, you will open yourself up to potentially being exposed to COVID and then a lot of hurt feelings will stem from that.

Interviewer: You know, being assertive doesn't necessarily mean the other person is going to react in a positive way. And if they don't, I guess you just have to go away with, you know, "I tried my best, but I have to make this decision for myself, or for grandma, or for grandpa, or for whoever." How do you deal with that? So again, I don't like conflict. I don't like it when somebody, you know, doesn't like me anymore. How do you deal with that? Is there a closing phrase you would use? Like, "I'm sorry we couldn't come together on this, but I still love you and care about you very much."

Dr. Chan: Yeah. Again, Scot, you did a great job. I think it's like you want to normalize this as best as you can during a pandemic. So this is an important holiday coming up. It's very important to a lot of people, but it's simply one day out of the year. And we have talked about previously, we're in a marathon. This is not a sprint. There's a lot of things happening in the country as we're trying to address this. So in my attempt to normalize, it's like, if everyone got together for Thanksgiving there's going to be disagreements. We've always had disagreements over the Thanksgiving table. Sometimes it's about the Dallas Cowboys and the Detroit Lions football teams. Sometimes it's about someone's political beliefs. Sometimes it's about someone not doing well at school or their job. It's normal to have conflict during Thanksgiving time.

This is a time when it might be normal to have a disagreement if we should really get together, or if we get together, it needs to be socially distant and safe with masks, or maybe we don't get together this year, or maybe we do a Zoom Thanksgiving and a virtual Thanksgiving. And that's okay because the most important thing is safety and health. And we want to stay together as a family in the coming months, and there's a light at the end of the tunnel. We all feel that. We all believe that. We want that to happen. That's still very much many months away.

So I try to end all these difficult conversations kind of like you gave with positivity. Let's say something nice. Let's say something that we can all agree on. I always like in these tough discussions kind of like a U shape. You start off high, you kind of go low, you go really deep, you kind of talk about feelings, emotions, values, and then you rise back up. You never want to end these discussions at the bottom of the pit. You want to rise to the top and say some nice things to each other, and agree to, you know, let's talk about something that's not as emotionally taxing, like the Dallas Cowboys or the Detroit Lions. Let's talk about something that we can agree on because these are difficult conversations. It's really hard to be assertive, but now more than ever it's really required.

The following is a summary of this episode. For the full experience, we encourage you to subscribe and listen.

"That is the first time I really went, 'Wow! This silly little hobby of mine can actually be used to make a difference in somebody’s life.'"

On this episode of Talking U & Med Student Life, learn about what cosplay is and how one of our medical students has fostered her passionate hobby into great opportunities throughout her journey in med school thus far. What cosplaying opportunities does SLC have to offer prospective medical students? How do you balance attending virtual med school, working full time, and studying for tests?

Hear what MS2 Erin has to say about how she got started in cosplay and what wonderful cosplaying opportunities she has had while attending the University of Utah School of Medicine.

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

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

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

Milo: Doing well.

Nisha: Yeah. Doing well.

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

Milo: Yeah, Wednesday.

Dr. Chan: Wednesday . . .

Milo: Friday. Friday.

Nisha: Friday.

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

Milo: Yes, yes.

Dr. Chan: All right.

Milo: Yeah. There was the quarantine.

Nisha: Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Chan: Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nisha: Yeah.

Milo: Yeah, it definitely did.

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

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

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

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

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

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

Milo: Yes, absolutely.

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

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

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

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

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

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

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

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

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

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

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

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

Nisha: Twenty-two programs I think.

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

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

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

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

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

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

Nisha: Yeah.

Milo: Mm-hmm.

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

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

Nisha: Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Milo: That's definitely true.

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

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

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

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

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

Dr. Chan: So where did you match to?

Nisha: Yale.

Dr. Chan: Where? One more time.

Nisha: Yale.

Milo: Yale.

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

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

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

Dr. Chan: Wow.

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

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

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

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

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

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

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

Milo: Yeah.

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

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

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

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

Milo: That sounds fantastic.

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

Milo: Thank you.

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

Nisha: And you too.

Milo: You too. Bye.

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Chan: Wow.

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

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

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

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

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

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

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

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

Claire: It can be.

Dr. Chan: Yeah.

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

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

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

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

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

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

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

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

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

Dr. Chan: They need their freedom. Yes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Claire: So fun.

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

Claire: Oh, yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Claire: She's both.

Dr. Chan: Okay. I love it.

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

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

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

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

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

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

Claire: Thank you so much.

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

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

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

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

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

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

Carson: Yep.

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

Carson: Excited, apprehensive.

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

Carson: Sure.

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

Carson: Got to keep them waiting.

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

Carson: Okay.

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

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

Dr. Chan: A scrub tech?

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

Dr. Chan: The autoclave?

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

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

Dr. Chan: Does Amazon deliver to Afghanistan?

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

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

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

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

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

Dr. Chan: Those recruiters cornered you?

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

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

Carson: Yeah, I was aware.

Dr. Chan: Okay.

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

Dr. Chan: Possibility.

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

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

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

Dr. Chan: Which was better for you?

Carson: They were both great.

Dr. Chan: Okay.

Carson: So Iraq has . . .

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

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

Dr. Chan: What's a line medic?

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

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

Carson: Sure.

Dr. Chan: Okay.

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

Dr. Chan: Okay.

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

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

Carson: You'd be surprised.

Dr. Chan: Okay.

Carson: Yes.

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

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

Dr. Chan: Fair, okay.

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

Dr. Chan: Wasn't as fun.

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

Dr. Chan: Okay.

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

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

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

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

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

Carson: Oh, sure.

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

Dr. Chan: Oh, I see. Okay.

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

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

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

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

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

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

Carson: Sure, yeah.

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

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

Dr. Chan: Just a little bit more sometimes.

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

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

Carson: I would have started a lot earlier.

Dr. Chan: Okay.

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

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

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

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

Dr. Chan: As a fourth year.

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

Dr. Chan: Some template, yeah.

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

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

Carson: Yeah, so . . .

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

Carson: Should I get a master's degree?

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

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

Dr. Chan: The first time you applied.

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

Dr. Chan: And feel sorry for yourself.

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

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

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

Dr. Chan: Okay, good.

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

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

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

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

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

Carson: But, yeah.

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

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

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

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

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

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

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

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

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

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

Dr. Chan: What were those three?

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

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

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

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

Dr. Chan: Okay.

Carson: I was over a UNI.

Dr. Chan: Tell me.

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

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

Carson: Oh, sure.

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

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

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

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

Dr. Chan: Yeah.

Carson: Absolutely.

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

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

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

Carson: Pace of third year or . . .

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

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

Dr. Chan: Interesting.

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

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

Carson: I think was more of the transition.

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

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

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

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

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

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

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

Carson: Exactly, it's great.

Dr. Chan: Yeah.

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

Dr. Chan: Yeah, I know.

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

Dr. Chan: So you flirted a bit.

Carson: I flirted.

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

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

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

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

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

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

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

Carson: Yes. I like . . .

Dr. Chan: C, all the above.

Carson: Yes.

Dr. Chan: Okay.

Carson: I liked them all for different reasons.

Dr. Chan: Okay.

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

Dr. Chan: Cars crashes, gun shot wounds . . .

Carson: Absolutely.

Dr. Chan: . . . falls.

Carson: Tons of blunt trauma.

Dr. Chan: Fights, drunk fights, yeah.

Carson: Good knife and gun club stuff.

Dr. Chan: Yeah.

Carson: The hours were horrendous, lead long, but I loved it. I thrived. The general surgeons were great. I learned a lot from them. Next one I went to was vascular surgery. Again, very long hours, but it taught me new approaches to stuff, because a lot of vascular surgery is all done endovascular now. So seeing some of the advancements in EVAR and TEVAR and stuff along those lines, I felt that, you know . . .

Dr. Chan: Little toys now.

Carson: Exactly, like my head would explode on every other case, like you can do that? Foregut bariatric was really awesome because I think there's a really on the bariatric side, people who, you know, you can help a really awesome patient population, who, for whatever reason, you know, really need some help, and you can do that, and you can be there for them. And I really liked that one because it wasn't just, "Okay, come in for surgery, we're done." It's a very long, drawn out and involved care process where those surgeons are plugged in with those patients forever.

And, you know, we'd have patients who were, you know, 11 months out and have an issue and guess who's taking care of them? We are, because that's where the service that they belong to. And then plastics was just mind-blowing as well.

Dr. Chan: Yeah. The whole concept of reconstruction, yeah.

Carson: Sure. I mean, I will be 100% forthcoming say, "I'm totally naive thinking about plastic surgery." I'd never really thought about in the past. I thought it was going to be a lot of, you know . . .

Dr. Chan: Cosmetics.

Carson: Rhinoplasty, augmentation things along those lines. And I didn't see a cosmetic procedure until the last week I was on the rotation. The very first case I was on was a woman who had a fungating mass on her right shoulder down to her chest wall. And so she had a forequarter amputation done where they took off her right arm right at the base. And we, I say we, I mean, I was in the room, I didn't do any of the work. But the surgeons actually took a flap from her anterior thigh and actually hooked all the tubes and everything up, all the vascular supply . . . I shouldn't say hooked all the tubes up.

Dr. Chan: No, no, but I like it. I like it. You're talking like a surgeon, yes.

Carson: I do know some words that make me sound smart sometimes. But hooked all the vascular supply up and closed her, and then I followed her in the hospital for a couple of weeks, and she's back at home now.

Dr. Chan: Wow, that's amazing. It's amazing what they can do. Yeah. I know I like to make fun of surgeons and surgery, but I think they do a phenomenal job and . . .

Carson: Yeah, I mean . . .

Dr. Chan: It's a hard life because the OR is long and there's a lot of risk involved.

Carson: Sure. Sure.

Dr. Chan: But we need people to be surgeons.

Carson: I mean, at the same point in time, if you can watch someone rebuild . . . I mean, if you can rebuild a pelvis from a fibula, that's an awesome skill to have.

Dr. Chan: So you're going through this experience, Carson, and you're definitely surgery.

Carson: Definitely surgery.

Dr. Chan: How did you pick which path on surgery for fourth year? Because you have to submit your residency application.

Carson: Right.

Dr. Chan: What was your thought process? How did you do that?

Carson: So my thought process is that I'd seen a lot of general surgery just from my time in Afghanistan and the trauma service, which is a general surgery service when there's not trauma going on here. And seeing other surgical services kind of out in the periphery, I will say in the periphery, but obviously they're working just as hard, and wanting to know what I could do past general surgery. So I applied to general surgery and . . .

Dr. Chan: How many programs did you apply to?

Carson: Seventy-seven.

Dr. Chan: Okay.

Carson: A bunch.

Dr. Chan: A bunch.

Carson: A bunch.

Dr. Chan: A bunch.

Carson: But here in academic center, we're very, very lucky because we have a lot of extremely specialized individuals for foregut bariatric, colorectal, plastics, vascular surgery, etc., cardiothoracic, on and on, and I wanted to expose myself to those other subspecialties. So I just started whittling through them. The ones that I thought were most interesting. Vascular, foregut, plastics were the top of the list. And that's everything that I could squeeze in with all the other requirements.

Dr. Chan: I see, okay. So you applied to 77 programs. Did you do any away rotations?

Carson: I did not.

Dr. Chan: Okay.

Carson: General . . .

Dr. Chan: What was kind of your philosophy going into that?

Carson: Yeah, so I sat down with one of my advisors, and we looked over everything and just the general gestalt is that general surgery is not one that you need to do an away rotation. There's definitely others that you 100% have to. Emergency medicine, you have to do an away rotation, but you don't necessarily need it. If there's someplace that you 100% absolutely want to go, I don't think it hurts you. And that was the same advice that I got. I don't think it hurts you. But if you're going to go there, you need to go there under the assumption that you're going to work your tail off. And you're going to walk out of there with an honors in the course and letters of recommendation that have, you know, written in gold ink, basically.

And I don't want to say I didn't want to put the stress on myself, but let's be real, medical school can be expensive. And having to travel to another state, afford lodging, and everything, that played a very large part into it, so . . .

Dr. Chan: So you applied to 77. Are you comfortable sharing how many interviews did you go on?

Carson: Not enough.

Dr. Chan: Not enough.

Carson: Yeah. I think that's the answer that, and pretty much everyone will give you.

Dr. Chan: Okay, all right.

Carson: Yeah, not enough.

Dr. Chan: So you went on not enough interviews?

Carson: Yes.

Dr. Chan: What's going on out there on the interview trail? What was your experience? Are some programs asking you, "Hey, we want to see you stitch," kind of like . . .

Carson: I'm lucky.

Dr. Chan: Okay.

Carson: No one asked me that. I've heard horror stories from other individuals who actually interviewed at places that I wanted to, but didn't get the opportunity to interview at, where they were taken into the operating room and . . .

Dr. Chan: Really? Wow, a lot of pressure on that.

Carson: Yeah, I don't know what I would do. I mean, I'm nervous enough sometimes.

Dr. Chan: Watch you scrub in as fast as you can.

Carson: Yeah, exactly.

Dr. Chan: Ooh, you missed a spot, yeah.

Carson: See, that's a trick though because you're supposed to spend a specific amount of scrubbing, so that's where they try and get you.

Dr. Chan: I'm sure all the doctors we've ever seen have always hit that mark.

Carson: Exactly, not at all. I want to say that someone was asked to tie, which is fine. I will say that if you're thinking about going to surgery, start now because it is a very perishable skill and sometimes when you're under pressure and people are staring at you, you are all thumbs and that's not good in tying suture.

But, you know, my experience on the trail was pleasant. It was fun. I met people from across the nation who I don't want to say were just like me, but we kind of had the same mentalities, had the same goals, and . . .

Dr. Chan: What kind of questions were the residency programs asking? Did they talk about what happened here in med school? Are they talking about, you know, your military service? Like what kind of things would come up?

Carson: Both. Kind of a mix. There were some interviewers at different places that, I don't want to disparage anyone, but it almost seemed as though that they had no idea who I was. And we did a very abbreviated, this is who I am, this is my story. One of the advisors here, I mean, I'm sure you know this, you know, you need to have, you know, a two-minute story about yourself . . .

Dr. Chan: The elevator pitch.

Carson: Yeah, exactly. So I got to practice my elevator pitch a couple of times. Some interviews only focused on my military service, which was great. I can talk about military service all day if somebody wants to hear about it. I'm sure they were yawning as soon as I left the room, but whatever. Very few actually asked about my medical school experience, actually.

Dr. Chan: Interesting.

Carson: I would get it seemed like generic questions. How's school been? What have you liked? What have you enjoyed? But then they'd come with a curveball. And it was just some of the toughest questions right out of the book. It's like they asked you the easy questions first just to . . .

Dr. Chan: Kind of soften you.

Carson: . . . kind of soften you up, and then it's . . .

Dr. Chan: Were they like, what is surgery?

Carson: What are your deepest, darkest fears? Stuff like that.

Dr. Chan: Oh, so it's more like . . .

Carson: No, that was like . . .

Dr. Chan: Oh, I started to say like, was it like surgical trivia questions? Like . . .

Carson: No. No pimping or anything like that. But, you know, what's your greatest weakness? And, I mean, we all sit back and talk, you know, think, well, if I'm asked this.

Dr. Chan: I work too hard.

Carson: Yeah. They don't want to hear that, not at all.

Dr. Chan: Spend too many hours at the hospital, yeah.

Carson: It seems like every answer I gave, which I was genuine and saying, you know, I think I'm weak in these areas, I would get push back, "That's not a weakness, that's everybody. What else?" Just like I have no idea how to appease you right now. That's how I feel, I'm sorry.

Dr. Chan: Well, to kind of transition, Carson. I mean, the match is a little under a month.

Carson: Less than that. March 20th.

Dr. Chan: How are you feeling? What's the emotional kind of . . . to me, like, as I talked to the students, it's just an emotional roller coaster, right?

Carson: It is.

Dr. Chan: And the internet is fantastic, but I think it just causes more panic on certain levels. And I'm sure you've checked out all these websites and, you know, and everyone in your classes, you know, who is also going into gen surg. So, like, how's it feel right now? What's going on?

Carson: So to be completely honest, I haven't really gone online.

Dr. Chan: Okay.

Carson: I've told myself it's going to be what it's going to be, and I don't need to worry myself. So I've kind of detached myself from that. Listen to the Dean of Student Affairs here and, you know, his pitch and the information that he's provided, the data he's given. And I found that satisfactory enough to be able to say, "I'll accept that, and that's great because I can't really change anything at this point in time." But you're absolutely right. It's a totally emotional roller coaster. Can't even say it right now, like choking up about it.

Something that I find interesting is that everyone's on that same roller coaster. It's just whether or not it's uphill or downhill at the same time. And occasionally you meet someone who's at the same spot. But it's nerve-racking, but at the same point in time, it's one of those things I can't do anything about it. So let me go read up on this anatomy so I can look okay in the OR tomorrow instead.

Dr. Chan: Are you the type of person that you allow your brain to like even entertain the idea that there is like a slim possibility you won't match, or do you not let yourself go there?

Carson: I'm the type of person that has a very large portion of my brain that will say, "You're not going to match."

Dr. Chan: Wow, wow.

Carson: Yeah. But again, what can I do? It would be very unfortunate if that were the case. I wouldn't say large. I'd say I'm about 60-40 right now, 60 I'll match, 40 I won't, which is frightening now that I think about it. But that much mental energy has gone to it.

Dr. Chan: But you start thinking about it then, but then, like, a part . . . to me like a way to kind of like modulate that is you have a backup plan. So are you the type of person that's just preparing yourself to like, "Oh okay, we'll I'm going to . . ." we call it the SOAP, the Supplemental . . . I can't remember.

Carson: Offer and Acceptance Program.

Dr. Chan: Yeah, okay, good. And are you someone that's like I just need to practice. I'll take anything. So you'll go to a different field that might be open outside gen surg? Are you the type of person like, kind of like in your past like you redouble efforts? Okay, I'm going to do more research and then redo the match next year and do gen surg for sure?

Carson: No, I have a plan, for sure.

Dr. Chan: Okay.

Carson: I am actually kind of the person who says, "Plan for the worst, hope for the best." So I am planning on SOAPing actually, and working towards that right now trying to make sure that my extreme phone speed dating skills are up and so that if I do get a phone call from a program, I'll be able to instantly turn on the . . .

Dr. Chan: The elevator pitch over the phone.

Carson: Yeah, yeah, exactly that interview switch with different letters and things along those lines, and then starting to kind of put together a plan of what happens after that, if that isn't successful. So there's definitely plans. I've definitely thought about it. But again, I don't want to get emotional or anything about it just because it's one of those if it happens, it happens. And I'll have a plan.

Dr. Chan: Well, Carson, what I know about you is you're a fighter. You're a survivor. You've accomplished so much. And again, I feel bad that like, this roller coaster is part of it. But you're going to be a great doctor.

Carson: It's life. I mean . . .

Dr. Chan: You're going to be a great doctor.

Carson: And I think that's something that I can . . .

Dr. Chan: You're in the worst spot now because it's ambiguous, and you're in this gray zone, and it's hard.

Carson: But, I mean, even really that same kind of emotional roller coaster has gone back. I mean, applying to medical school, am I going to get in? Am I not going to get in, right? I think that's some something that even medical school applicants experience. And suffice it to say is it doesn't go away, it just changes. So it builds character, that process. It builds character.

Dr. Chan: So does serving in the military and going on multiple tours just . . .

Carson: That's just fun.

Dr. Chan: Okay.

Carson: That's just fun.

Dr. Chan: Well, Carson, I really appreciate you coming on.

Carson: Absolutely.

Dr. Chan: Do you mind coming back on after the match and . . .

Carson: Sure.

Dr. Chan: No, not like the day of but like, you know.

Carson: Oh, I won't be here, so . . .

Dr. Chan: Have some time to process it, whatever happens.

Carson: Yeah, I actually won't be here for match day.

Dr. Chan: Oh, where are you going?

Carson: I'll be in Morocco.

Dr. Chan: For fun or for protecting our country in some roundabout way?

Carson: Yes. For anybody who is in the military who might be listening here, I don't want to sound very OPSEC-y. Sorry, I have to put that in there though.

Dr. Chan: Oh, thank you.

Carson: I will be in Morocco.

Dr. Chan: Okay.

Carson: Yeah.

Dr. Chan: All right. So they'll let you know via email then.

Carson: No, I've instructed someone to open my envelope and call me.

Dr. Chan: Okay. Do you have to like sign a form to give permission to someone or you just say, "Hey?"

Carson: I don't know.

Dr. Chan: Okay.

Carson: I mean, I told somebody with witnesses around that it was okay if they stole my envelope and call me.

Dr. Chan: And then they would call you immediately?

Carson: Yeah.

Dr. Chan: Okay. If it's 10:00 Utah time, what time is it in Morocco? Have you already figured this out?

Carson: I can't do math. I don't know.

Dr. Chan: I was just thinking you're going to get this phone call in the middle of the night, so, yeah.

Carson: No, it won't be in the middle of the night.

Dr. Chan: Okay.

Carson: Actually. No, it will not be the middle of the night. But it'll be fun. That will be great.

Dr. Chan: Well, Carson, I really enjoyed this.

Carson: Me as well. Thanks for having me.

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

Interviewer: Are you feeling overwhelmed, distressed, depressed, or just simply need to talk, but not sure how to proceed? Dr. Benjamin Chan is a psychiatrist at University of Utah Health. And what do you recommend for someone who feels a need to seek mental health care in today's world? Has that changed, or is it pretty much the same path?

Dr. Chan: It's still pretty much the same path. I mean, we have our outpatient providers, counselors. So we have therapists, psychologists, psychiatrists, not only here at the U, but throughout Utah, throughout the nation.

There has been a large uptick of activity. People are calling in, scheduling appointments, talking through their feelings. There's so much negative emotion, so much uncertainty that it feels good just to connect with someone and share those feelings.

Now, my mental hat that I put on says, "Oh, this has to be with a mental health professional. They're trained. They can do cognitive behavioral therapy. There could be a medication management aspect to this." But when I take off my mental health hat and just put on my human hat, that connection can be with someone in your family or a long lost friend from college or high school. And it's incredibly powerful and beautiful to connect with someone and share those emotions.

So yes, the University of Utah Health, everyone who are mental health providers are here and ready, and we are very, very busy and that pathway is still open. But I also feel that connecting with someone is also a part of that ability to take care of yourself during these times.

Interviewer: It's certainly a stressful time for many of us. But what about kids? Dr. Benjamin Chan specializes in child and adolescence psychiatry at University of Utah Health. What can parents do to help their kids during the COVID crisis? And, I mean, I guess, first of all, do children feel the stress as well?

Dr. Chan: Incredibly so, especially when most children have been sent home from school. Children, like us, crave structure. They crave routines. And those routines have been upended during the past few weeks. And no child or teenager will tell you, "Hey, I want more routine." They will tell you they want more iPad time, more screen time. But all children and teenagers crave routine. They seek it out. They flourish. They do really well with it.

So I like to use the example, when I was a child, of a chore chart. For me to get my allowance of, like, $10 a week, I had to do X, Y, and Z on my chore chart. Now, I remember, there were physical little tokens I had to do, take out the trash, wash the dishes, take the dog for a walk, clean my bedroom. And I got my allowance. So my advice to parents is to create structure within their home. Kids, teenagers will respond to that structure. So even if it has to be, like, a physical manifestation of a chore chart: when people should get up, what time should they have screen time, what time should they work on homework, what time should they call a friend on a phone, what time should they go outside for a walk. People, kids, teenagers will respond to that.

Interviewer: Dr. Chan, are there some warning signs that parents should look for to help indicate that, maybe, something isn't right and they do need to do something?

Dr. Chan: They should look for teenagers who seem very sensitive or frustrated. Anger is very common. And, again, that is very normal, but where I get very concerned is if that leads to a deterioration of their functioning. If they seem to be in their bedroom for an extraordinarily long time, if they are not communicating their feelings as much, if they are not finishing their workbooks at home or they are refusing to call their best friend on the phone, that's something I would recommend that parents should really keep an eye on is a deterioration in their functioning.

Interviewer: All right. And that would be a good time to check your child's routine. And don't forget to include a little bit of work, a little bit of play, some socialization, of course, appropriately physically distanced. And if you continue to have trouble and your child is struggling, don't be afraid to talk to them about what is going on and involve a professional to help you get your kids back on track, if necessary.

Dr. Chan: Why does someone decide to go into triple board residency program? How do you promote wellness and balance during a five-year residency program? What's the difference between West Coast swing dancing and the jerk and pull swing dancing found in Utah? Today on "Talking Missions and Med Student Life," I interview Dr. Powell, a second year psychiatry resident and triple boarder here at the University of Utah School of Medicine.

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

Dr. Chan: Well, welcome to another edition of "Talking Missions and Med Student Life." I have a repeat guest back here, Dr. Powell.

Dr. Powell: Hi.

Dr. Chan: How are you doing?

Dr. Powell: I'm doing really well.

Dr. Chan: And you are in your second year of residency?

Dr. Powell: Yes.

Dr. Chan: All right. And you were on the podcast about two years ago, give or take.

Dr. Powell: Yeah, third or fourth year. Anyway, med school.

Dr. Chan: All right. So when you graduated, what did you go into?

Dr. Powell: I went into a combined residency program at the University of Utah. The three programs that it combines is pediatric medicine, adult psychiatry, and child psychiatry. And just to give you some perspective, in the country there are nine of those programs versus the 900 pediatric programs I could have chosen from if I had just gone into pediatrics.

Dr. Chan: Lot of pediatricians.

Dr. Powell: Yes.

Dr. Chan: A lot of pediatricians. Okay. And why did you want to do the triple board program? What attracted it to you originally?

Dr. Powell: So when I was on the wards during my third year of medical school, when I started medical school, I actually had written off psychiatry and pediatrics. I thought I was going to go into family medicine, maybe some geriatric medicine. And then as I'm getting on the wards, I just got more and more excited about kiddos and I'm on the pediatric wards. I'm enjoying talking to kids. I'm enjoying talking to teenagers and kind of keyword talking there. I liked the medicine but something felt like it was missing. And then when I did my rotation on child psychiatry, I realized I really like this but I don't want to leave out this medicine piece. I like these medically complicated kids. I like these kiddos who have a lot going on and they need somebody who can really dig in there with them and work on their medical and psychiatric problems. And so that's why I decided on a combined program.

Dr. Chan: Was it daunting to think that you needed to be like do three programs in one? Was that kind of exciting or . . .

Dr. Powell: It was. I think kind of like the decision to go to med school and then residency, you don't want to think about it too hard otherwise you can get into your head and kind of talk yourself out of it. I do get a lot of from attendings and other residents and other programs, "Wow, you're going to do three at one?" But for me, it just makes so much sense that they just naturally fit together. Right now I'm on child psychiatry rotations but I'm at the children's hospital and so thinking back to when I was walking around as a pediatric intern at the children's hospital and the things I was thinking and what I was concerned about and how I was getting things done, I can see the growth in a year. And it's so fun to now on the psychiatry side be supporting the medical teams. And I know what the medical teams need and the way they need it because I was there just last year.

Dr. Chan: So I want to talk about the jump. Like I have a theory and you can agree or disagree that the jump from undergrad to med school is pretty big. But I feel personally that the jump from med school to intern year is huge.

Dr. Powell: I would agree.

Dr. Chan: So I'm curious, what was your experience for your intern year? What did that look like? How hard was it? How stressful was it?

Dr. Powell: So I remember, wrapping up fourth year I did everything that I at least thought would be important to kind of wrap up and make my intern year easiest as possible. I ended up staying here at University of Utah. I was a medical student here so I was lucky enough I could stay in my apartment. That was nice. I took a nice, big vacation at the end of fourth year. I went out of the country.

Dr. Chan: Where did you go?

Dr. Powell: I went to Oaxaca, Mexico, and probably butchering that name still.

Dr. Chan: I just want to say the word Oaxaca.

Dr. Powell: Even when I was there for a month, I was still saying it wrong. But I went there and I did something totally and medicine related and loved my time. I'd never been to Mexico for an extended trip like that. It was fantastic. And so just a lot of the time, kind of like, "Okay, here we go." Once intern year did start, I think going in just knowing it's going to be hard, just expecting the hours to be long, just setting your expectations in a place that you're not going to be disappointed because I can't change the weeks. I worked 80 hours. What I can do is take care of myself on my days off and not get too down on myself and just be okay with the learning curve that I'm in. I actually I felt like I was putting more pressure on myself in retrospect than everyone around me was because I was an intern. I was a new intern.

It was July and everyone in the hospital in the teaching hospital knows that's when the new interns come in. So in retrospect, I actually could have asked for help a couple more times, even for things that I thought was really simple. But, yeah, it was hard but you kind of just get down and you do it. That was the biggest thing. When I asked for help, and then people would respond, it was lovely because then you felt supported and you knew where you could go for help.

Dr. Chan: Did you feel your tactic of trying to take a lot of intense fourth year electives, did that help you or it was just tough to say?

Dr. Powell: So I actually stacked all my intense fourth year electives in the beginning of my fourth year, all the required and electives that I had chosen and then I had a few earlier in the spring and fourth year and initially starting fourth year like my plan was to kind of work right up really hard, right up until intern year. And then I changed my tactic personally because I just realized I was going to be very burnt out on med school and if I just rolled straight in from hard things from fourth year to intern year I wasn't going to have the energy reserve I needed to get through that year.

Dr. Chan: That's why we needed the fish tacos in Oaxaca.

Dr. Powell: Yeah. That's why I was there. It was lovely. It was absolutely lovely.

Dr. Chan: All right. So intern year, what were your first . . . the entire year is pediatric, right?

Dr. Powell: Yeah.

Dr. Chan: So you're essentially a pediatric intern.

Dr. Powell: Yes.

Dr. Chan: What does that look like exactly? Like what kind of teams rotations did you start and what time were you going to the hospital? And how is this different than being a med student?

Dr. Powell: My first two weeks as an intern were actually on night flow. So I was arriving at 5:00 p.m. and leaving at 6:00 or 7:00 a.m. the next morning. So for the first two weeks that was quite a jump because already you're transitioning your sleep schedule and now you're trying to learn this hospital system as an intern, and you're doing it on nights where . . .

Dr. Chan: Things are closed.

Dr. Powell: . . . things are closed.

Dr. Chan: So what is the night flow? What does the night flow look like?

Dr. Powell: Yeah, so I was on what's called the hospitalist team. So the general medical teams in the hospital. So kiddos who don't necessarily need to be admitted to a sub-specialty team like gastroenterology or cardiology, instead are admitted to hospitalist teams. So kids are coming in with pneumonia or maybe babies with some weight loss that's unexplained. Just very general kind of bread and butter pediatric things that would be admitted to the hospital and it just happens to be that these kids showed up at night. So I'm the one admitting them with the help of my senior resident.

Dr. Chan: Okay, let's just say you weren't alone. Did you have a buddy to kind of . . .

Dr. Powell: Yeah. So there is a couple of interns. And then at the kind of the top of the pyramid, there was a senior resident that's overseeing these different interns. And then I don't believe that first two weeks we had medical students around. But then like the weeks next that I switched over to them, that's when the medical students started coming because when they were coming for the beginning of their third year for their clerkships. And then we also had our sub-I's for their fourth year showing up later in July as well.

Dr. Chan: And were you supervising the med students?

Dr. Powell: Not initially but by the end the second half of intern year, I was taking more leadership, at least with the sub-interns. The third year medical students were still supervised by the senior residents, but as an intern, I was given responsibility with some of the sub-I's because that's what they are. They're sub-interns. They're kind of be expected to be functioning at my level. So it's best to pair them up with a more experienced intern.

Dr. Chan: And would you say as an intern, you just had a lot more responsibility and a lot more duties compared to a med student?

Dr. Powell: Yeah. Occasionally as a med student, I remember looking at my interns or even my seniors, and I'm like, "Oh, I feel like they're ignoring me." And then once I was on the intern side, I realized, like, if we're ignoring you, it's not on purpose. We have one million things to do but only one of the one million is something that you can actually help with because the rest of them need that like MD signature or whatever it is pass off to make it happen. So yeah, I would that was also part of a learning curve is not only learning how to be an intern, but learning how to now supervise medical students when I was just one a year before. But I think by the end of intern year, you have your feet under you enough and you're able to start, especially if you have a medical student that shows up and is enthusiastic and wants to learn and help even if it's not something that they're interested in, but they're still like, "Nope, I'm here to work and learn." Those are the best students to rope into the team flow.

Dr. Chan: That's awesome. And did you get to pick what you did during the intern year or did they just kind of tell you?

Dr. Powell: Somewhat. The categorical pediatric resident, so those who are just doing a regular three-year pediatric program and not the combined program I'm in, they have a little bit more flexibility during their intern year than I do. But what I did get to choose, I did get to choose a couple of different four-week electives. I chose endocrinology, especially with kiddos with diabetes, that's a chronic lifelong illness. There's an overlap there with behavioral health and psychiatric care. So I wanted to see the medicine side of what those kiddos are experiencing. I also chose gastroenterology outpatient for four weeks. So a lot of what we would call functional abdominal pain, kiddos who are really anxious and maybe have other psychiatric issues and they end up not in a psychiatrist office but a gastroenterologist office because their presenting symptom has to do with their stomach.

Dr. Chan: The mind-gut link. Yeah.

Dr. Powell: Yeah, it's really powerful. So I wanted to see what is the workup, what does it look like when these kids do get sent to these specialists? And also those who do have, again, lifelong chronic illnesses that they will see a gastroenterologist for the rest of your life and whether they have premorbid or comorbid psychiatric disease, just kind of seeing what does it look like and how is it taken care of in these sub-specialty offices? So those were a couple of my choices that I had in addition to the work on the hospitalist teams.

Dr. Chan: And then did you have a clinic, an outpatient clinic?

Dr. Powell: Yes. Yeah, I have . . . it's called pediatric continuity clinic. It's a half day once a week and this is something that I'll do for my entire residency. And it's general pediatrics, so ages, you know, newborn to 18 and it's sick visits, you know, "I have a cold, is it pneumonia? And my belly hurts, is it something with my belly or is it something anxiety-wise?" I see teenagers for mood checkups. I see newborns that I met when I was in the Well-Baby Nursery as an intern.

Dr. Chan: The [WBN 00:12:01].

Dr. Powell: The WBN. And we hit it off myself and the parents and since they were planning on coming to the clinic I was already working at they chose me as their primary care provider, their PCP. And some now I've actually have a couple of kids that I've followed for every one of their well child checks from since they were born. Until now, they all just turned a year old a couple months ago.

Dr. Chan: So even if you're on a child's psych rotation, you still have your pediatric continuity clinic one day a week, an afternoon a week. That's pretty cool.

Dr. Powell: Yeah. It's a fun break, especially some days are hard on psychiatry. So it's a brain break to like, "Okay, I'm going to go do some well child checks. I'm going to see some of my healthy kiddos or even just do some quick sick visits and remind myself what a cough and a cold looks like and what looks sick and not sick in a child." And then vice versa. And a few years, I'll actually start my kind of a continuity clinic for psychiatry as well, then I'll be doing that in addition to my peds continuity clinic. And so then I'll be doing both of those no matter if I'm on the psych side of rotations or the pediatric side.

Dr. Chan: And going back to this combined program, so, like it's five years, how do you split up to three different specialties within the five years?

Dr. Powell: So there's an official document from the accrediting board nationally for these programs and that it's this percentage and this percentage of my time in pediatrics, this percentage of my time child psychiatry, and this particular percentage of my time in adult psychiatry. I forget the exact percentages. But what each program has done is crafted what they feel is the ideal schedule for getting exposure in a good order of now you're able to build your skill. So even though I'm switching from pediatrics to child psychiatry, I'm using my skills as a pediatrician but now applying it in my child psychiatry rotations and then progressively, just like with any residency program, you kind of do harder and harder things as you go on. And they've also they've kind of woven that through all three programs.

Dr. Chan: Okay. So it's very integrated.

Dr. Powell: Yes. Yeah. So you mentioned my intern year, that was entirely pediatrics. And that's for a couple of reasons. The way the U has chosen to do that is they want us to be able to get to know our pediatric cohort that is going to be here for three years and we'll graduate after three years, and then I'll be staying on for another two years. So they want us to have that kind of home base in pediatrics and feel like we belong there. Especially since they'll be turnover when by the time we're seniors. And also, I think, and I'm happy for this is that pediatric intern year is intense. There's a lot of hours, there's a lot of kids, and then at the program here, it's high volume. So you are seeing a lot of kids very rapidly . . .

Dr. Chan: Lots of kids in Utah, I've heard.

Dr. Powell: There's a lot of kids in Utah.

Dr. Chan: Lots of kids in Utah. Yeah.

Dr. Powell: So I think it teaches you not only good medicine as a pediatric intern, but just how to be a resident like it's very like here's this time intensive thing of like how to be a resident. So then when I make that switch, the first switch I made was to adult psychiatry my second year. So July of my second year I'm on adult psychiatry for the first time and I'm the equivalent of a psychiatry intern. But in that I'm new to adult psychiatry, but as far as my workflow and my and knowing the logistics and being able to get things done, I'm a second year resident. And so it's kind of fun because attendings, you show up and they're like, "Oh, I have one of the newbies," and they're like, "Oh, I have the second year newbie."

Dr. Chan: Yes, yes. I have a triple boarder.

Dr. Powell: Yeah. So it's kind of it's one of the . . . there's a couple of different switches that we make. And then when we show up and everybody is happy to see us because we're there and we're going to work hard and we already kind of know how the hospital works.

Dr. Chan: Yeah. How do you find balance? How do you find your wellness during intern year? How do you do that? Because I get the sense 60 to 80 hours a week . . .

Dr. Powell: Yeah, yeah, is a lot.

Dr. Chan: So maybe one day.

Dr. Powell: One day off.

Dr. Chan: It's usually not the weekend. It's usually like a . . . or it is the weekend? I don't know. Is it a random Friday?

Dr. Powell: It's usually like a random weekday. So the blocks that I was working six days a week, it was usually not a weekend that I got off. It was a weekday and then occasionally when I was on outpatient rotations I'd get one day or both days of the weekend off. And so you got two days off on a weekend, it was like, "Wow, this is what a normal weekend it is."

Dr. Chan: Yeah, what is this feeling I have? Yes, yeah.

Dr. Powell: So I looked at my schedule at the beginning of my intern year and I realized that a lot of my inpatient rotations were over winter break or like the winter season, I should say, and I realized I'm like, "You know what? I do like being in the mountains. I know how to snowboard, but I want to learn how to ski. I've been here for four years and this is now my fifth winter here. I want to learn how to ski."

And it was I would say a little bit of an ambitious goal for an intern to be like, "I'm going to learn how to ski during intern year." But once I realized some of my days off were during the week, I knew there'd be less crowds, less traffic, and the mountains are already so accessible. So I say that relatively like there's actually not that much of a time to get to the mountains here to go skiing. But I bought a pass and I was skiing on, I would say, most of my days off even if it's only for an hour or two because the rest of the time I wanted to sleep in or get some groceries, or anything like that, but just to get outside and experience something new. And so I prioritize that.

I really liked dancing. I'm West Coast Swing dancer and during med school I was doing it competitively. And I realized, "You know what? I want to try something new." And so I kind of put that on the back burner for a year. And it was a conscious choice because I knew I wasn't we have time for both. And since West Coast Swing dancing, most of the dances happened late at night and I was going to be on a regular schedule of getting up really early. That's kind of why I chose to like "Okay, now I'm going to like maximize my daytime hours and I'm going to maximize them outside since I'm going to be in the hospital most the time." So I switched. That's how I found the balance back here.

Dr. Chan: That's beautiful. What is West Coast swing dancing?

Dr. Powell: Yeah, it's a type of swing. Actually most people when people think of swing at least in this area, they like think of kind of what I call as like Utah jerk and pull because it's actually just like this like really . . .

Dr. Chan: Is that like where in front of businesses with those big inflatable people then like blows the air and goes like that?

Dr. Powell: No, it's lead and a follow, holding hands and it's like a partner dance.

Dr. Chan: Jerk and pull.

Dr. Powell: I call it the jerk and pole. It's this colloquial. It's actually like most people just call it country swing, but West Coast swing is actually the nickname. It's like the ballroom of swing because it's a smooth swing.

Dr. Chan: Is there an East Coast Swing?

Dr. Powell: There is an East Coast Swing. That's the one that most people know of. It's like kind of like more like Lindy Hop like you're like really upbeat or like the jitterbug. Those are all closely related. It's a lot more . . . there is swinging involved. But it's a lot more like up on your toes and fast whereas West Coast swing is you're actually flat footed and going really smoothly through the music.

Dr. Chan: And you do competitions?

Dr. Powell: I haven't recently, and again like I did a lot during medical school because I would get weekends off regularly and that's when the competitions are held. But as added intern year I was like, "You know what? Switching gears I'm not going to be able to compete this year. So let me like focus on a different hobby, something that I can do during daylight hours and not have to stay up late for." And then, during second year, I have gone to a competition or two not with the hopes of winning anything and I didn't. I fell horribly on my face because I was out of practice, but it was fun being there with my friends and reconnecting with my friends who I hadn't seen for a while.

Dr. Chan: That's wonderful. I had no idea you did that. That's really cool. And your second year in, any wavering, any doubts, like, "Oh, I really like pediatrics. Maybe I'll just switch and be a categorical pediatrician"?

Dr. Powell: It's usually . . .

Dr. Chan: So you know what I'm talking about?

Dr. Powell: Yeah.

Dr. Chan: Because it's a long program. It's five years.

Dr. Powell: It's a long program.

Dr. Chan: You straight [inaudible 00:20:07] grade on your pediatrics.

Dr. Powell: I might have more feelings like that, especially at the end of my third year is I see my pediatric cohort graduating, either moving on to being an attending in a general pediatric office or moving on to fellowship. I think it on my good days, which I would count today as a good day, I feel perfectly happy and content and I don't feel rushed that I have to make my next career decision. I'm happy just being in a space where my job is to just learn. And also I get to choose some rotations and things of things that I know that I might never see again. So I see it as a privilege to like learn and understand these different patient populations.

And so it's just cool to be in that space. Because once you're out of residency and fellowship, that changes. You're here, this is your specialty, this is what you're doing a little. I definitely on days where it's been long hours, I've had a really frustrating day. I definitely I'm not immune to the thought of, well, I could actually quit a year early and I'd still be done with pediatrics and adult psych. And then I could just like do one of those. Not necessarily combine them. I wouldn't have the child psych finished. But yeah, I have thoughts like that. And then I have another good day and I'm okay with it.

Dr. Chan: Okay. So it's like as long as a good days outnumber the bad you're on the right track.

Dr. Powell: Yeah. Yeah. And I mean, sometimes, and I have known there's people been in my program who made the decision like, "No, actually, this isn't for me. I have to make a switch." And it's hard. And med school, I thought it was impossible in med school. And so I didn't think that wasn't even a thing. But I've realized, you know what? If that does need to happen, you can make it happen. It's difficult. You might be behind, you might be starting over. There's a couple of people that I've known for my program that they finished their program and then they restarted as an intern in another program just because they like, you know what I got to do what's going to be best for me and what I want and what my goals are. And I realized the first choice I made wasn't the best one. That it's not common but it's not uncommon if that makes sense.

Dr. Chan: Yeah. People don't realize that from the outside that there is some switching that can happen within residency programs. It takes a lot of work.

Dr. Powell: It does.

Dr. Chan: Bridges might be burned a little. But, yeah, I mean, I think for a lot of students, they think that the residency is going to be like X and then they start doing the residency and it turns out to be more like Y. Like, "Oh, well, this is not what I envisioned for myself." So people sometimes can switch residency programs. People graduate residency programs, go and practice and then they get disillusioned or they want to do something else and they can . . . you can do two residency programs. A lot of people like my age who are thinking about going back and do another residency program. So to each his or her own.

Dr. Powell: Yeah, occasionally, also on bad days, in addition to just thinking like, "Okay, I can be done at this point in my residency and I'll have enough qualifications to work." I also have the thought of, "Oh, maybe I'll just go back to undergrad and do something totally . . ."

Dr. Chan: Yes. You might have to eat a lot of money.

Dr. Powell: They're going, "Yes, that's silly."

Dr. Chan: Yeah, it's debt thing. Yeah.

Dr. Powell: Let's pay off my debt first. That's when I start calculating how many years I have to work as a doctor and pay off my debt and then . . .

Dr. Chan: How many years would I have to yes, as not a doctor. Yes. All right, so Rebecca, like where do you see yourself practicing? Because I know you're from Southern Utah. So do you see yourself ending up down there or like what are your current thoughts?

Dr. Powell: There's a chance. As an undergrad, I did a lot of volunteer work in the Four Corners area of Utah, Arizona, Colorado, New Mexico. And I'm from St. George, the opposite end of Southern Utah. So I just liked that area and I like that space. I like that desert landscape and that's where a lot of my family is. And then as a medical student I spent more time down there in the Four Corners area for six weeks through my family medicine rotation and loved it again and actually just this week I am working with the schedulers on the adult psychiatry side to see how many weeks I can get down to the Four Corners area again for psychiatry rotation, so I keep being drawn to that area and making connections and networking down there. So I think that is a possibility I could end up there for at least.

Dr. Chan: What is it about Southern Utah that like excites you? Like what attracts you to it?

Dr. Powell: Initially, it's like I do have family there and so like that like special piece of like spending time there with my grandparents in the summers is always fond memories. It's just a beautiful area and I like kind of . . . I think I'm more of a small town girl. Like I like the pace down there. I think I already said this, I'm going to say it again, it's a beautiful country and I can just see myself working really hard during the week and then every weekend just enjoying going camping and being outside. Cost of living would be fantastic.

Dr. Chan: And there's a huge need because I remember when I'm on service, we get a lot of children, teenagers from Southern Utah. And we can treat them up here in Salt Lake but like for aftercare follow, there's not a lot of providers in Southern Utah.

Dr. Powell: And generally and at least for on the psychiatry side and the child psychiatry side, in the state of Utah, there's only two counties that have the enough child psychiatrists per capita. One is Salt Lake. We have an academic center here. There's a lot of residents and attendings that are child psychiatrist and the other one is Washington County, which is St. George, Utah where I'm from and the only reason they have enough down there is because they have one child psychiatrist in that entire area. So it would also be interesting for me because there is a small part of me that I'm like, "You know what? It would be cool to take care of some adults in psychiatric in a psychiatric capacity, have like some percentage of my practice doing that." And in Four Corners, so they're in Southeastern Utah since it's very limited, I would kind of be able to like write my own ticket as far as this is how many kids I want to see, this how many adults I want to see because I would be not it but I would be one of the few who could provide the kind of services that they need in that area. That's really needed.

Dr. Chan: Like what I've seen is you probably have like a really busy like inpatient outpatient consult, you'll probably do a lot of different things.

Dr. Powell: Yeah. I think there were a lot of different hats, which is kind of what's fun about residency so far and I haven't . . . all the switches I've made between the three programs, inpatient and outpatient pediatrics, adult and child psychiatry, nothing's really stood out is like, "This is the one that I absolutely love." I just kind of like it all. And I think that's part of the reason why I'm drawn to that area is I could see myself wearing a lot of different hats down there and enjoying it and maybe eventually I'll kind of narrow it down to one. But early on in my career, I see myself being very happy kind of blazing the trail. And then getting other people down there, whether it's doctors or PAs or NPs and just kind of building what they already have down there. And like just making it grow.

Dr. Chan: Yeah, sounds like building a really good infrastructure.

Dr. Powell: Yeah.

Dr. Chan: This is wonderful. It's beautiful. All right, I guess last question, Rebecca, any advice? I love this question. Like anyone who's listening who might think they can't do it or is thinking about . . . they love this idea about triple board and they're not sure if they can do it, if they're not sure they can go on to med school or residency, what would you tell them? What advice would you give them?

Dr. Powell: I would tell them that at least explore it. And that means different things for different levels. For me as a premed, I was actually a finance major. And when I decided, "You know what? Maybe I want to go into medicine." I was a junior in my business program. So I went and found the office at my undergrad that was known for helping kids get into medical school. I said, "What should I start doing?" And they said, "Take this seminar, meet these doctors, come look at these guest speakers, start volunteering here, see if you even like it, expose yourself to it."

So I started volunteering in different hospitals just to get exposure to be like, "Okay, I like the idea, but do I actually like being there in the space?" And I did. And then the same with medical school, like I said, at first I didn't think I was going to do kids or psychiatry, but once I was exposed on the clerkships, I realized I really did like. And also there was a lot of pressure I feel like during first and second year of med school to be like to already know what you want to do because then you can go join student interest group. You don't know what you want to do. If you have a slight interest in something, go join that student interest group. Go listen to that guest speaker, go get that free meal, which is the best part of that . . .

Dr. Chan: Free meal, that is the best part of med school. Yeah, all the free food.

Dr. Powell: Just to hear and listen and like ask questions. And then just really take advantage of anytime that you have assigned clinical duties anywhere, whether it's a clerkship or a different class or something like that. Just really understand like, "Okay, this is a specialty I'm going to go see. This is what I'm seeing. Is this inpatient or outpatient? Is it community based? Is it hospital based?" Just really pay attention because something might grab your attention that surprises you.

So allowing yourself to be exposed and being open to something that does grab you and then when it does just start asking around like, "Hey, who do I talk to about this?" Because that's what the reason that the doctors and residents and people that work here were curious because they like part of that teaching and that mentoring environment. That's just part of it. And so being able to after you find kind of an interest even if it's just a slight interest, you can just ask. Start asking.

Dr. Chan: Rebecca, I'm so glad you're here. I'm going to have you come back . . . I want you to come back every year to give a little updates.

Dr. Powell: That's be great.

Dr. Chan: Even though, yeah, Southern Utah totally need you, like I hope you like stay in practice here and join us.

Dr. Powell: I might. I might. Even though I said I'm small town, Salt Lake's really grown on me. So there also is a part of me that might stay here. I'm in my second year so I have exactly three and a half years, not that I'm counting, left before I have to graduate.

Dr. Chan: Make that decision about where you're going to practice. Cool. Well, thanks, Rebecca.

Dr. Powell: Thanks, Dr. Chan.

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