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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.

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.

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"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.

Dr. Chan: How does an architecture internship in China make one decide to change gears and pursue medicine? What are some ways to survive and thrive during your post-bacc studies? Why is workplace culture such an important question to ask during residency program interviews? Today on "Talking Admissions and Med Student Life" I interview Lily, a fourth-year medical student here at the University of Utah School of Medicine.

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

Dr. Chan: Well, welcome to another edition of "Talking Admissions and Med Student Life." Lily, we have been circling each other for years, and finally we are going to do this podcast. Maybe we'll do a couple more before you leave.

Lily: This is true.

Dr. Chan: All right, fourth-year med student.

Lily: Yes. Thank goodness.

Dr. Chan: And we're not going to talk about what you're going into. You were going to do a reveal.

Lily: Okay.

Dr. Chan: Let's go back to the beginning.

Lily: Okay. Yeah.

Dr. Chan: All right.

Lily: I know exactly where the beginning was and I think about it often.

Dr. Chan: You popped up on my radar. I remember you interviewed with us and you were so just full of life and energy. I remember studying your application. I remember I told myself, "There's no way that we're going to get someone like Lily to come to our med school."

Lily: Aw, keep talking.

Dr. Chan: But I remember that you were just so positive, and then I think you sent me a nice note afterwards. Then I remember you got in and I called you on the phone.

Lily: Which I remember distinctly. Yep.

Dr. Chan: It was windy, and I think you were on a golf course.

Lily: No, no, no, no, no. You're exactly right, it was windy though. I remember, to this day, I remember the exact moment. It was at Norman North High School in Norman, Oklahoma where I was doing some teaching. I distinctly remember walking through, I think it was January or so. I was walking through the halls and I picked up my phone, and I noticed a missed call from Salt Lake City. I ran outside, hence, where it's windy, on the plains of Oklahoma.

Dr. Chan: Okay, yes. Hurricanes sometimes. Tornadoes.

Lily: Yes, it will blow you away. And it was Dr. Chan. One of the best days of my life.

Dr. Chan: And you were so effusive with praise on the phone. I remember, sometimes when I call people they're like, "Eh." You know, especially people who are not from Utah.

Lily: No, no. Not me.

Dr. Chan: I know that our tuition, I get all of that. I just remember you were so positive. I went, "I think she might actually come here."

Lily: That's because I was truly, and to this day, I was so excited to come here. I'd been waiting and hoping. And it happened. You made it happen.

Dr. Chan: So let's back up.

Lily: Thanks, Dr. Chan.

Dr. Chan: So you grew up in Oklahoma.

Lily: I grew up in Oklahoma. I was born in D.C.

Dr. Chan: Born in D.C.

Lily: Grew up in Oklahoma though. Formative years we'll call it.

Dr. Chan: And then when did you decide to become a doctor? Help people understand that. You have sort of a non-traditional path.

Lily: Yeah, no. Absolutely. Also, I should mention that I just returned from several weeks of residency interviews. It feels better telling you this. The story of like, "Where did you go? Where did you come from?" I like this. I got similar questions, but I like telling you about it. Great question because I do have this kind of meandering path. I decided to go to medical school essentially at the end of my undergraduate time. It seems like, it looks like it was kind of random. However, it wasn't. I had just, to be honest, multiple things that I was interested in from an early age. Science was one of them. I went to Yale for undergrad.

Dr. Chan: Where'd you go?

Lily: I went to Yale.

Dr. Chan: Yale. Okay, okay. I've heard of this.

Lily: Go Bulldogs.

Dr. Chan: Small liberal arts college . . .

Lily: Small liberal arts school in New Haven, Connecticut.

Dr. Chan: Yes, okay.

Lily: It was a wonderful place though. It was a huge privilege to be able to go there. That was also quite random. I had my parents, you know, they went to school in Oklahoma. My dad went to the Air Force Academy. I had no family connections there. Fortunately I just had parents who, the prevailing theme throughout our life was, you know, pursuing educational opportunities. So I ended up out at Yale. And, quite frankly, what Yale does very well is the humanities, liberal arts, the arts themselves, and the most extraordinary libraries in the world. I'm biased but, you know, Sterling Library and Beinecke Rare Manuscripts Library, Manuscripts and Archives. I spent quite literally hundreds of hours in those places as an undergrad and absolutely loved it.

Dr. Chan: What was your degree in?

Lily: It was in American Studies.

Dr. Chan: Oh, okay.

Lily: Not many places have a degree in American Studies, so people are unfamiliar. But it is . . .

Dr. Chan: So it's kind of Political Science, American History . . .

Lily: Yeah, it's American History, kind of, with a social and cultural context. I did, though . . . Yale didn't have minors, but I did have areas of focus in architecture and sculpture. So I actually thought I was going to go to architecture school as an undergraduate. To get back to your original question of, you know, "Why medicine?" Or, "When did you decide to go to medical school?" I basically, the summer before my senior year of college, I distinctly remember the exact moment. I was sitting in an architecture studio in Beijing, China. Wonderful experience. I have nothing bad to say about architecture. I love design, and it's a wonderful way to spend a life, a career. But I love working with people. I love the substrate of the work of people and medicine. I did have a previous, you know, love and appreciation for the sciences as well. Medicine seemed like that that was going to better fulfill that interest. So honestly in that moment, I even remember sending my mother an email of all things, and I said, "I'm going to go to medical school." At that time, you know, I had spent my undergraduate years essentially just having interesting, fun discussions with people and arguments and debates, and writing hundreds of pages of essays. So I certainly was not in a position to apply then.

Dr. Chan: It was out of the blue.

Lily: Yeah.

Dr. Chan: You don't come from a gap background.

Lily: Completely out of the blue.

Dr. Chan: No background in medicine, no doctors in the family.

Lily: No one in my family is in medicine. Nope, not at all. So in some ways it was just very spontaneous in that sense. So began the interval quest to get into med school, which were some very difficult years.

Dr. Chan: So you just, I think you did a post-bacc program.

Lily: Yeah, I did.

Dr. Chan: All right, so how did you identify the post-bacc program?

Lily: I applied to all the ones available. I was on the East Coast. I was in Baltimore for a post-bacc program. It was probably, that was, I think, the most difficult year of my life. And I mean that honestly. As all pre-meds know, the prerequisites are quite difficult. Do them all at once, it makes it much more difficult.

Dr. Chan: So this was solely, kind of an academic post-bacc? No research, no community service?

Lily: Solely an academic post-bacc. There was research involved, but, you know, it's kind of at your discretion what you can do. And I did get involved in research and a couple projects. This was at Johns Hopkins, you know, an extraordinary place to just kind of cold call or cold email people and say, "Hey, I want to get involved." And I did that and took a bunch of classes all at once, which I don't recommend. But it was kind of a kickstart you could say to getting down the med school application path.

Dr. Chan: I get the sense, because I know we've talked about this in the past, Lily. But I get the sense that this experience wasn't the most overly reassuring path to go to medical school.

Lily: Oh, no. Yeah. Exactly, yeah.

Dr. Chan: It sounds like it was, like, stressful, super competitive on some level.

Lily: Yeah. Well, I tell people, like you said, we've talked about this before. I think things have changed even in the last, and I'm no expert of course, just my personal perspective. I think even in the last five to eight years things have changed about how, not only how you can pursue a post-bacc and how you can take classes to get into med school, and get into med school, and how you can spend your undergraduate years. But I think there are other ways that people, better, more efficient ways of getting into med school. Like, you don't have to do a post-bacc. And when I say, "Don't have to do a post-bacc," I mean, like, a formal program.

Dr. Chan: Yeah, but you still can take the classes on your own . . . yeah.

Lily: Yeah, you can still take the classes, and I highly recommend that. I actually did end up taking a few extra classes after my time in Baltimore, back in Oklahoma. And it was great because I had time to do research and I was doing some teaching. But yeah, I mean, it was a wonderful time in my life, but it was a very difficult time, because, as you said, you know, complete uncertainty if things were going to work out, which is very . . . a little bit scary.

Dr. Chan: So I get the sense the plan was you do your post-bacc, do all the pre-med reqs, and then did you take, did you study the MCAT at that time?

Lily: I didn't take it the same year.

Dr. Chan: Okay.

Lily: Which some people do do, which I respect that, but it's a lot.

Dr. Chan: It's a lot.

Lily: Yeah. It's a lot.

Dr. Chan: So then the plan was you move back to Oklahoma. You just went ahead and taught high school.

Lily: Yeah.

Dr. Chan: And then you took the MCAT.

Lily: Yeah, exactly. Exactly.

Dr. Chan: Okay.

Lily: So I tried to be a little more sane throughout the process.

Dr. Chan: Okay, all right.

Lily: Well, and I should say too, like I said, I come from this Humanities background. I will advocate for myself and say I'm a smart student. However, I was never someone who was good at multiple choice exams. To be honest, that was the biggest deterrent to potentially going to medical school. And actually just the prerequisites themselves is, I mean, every class whether it's an intro course or advanced level, all it is is multiple choice exams and testing. I did decide, though, I just made this decision that I wasn't going to let it be the deterrent ultimately. But because of that, you know, I just completely had to change how I, you know, studied and it wasn't always rosy. There were some pretty awful times.

Dr. Chan: I bet you were an amazing high school teacher.

Lily: Thank you.

Dr. Chan: Did you ever have, like, "Oh, you know, maybe I should stick around and do this"?

Lily: Oh, yeah. And they actually offered me the full-time math teacher job.

Dr. Chan: Oh, fun.

Lily: Because I was, I did love it. You know, it's funny. Every job I've ever had actually . . . actually, my first job, I don't know if I've told you this before, the first job I ever had was for a minor league baseball team . . .

Dr. Chan: Oh, I didn't know this.

Lily: Yeah, in Tulsa, Oklahoma. I was the person who did the on-field promotional things.

Dr. Chan: So you didn't have to wear a costume.

Lily: I had the option but never got the opportunity, which is upsetting.

Dr. Chan: Is it the Tulsa Tornadoes?

Lily: No, the Drillers.

Dr. Chan: Oh, okay.

Lily: Like oil drillers. I had the opportunity to wear the hot dog costume once, you know, in the race.

Dr. Chan: Oh, do the race?

Lily: Yeah, but unfortunately one of my colleagues got there first. No, but . . . okay, so that was my first job. But what I was going to say is that every job I've ever had in my life has been related to academia essentially. And I mean that in the full spectrum of things from a camp counselor, math and science, teaching, like, space camp stuff, to being a TA in the biology department at the University of Oklahoma, to assistant teaching kind of in this tutoring program for Native American students in Oklahoma, science and math. I mean truly every job I've ever had has been in education. And that's not to, and I'm leaving out, you know, not to mention the other research work I've done. So I guess the point is though is that's why medicine was so attractive to me and why even now it's been validated that I love this environment. It's a continuous learning and teaching environment. So it fits though that I have this teaching career and here we are.

Dr. Chan: I think at the core, like, you know, what is medicine? You have the awesome responsibility that you've learned a lot about the human body.

Lily: Yeah.

Dr. Chan: Medicine, procedures, and you get to educate.

Lily: Exactly, yeah.

Dr. Chan: Teach your patients why you're doing x, y, or z.

Lily: Yeah, well . . .

Dr. Chan: To me that's kind of the ethos of medical care.

Lily: Yeah, it is. You know, I don't think, I didn't even fully appreciate that though before medical school and before, even now, several years deep into it. You know, you teach your patients obviously, as you mentioned. You also teach each other. I mean, I remember, you know, the first couple of days even of my third year clerkships and, you know, you're expected all of a sudden, you just immediately have to start presenting. And I didn't even quite understand what they meant, but, you know. "Okay, Lily, you're going to do a presentation on Friday for, you know, before rounds." That's how we learn in medicine. I mean, that's, you learn these snippets and these chunks because that's what you have time for. But it's just constant, you know, education for each other. So it's a lot of fun in that regard.

Dr. Chan: So going back to Oklahoma.

Lily: Uh-huh. Have you ever been there?

Dr. Chan: Yes, lovely airport.

Lily: [inaudible 00:12:44] say now. It's actually quite nice.

Dr. Chan: Actually I didn't venture outside. It was a connecting flight.

Lily: Okay, all right.

Dr. Chan: So you said Oklahoma.

Lily: Was it Oklahoma City or Tulsa?

Dr. Chan: I'm pretty sure it was OKC.

Lily: Oh man. Okay. I can't even remember. Jeez. I'll forgive you.

Dr. Chan: All right, so what was your strategy applying to med schools?

Lily: Yeah.

Dr. Chan: You've been to Yale. You've been to Johnny Hopkins.

Lily: Yes.

Dr. Chan: You've lived on the East Coast. You've lived in the Midwest South. What's Oklahoma consider itself?

Lily: I call it the Southern Plains.

Dr. Chan: The Southern Plains.

Lily: It's not the South. It's not the Midwest. It's certainly not the Rockies or the West.

Dr. Chan: So you've grown up there. You've lived there. You're living there back then.

Lily: Yeah.

Dr. Chan: What was your strategy applying to schools?

Lily: Yeah, so quite honestly I applied all over. However, in the back of my mind though I did have ideas of where I wanted to be and specific reasons why. So, as we've talked about, I went to, I had this private, liberal arts, smaller school education. I really did go into the application process with the idea that I should have a broad background of educational experiences. So I specifically was looking for a large state medical school and state university. This is, you know, this could probably also apply to, you know, some other private medical school. But I just do believe that state flagship universities are, I think they're awesome places to be that are exciting. The collaboration of, you know, different schools within the institution as well as undergrad institution. They're just fun places to be. And like I said, I love the university environment.

To be honest, Utah specifically, and I'm not making this up just to humor you. I distinctly remember being in Baltimore. This was like six, seven years ago. So even a couple years before I was eligible to apply to med school. And I distinctly remember going on the Utah website. I can't remember what it was specifically, but I thought to myself, "This is a place where exciting things are happening." I just truly remember that moment, and it's the absolute truth. It's been validated over the last, you know, four years. We've got buildings popping up everywhere, so many different initiatives. And it just also seemed like a unique place in the sense that . . . I'm trying to sell it for you here.

Dr. Chan: Thank you, appreciate it.

Lily: But I truly, thoroughly believe this. It's been reinforced to me even now, having traveled around the country the last couple weeks for residency interviews, we have a very unique situation out here. You know, we're the only university medical center for hundreds and hundreds of miles.

Dr. Chan: Intermountain West. It's kind of core . . .

Lily: Yeah, five states. Five states, yeah.

Dr. Chan: This side of the Rockies, yeah.

Lily: So, like, we are the place. We're responsible. I think there's, for even that reason alone makes it incredibly unique and exciting. You know, you want an expert in something, they have to come here. You know, I've worked on the ICU a couple months ago and it's on a higher floor of the hospital right next to the helicopter landing pad. And the helicopters are just constantly, constantly coming in and out.

Dr. Chan: Come in and out all the time.

Lily: Yeah, it's really amazing.

Dr. Chan: So you meet patients from, like, Colorado, Montana, Wyoming?

Lily: Yeah, absolutely. You learn how far it takes, you know, for them to drive home and, you know, you're trying to negotiate that. This is definitely no Manhattan where there's five . . .

Dr. Chan: It's not an Uber ride away.

Lily: It's not an Uber right away. Yeah.

Dr. Chan: You interviewed at all these programs. I know you got into a number of them.

Lily: Yep.

Dr. Chan: So walk me through that history in the making. Was it hard? Was it easy? Were you undecided? Like, how did you end up making that decision?

Lily: You know, it was quite easy because I loved Utah. And I told you this before. I even knew it, I was waiting on it. I told you I was waiting on it, that phone call. So, like, when you called me, I knew I was coming here.

Dr. Chan: Correct.

Lily: I just immediately got rid of my other invitations and I said I was coming out here.

Dr. Chan: Even at your home school?

Lily: Even at my home school, yeah. I did. That was an option. I have all due respect for, you know, my home state institution. You know, and I have to say it is a privilege to have traveled around the country and go to these different places. You know, certainly one's home med school is a wonderful option. Wherever, any med school is a wonderful option, especially these days it's so competitive. You know, there's so many more incredible applicants, you know, for every spot.

Dr. Chan: Yeah, more and more people applying. Yeah.

Lily: So really anywhere you can get into. But fortunately I did have some choices. But I wanted to come here. It felt right, yeah.

Dr. Chan: All right, so you get here, you come here.

Lily: Yeah.

Dr. Chan: And then you find out you're in my CMC group.

Lily: Exactly.

Dr. Chan: What was your first reaction?

Lily: We should have, we should . . . you know what's funny? I even remember where I was when I got that email.

Dr. Chan: It was randomly assigned. I had no part in it. I remember clearly the day they sent me the list of students assigned to my group. I saw your name and went, "Oh, yes." I just got Lily.

Lily: Oh, yes. Well, I'm glad it was that reaction and not one of grief or mourning. It's funny, I remember the moment too because I was actually visiting the state capitol here. I was kind of doing my, you know, welcome to Salt Lake little tour.

Dr. Chan: By visiting the capitol.

Lily: Exactly, yeah. Hey, hey, it's a beautiful view.

Dr. Chan: It's very . . . people from outside the state. But then did you also go by the Great Salt Lake?

Lily: Oh, I've been there.

Dr. Chan: It's also, like, kind of a touristy thing that . . .

Lily: I was there just two weeks ago.

Dr. Chan: . . . that people from Utah usually don't do.

Lily: Hey, now.

Dr. Chan: But for other people it's kind of, "Oh." Because it's really stinky out there.

Lily: There's some bugs. But, no, it's beautiful. There's buffalo.

Dr. Chan: It is beautiful.

Lily: Maybe I was just looking for the buffalo to feel at home like Oklahoma.

Dr. Chan: Is that Antelope Island?

Lily: Yes, exactly.

Dr. Chan: Oh, okay. I mean most people go out to, like, Saltair and kind of approach the Salt Lake from that . . .

Lily: Oh, oh, I see. Not that way.

Dr. Chan: All right, so you were at the state capitol?

Lily: Okay, yeah, so anyhow, I just remember reading that email that I was in Dr. Chan's group. So CMC is the Clinical Methods Curriculum. So I should have, we probably could've told the listeners at the beginning of this that I have had the fortune of spending four hours a week, like scheduled time.

Dr. Chan: Many hours together.

Lily: A week for the first thing of two years of med school in addition to, you know, other interactions.

Dr. Chan: Do you know they're making CMC more longitudinal now?

Lily: I did actually. I did.

Dr. Chan: And it makes them really angry but I have my Brighton 3.0 group. So you're my second group.

Lily: MS3?

Dr. Chan: Yeah, and we'll be, they'll be getting together throughout the third and fourth year.

Lily: Oh, gosh. How do you feel about that?

Dr. Chan: Well, I love it. I feel bad because I've spent so much time with you guys the first two years. And then, like, then it's nothing.

Lily: Yeah, that is true.

Dr. Chan: And just the occasional random pop-in.

Lily: Yeah.

Dr. Chan: So it sounds like, you know, just kind of check-ins.

Lily: Yeah, I think that's great. Yeah, so we meet so in a structured fashion for the first two years, and then, I guess, because we're not part of that new initiative that I just didn't get to see you anymore.

Dr. Chan: No, no, no. I saw you around. People talk about the [locals 00:19:35].

Lily: Yeah, I see Dr. Chan all the time because I . . . but, okay, anyhow.

Dr. Chan: Okay.

Lily: So CMC. I was in CMC with you. I think there were two wonderful years. So we learned how to basically, like, actually how to doctor.

Dr. Chan: Yeah, physical exam, progress note, interviewing, yeah.

Lily: All the things you want to know on the first day of, you know, MS3 . . .

Dr. Chan: Oral presentations.

Lily: Oh, yes.

Dr. Chan: This is all the stuff that really helps in third year.

Lily: Yeah.

Dr. Chan: Yeah, medical education is weird because, like, CMC is, like, super important.

Lily: Yeah.

Dr. Chan: But it's not . . .

Lily: I would argue it's the most important in many ways.

Dr. Chan: It's not as self-evident because people during their first two years are really focused on class work and step one.

Lily: Yeah, exactly.

Dr. Chan: But then everything pivots for third year. Then I think people start to realize that, "Oh, this is why CMC's so important." That's kind of, like, the knowledge you'll need for third year.

Lily: Exactly. Well, and I have, you know, I think one . . . so my background obviously a little bit broad in the academic sense, you know, lots of thinking and discussing and presenting. And I don't think it's so underappreciated now, but I do believe those skills, like, obviously one has to have a kind of a baseline ability in the sciences. But, you know, at the end of the day it really is how you're able to interact with people.

And CMC, this course, like we just said, reinforcing that presenting, learning how to present patients, but learning how to just speak in front of other people and make a concise argument and present your facts. Like, that is medicine, at least very much in the early years. That is so much of medicine. I mean, you do have to have knowledge of course of, you know, what your differential is. You know, the supporting signs and symptoms for it, which comes from, you know, the science years. But the clinical method, it's like, this is medicine. This is medicine in a nutshell. So I actually thanked you. So you're a psychiatrist. So we had a unique situation, I think.

Dr. Chan: Yes, yes.

Lily: Which I loved.

Dr. Chan: Yeah, you guys were very open about that. I remember that.

Lily: Yeah, because you've got, you know, like a pulmonologist and a neurologist.

Dr. Chan: Yeah, family practice docs.

Lily: Family practice docs.

Dr. Chan: Internists.

Lily: Yeah, so they're just, you know, loving the knee exam, but I really think, you know, we did fulfill that just fine. But I do think that you were a unique resource in that. You know, we're asking, learning how to ask difficult questions and have difficult conversations. And, like, that right there is medicine in a nutshell. It truly is. So I think it was a great experience. I was lucky to have you.

Dr. Chan: Oh, Lily, I love it. All right, I'm turning red. Okay.

Lily: There you go.

Dr. Chan: Next career choice. Okay, for the first two years every time I would officially or unofficially ask you, neurosurgery. Brain surgery, brain surgery, brain surgery.

Lily: I was very subtle though. I was never in your face. I'm very introverted . . .

Dr. Chan: No, no, no. I'd never say you were in my face, but you were, I felt pretty committed, you know, very beginning.

Lily: Yeah.

Dr. Chan: And I know you did research . . .

Lily: I did, yeah.

Dr. Chan: . . . in neurosurgery. I know you were shadowing a neurosurgeon.

Lily: I did a ton of research.

Dr. Chan: Help us understand, like, how much did third year kind of play into that? Like, the evolution of your career choice.

Lily: Yeah, great question. So I think like all, you know, med students are kind of decision path. You know, pre-meds, people have an idea of what they want to do. And even in med school, even, you know, late into third year of med school people, you know, they adjust their choices. It is true. So I, in that intervening period between undergrad and med school, I did do a significant amount of neurosurgery research. A lot of that essentially had to do with the fact that I, you know, just reached out for an opportunity, and, you know, one of the first people who responded was this neurosurgeon. And I'm deeply grateful for that experience and was fortunate to do quite a bit of research in that area.

I did continue it in the early part of med school here with a wonderful neurosurgeon up here. And, you know, I think the overwhelming theme of, kind of, my interests is that I always loved surgery. The neurosurgery part came into the fact that I was always searching for something that, quite frankly, was just kind of interesting technologically or, you know, the patients. And I still, like, regard it in that way. However, I think what I, over the course of third year, I recognized that the way I want to, the rhythm of the way I wanted to practice medicine, the people I wanted to take care of, how I wanted to spend my days, it just, like, that wasn't the best option and it wasn't congruent with that. So the big reveal, so I'm doing OB/GYN. That's the plan at least. I just absolutely fell in love with the specialty when I was on this rotation.

Dr. Chan: So where was OB in your . . . was it, like, in the middle, the end, the beginning?

Lily: No, it was actually near the beginning, which is, like, which is kind of funny. It was in the summer of my third year. So it was the very beginning. And then so I kept it in the back of my mind throughout all of third year. And also, too, the thing is, I loved everything I was doing. I mean, some people have the idea that they're going to be an orthopedic surgeon, you know, from high school or whatever. You know, I just, I knew I loved surgery, but to be honest I enjoyed every rotation. I love, you know, this is going to sound corny and clichÈ, but it's the truth, like, every time I get in a new clinical context I say, "This is fantastic."

I did love, in particular though, there is, here's another thing, a misconception. I think a lot of people think, you know, individuals go into OB/GYN because it's this, like, happy, easy context in which to work, which is the farthest thing from the truth. You know, these are people that I deeply admire, the people who are working in this field. They're dealing with very difficult situations. It's critical care essentially, but not just for one person but two people. It's, you know, you have these longitudinal relationships with patients and there's many, kind of, branches that you can, areas in which you can practice from, kind of, the general area. So I've done a significant amount of work in multiple rotations in GYN oncology for example. Another, like, fantastic area where there are these totally badass surgeons, but they're also, you know, doing chemotherapy. So I just, I loved the opportunities that, you know, that it offered.

Dr. Chan: Was it more the OB or the GYN part?

Lily: Oh, it's both.

Dr. Chan: Because you do three weeks and three weeks, right?

Lily: So I think OB is what snags people. Because, I'm not kidding you, you can ask any of my classmates or frankly any med student around the country, and labor and delivery will have been one of their favorite, if not their favorite rotation. But then they just don't end up going into it. But it'll be, like, what they had the best time in. You know, and as people should. It's a lot of fun. Like, who doesn't love to, you know, literally catch a baby. I think too, I think the people in OB/GYN, I think they're, you can't often make generalizations in medicine and you shouldn't, but I think that they're decent people. You know, the residents here are fantastic and fun to work with. They're very smart. You know, I had the fortune of working with a chief resident here for two months on my sub-Is. Literally, I did two sub-Is here and she happened to be the chief on both of them. It was the best teaching I've had in all of my clinical years of med school.

Dr. Chan: That's great, yeah.

Lily: Yeah. And so I just, you know, all things considered, I thought this is the way, you know, I want to spend my life. And, you know, and not to be, you know, too clichÈ, but I do think that there is some really redeeming aspects to it as well. You know, you help . . . I think to also doing medicine, sorry I'm backtracking a little bit. I think if you're going to do medicine, these days in particular, I mean, it should always be this way, but I think these days now, I think there is an obligation to primary care. It's not to denigrate any other, you know, super specialty. And I think we should also have, you know, an obligation to society.

I say that in the sense that I wanted some area of medicine where, you know, I'm taking care of women, you know, who, you know, socioeconomically disadvantaged in whatever way, an OB, an OB/GYN is such a perfect way of an opportunity for that, of making the community a better place. And I really believe that, you know.

Surgery's wonderful, you know, neurosurgery's wonderful and they do amazing work. Obviously, all these specialties are essential. However, hopefully you can kind of see, like, my personality. You know, I love being around people and, you know, being involved in our community and, you know, our broader Salt Lake and Utah community. So it just seemed more appropriate. It's very, you know, socially-based, values-based advocacy. You're required to advocate for other people and I think that was why it just kind of fit together.

Dr. Chan: So you do begin at the beginning of summer. Did you still do a neurosurgery rotation year after a year?

Lily: No, I didn't. Yeah, I know, right?

Dr. Chan: All right. So, like, was it, like, an instantaneous conversion?

Lily: Yes.

Dr. Chan: Or did you kind of struggle? Did you make that decision end of third year? I mean, walk me through that.

Lily: It was, I just, it was in the back of my mind through all of third year. And I did my surgery rotation in the winter, actually it was this time last year. It was December/January and I loved it. I loved my surgery rotation. So I really at that time was evaluating the context in which I wanted to practice surgery, which I think is a very important distinction.

And of course, I don't know as much as, you know, there's other people who could speak to this much better, but this is just my personal, you know, decision making on this. Surgery is very different in different contexts. You know, the people are different, the patients are different, the way you treat your patients, how often you see them, you know, the rhythm of your OR days, how much you're in the OR is very different from subspecialty to subspecialty in surgery. And even in general surgery. Don't get me wrong, like the Whipple, like the pancreas, like it's extraordinary what they do, but I just cared a lot less for it than I did some other surgery procedures. And the same can be said, you know, for the pelvic organs. I'm sure other people would . . . Dr. Chan: You're very correct.

Lily: Talking to the psychiatrist here.

Dr. Chan: All right, so . . .

Lily: So anyhow, you know, it was towards, it was towards the end of third year but they do, you guys start making us make choices pretty quickly.

Dr. Chan: You say "they," it's the system. It's not "you" . . .

Lily: The system. I'm going to loop you into the system. I'm going to include you.

Dr. Chan: The medical education system. I did not move up the day for when residency applications were due.

Lily: Well, they make you start submitting your thoughts in we'll say January.

Dr. Chan: Everything's compressed. It's this endless cycle of applying.

Lily: Yeah, it is. But that means we're well-prepared.

Dr. Chan: Before we talk about that . . .

Lily: Yeah.

Dr. Chan: . . . during this time, you also decided to embark upon your political career.

Lily: I had to think for a second of what you were talking about.

Dr. Chan: So tell me, like, do the people recruit you? How did you become involved in student government? How did this played out?

Lily: Great question. So I am a Student Body Officer, which . . .

Dr. Chan: You're Student Body President.

Lily: I'm Student Body President, I know.

Dr. Chan: El Presidente.

Lily: I am, I am. I'm a Co-President with two other fantastic guys in my class, Brian and Scott. We have had a great time. So I hadn't been formally involved in, like, class presidency or in student class council up until this point, but I'd always been involved in, like, med school things.

Dr. Chan: Yeah, yeah, you were very involved.

Lily: Yeah. Like, I love being involved in the community.

Dr. Chan: Lily's on this committee. She's tackling this cause.

Lily: Exactly, yeah. Well, it's fun, you know? You know, like we've talked about, like, that is, you know what institutions, that's what we should be doing at an institution, especially in medicine. There's lots of quality improvement advocacy. So medicine is, like, perfect for that context of my personality. So, yes, so I did end up running for Student Body President. And, yes, it was kind of spontaneous. I by no means plotted a, you know, a well thought out campaign or anything like that. But this, the three of us just decided that this would be . . . you know, I met Scott in anatomy lab freshman year and Brian was also a good friend. You know, we had amongst the three of us, kind of had different backgrounds and personalities. We quite frankly thought to ourselves, "Let's just do this. It'll be fun."

Dr. Chan: So how, I mean . . .

Lily: We thought we represented the school well.

Dr. Chan: So to an outsider, like, what does it mean to be Student Body President of medical school?

Lily: Yeah.

Dr. Chan: Like, what kind of issues do you tackle? Like, what kind of initiatives do you drive? I mean, what's the job?

Lily: Yeah, great question. It is, you know, so there were some formal, like formal obligations. So we meet essentially once a month with the administration, the Dean's office for example. And during this meeting we have our Class Presidents. So there's two Class Presidents per class. And then in addition each class has, I believe it's five class committee members. Then amongst the committee members there's, kind of, different responsibilities with the Alumni Association, with, I'm trying to think of others . . . diversity in professionalism but, kind of, other subcategories. So we are, kind of, the . . . I don't want to use the word "hierarchy," but in terms of, like, oversight . . .

Dr. Chan: You're the leadership.

Lily: Yeah. We're in leadership and so we're kind of looking out for our Class Presidents who are looking out for their, you know, their Class Councils. So that's kind of the formal organization of it. We have some, you know, formal obligations, some of which are, you know, more frivolous than others. For example, like, we order the jackets for the School of Medicine, we plan school events. At the other end of the spectrum though we get involved, we're kind of like the first call you could say for, you know, communication with the Dean's office.

Dr. Chan: Yeah, student response. Student feedback. Student reactions to X.

Lily: Yeah, student response. Exactly, yeah. And there's a lot of that. So, you know, we're heavily involved in, you know, professionalism issues, providing input, getting students involved and forming committees, and, you know, acquiring feedback to present to the administration. You know, in matters related to curriculum or professionalism issues. So it's very broad. I'm trying to think of just the most recent issues that came up.

I mean, one of the more fun things we did recently was, you know, some anonymous person donated some money to support a family for Christmas here. So we kind of helped organize that. You know, this wasn't so much . . . this is the other issue too, explaining too, is that I have so many responsibilities on different committees that they intersect, yeah.

Dr. Chan: I know, it just, yeah. You look very serious right now because I can see you're running through all of them.

Lily: I'm trying to remember which ones are discretely SBO and . . .

Dr. Chan: So here's a process question. Like, you, Scott, and Brian represent the entire student body.

Lily: Mm-hmm, yeah. That's accurate.

Dr. Chan: For better or for worse.

Lily: Yeah. Hey, for better.

Dr. Chan: How . . . well, my next question, my follow-up question. So like, the administration, they have initiative or question or they want your take . . .

Lily: Yeah.

Dr. Chan: How do the three of you represent the entire student body? Do you, like, use Survey Monkey?

Lily: No, that's so 1999.

Dr. Chan: Do you use focus groups?

Lily: No.

Dr. Chan: Do you see what I'm saying? I think it's hard because, like, the student body, there's 500 people from all walks of life, different cultures, different backgrounds, different educations, some are more advanced in their training. I would argue that people who are a little further along in med school probably kind of see the bigger picture. So how do you do that?

Lily: Yeah, great question. And we're always, we're still figuring that out. Only six months in here. So I think, you know, going back to why we ran and how we selected ourselves. So the overwhelming, kind of, reason why we're, how we're able to do that is because, like I said, we come from different backgrounds. So I'm out of state, didn't even go, I'm not even from here. I have no family here, no connections. So, you know, I have, although we have many mutual friends and cross paths with different groups of people, classmates, I know different people, let's say, than Brian who went to BYU, he's from Utah.

Dr. Chan: From here.

Lily: Yeah. And so, like, he knows, you know, many, many people in the MS1 class that I just did not know because he went to undergraduate with them. You know, Scott, he went to the University of Utah. We all studied different things.

Dr. Chan: You did form a power ticket. I love it, yes.

Lily: There we go, yeah, exactly. You got to have that varied ticket though.

Dr. Chan: Yeah.

Lily: So I think that's the first thing, is that we recognize that, you know, we all know different people. Now, to answer your question of how do you go about these things, there are many ways and you have to adapt. So we don't use Survey Monkey but good . . .

Dr. Chan: What's the 2019, 2020 version?

Lily: Well, Facebook is still up there.

Dr. Chan: Really?

Lily: Yeah, I know, right?

Dr. Chan: Because my staff was telling me Instagram is where it's at.

Lily: Yeah, you did just get a new Instagram. I followed you but I haven't gotten a follow back.

Dr. Chan: Well, I don't know how to do that because I literally, I have to sit with my staff and they have to like, it's like teaching me the alphabet. Like, I watch them and they're so fast with their little fingers and styluses. I'm going, "Wow."

Lily: There you go, I know. Well, you're going to have to move faster.

Dr. Chan: Facebook was so much easier. It's kind of an older person thing.

Lily: So we use Facebook. I mean, even just today for example, I posted congratulating our MS2 class who just finished essentially their first semester of second year med school. You know, so Facebook, we do email, we have our class panelists. You know, we show up in person too, you know, which I think is the most valuable way of communicating with people. You know, a couple months ago . . . unfortunately the MS4s have been out of town the last couple weeks interviewing across the country, but we try to be present in person. We visited the MS1 class for example conveying certain ideas and information on issues. And also just saying, "Hey." So in-person communication I think is always the best way to go. You know, you asked about how we go about kind of, like, solving issues or resolving issues.

Dr. Chan: Some of which are unresolvable.

Lily: Some of which are unresolvable. You can do your best to approach it. You can never go wrong . . .

Dr. Chan: Oh Lily, you're destined for higher ed administration.

Lily: I've learned very quickly.

Dr. Chan: Yeah.

Lily: But you can never go wrong by, you know, facilitating at least, you know, a good number of people who have a diverse set of opinions to contribute to the conversation, perspectives, especially in a place as diverse as a medical school as an institution like this. You have to have contributions and input from multiple people. So it is our responsibility I think to facilitate that.

Just depending on what the issue is, you know, we have our Class Presidents and our Class Councils who are readily available to contribute to these various committees. Or even, sometimes an issue will come up and we'll form a group in concert with the Dean's office, and we'll form a group that we think that, you know, we'll ask people to volunteer, we'll ask people specifically just because, who knows? They might have been affected by a particular issue. That's how we get a lot of, you know, student involvement. Some students love being involved more than others. I think we do try to make an effort though to make sure others have their voices heard as well. And sometimes I admit we do use surveys, but it's like a Google survey, Dr. Chan. I mean, come on.

Dr. Chan: Not Survey Monkey. Okay, Google survey. I'll have to have my staff show me that. Okay, so, OB/GYN residency applications.

Lily: Yeah. Hard to believe I'm in this position.

Dr. Chan: I know. Like, how many do you apply to? If you're interested in OB/GYN, do you do away rotation? What's kind of been your strategy?

Lily: Yeah, oh man. You know, we have received lots of advisement from Dr. Stevenson, our Dean.

Dr. Chan: I'm sure the internet also has more . . . the interwebs.

Lily: The internet has lots of things. I stay off of it though. I don't like to . . . that's a mess if you get into it. My strategy was basically to apply broadly, which sounds vague but that is the absolute truth. You know, OB/GYN now, you're having to apply to 50, 60, 70 programs. Of course, that all depends on what your credentials are and your background. I was a little uncertain of how I would fall into things, you know, in particular because I didn't have any explicit let's say OB/GYN research or experience, I think that's totally fine. But one of my classmates, for example, you know, he had a very specific OB/GYN volunteering and research, which is wonderful. He's a fantastic candidate. But I was just, like, very different in that regard. So I was a little uncertain how it would be received, and it's been received just fine. So I admittedly applied to many programs. I won't tell you the exact number.

Dr. Chan: It's up there though. In the 50 to 70 ballpark.

Lily: It's up there, yeah. Frankly, mostly out of necessity. I mean, it's just what you have to do. And I admit that unfortunately, you know, people have very strong opinions about this. Unfortunately I think, mentally, myself, I could not not apply to places knowing how far it's taken to get to this point and then risk not applying to enough places.

Dr. Chan: So a part of that's kind of, like, anxiety driven. It's going to cover all your bases.

Lily: Yeah, well, exactly, Yeah. And people will tell you too, and I understand there's statistics, there's numbers to back up the fact that, you know, after a certain number of applications, the return doesn't increase. However, still, it's difficult to kind of get past this fact that you have to get an interview in order to be eligible.

Dr. Chan: Do you feel comfortable sharing how many interview offers you got?

Lily: I will tell you that I went on a dozen interviews.

Dr. Chan: A dozen, good. All right.

Lily: Yeah.

Dr. Chan: So that's good, right? Isn't that kind of the sweet spot?

Lily: Yeah, so that is the sweet spot. For OB/GYN, it's apparently, like, 12 to 14 is what they say.

Dr. Chan: Okay.

Lily: And they vary from . . . I admittedly applied to mostly university programs. You know, I am no expert of course, and everyone has different opinions on community-based programs or university, and kind of what surgical numbers you get. You can ask Dr. Silver, the chair, for probably a better perspective. But just, like, personally, I think it's been deeply informed of my experience at Utah here. I just love these big academic medical centers. They're exciting places to be. They're a lot of fun. So I was looking for something kind of in that, you know, similar spirit I guess you could say.

Dr. Chan: So it's four years long.

Lily: Four years long.

Dr. Chan: Four years long. And then what kind of fellowships are attached to it? Are you thinking about a fellowship at this point?

Lily: Yeah, yeah. You're reminding me of your other question that you asked a few minutes ago.

Dr. Chan: Away rotations.

Lily: Away rotations, which is true. So I thought, everyone talks about away rotations in med school. I didn't realize that you don't have to do them.

Dr. Chan: You don't, yeah.

Lily: I know that seems kind of funny because the majority don't, but I didn't quite realize that different specialties actually, like, some of them apparently even dissuade you from doing it because you can . . . by showing up in person and showing your face you could ruin your chances.

Dr. Chan: Well, I don't think that's what they put on the websites.

Lily: That's not what they put on their website. I fully endorse, you know, visiting other institutions. And I say that too because . . .

Dr. Chan: Well, it's an audition, right?

Lily: Yeah, Well, it's an audition.

Dr. Chan: So I think if you go do an away rotation at an outside facility, it's your time to shine or not shine. Right? Yeah.

Lily: Yeah. Well, and also, shouldn't that be your attitude regardless? And that was my . . .

Dr. Chan: Well, yeah, but it's kind of high-pressure though.

Lily: It is.

Dr. Chan: Like you're always being evaluated.

Lily: No, it's true. But, quite frankly, so I applied to multiple away rotations, and I ended up selecting two of them and doing two of them in Maryland and in Pittsburg. I had a fantastic time at both. And I didn't even . . .

Dr. Chan: Yeah, different cultures, different hospital systems, yeah.

Lily: Yeah, exactly. And I think . . .

Dr. Chan: Hanging out with other students.

Lily: Yeah, no, it's true though. I think, though, it's almost a responsibility to kind of go out and have these, like . . . it's like, never again in your, well, in medicine it's a little different. Like, you can do rotations at various hospitals, but this is the first time in your life, like, you have this privilege of literally dropping yourself in the middle of, like, a hospital in, that you had no connection to previously. You literally pick up your ID and then you walk over and walk into a surgery. I mean, it's because, of course, we've negotiated these relationships with other institutions and reciprocal . . .

Dr. Chan: Yeah, reciprocity.

Lily: There's a lot of, there's a lot more to it than of course just showing up. You know, safety stuff and insurance. But that's all in place, and so I figured, you know, why not? I think it's important too you see how other hospitals operate, everyone does things differently. Even, like, how a clinic works is very different. How an OR works. You know, at one of the institutions I was at, there were many fellows. So I did it in GYN oncology, so ovarian cancer, cervical cancer, which is a pretty intense rotation. It's not a vacation by any means.

But I specifically chose GYN oncology within OB/GYN because I think it's the best way, at least for me, I thought it was the perfect venue to prepare for intern year. It's ICU based. The intern has really all the floor responsibilities, you're learning how to manage very sick women, and obviously there's some pretty extraordinary surgeries that take place. So, you know, I just think it was the best learning experience. Obviously, like, labor and delivery and obstetrics is, you know, can also be wonderful preparation. But this was just the way I chose to do it.

Dr. Chan: Was it intimidating to be in, like, a different hospital system? And everyone has, like, white coats that look really different.

Lily: Yeah, exactly.

Dr. Chan: And then people are kind of friends and they know where the lounge is, you know? And you don't know where anything is and they kind of hang out after hours and maybe they invite you, maybe they don't. You know what I'm saying?

Lily: No, no. Absolutely.

Dr. Chan: Because I remember I did one away rotation. I just remember it was, like, it was a lot of fun.

Lily: Really? In psychiatry?

Dr. Chan: It was fun. We were trying to get out there. But there's also a kind of, like, lonely. I kind of felt like, oh, this is not really an accurate feeling what it would be like exactly because I would have friends at this place if I matched here.

Lily: Yeah. No, I mean, that's a great point. And I admit, you know, the two months . . . so I was just gone completely for two months. Empty apartment here in Salt Lake City. Staying in completely new cities. Admittedly it is difficult because you are walking into a place where you don't even know where the bathroom is. And then right after you check in and get your ID, you're going to work. And you have no idea where anything is.

However, I think though, that is honestly what medicine is. In third year of medical school you will quickly learn, or I quickly learned, that you are given, you know, you get an email with instructions on where your family medicine clerkship is starting or, you know, where you're starting on surgical oncology on Monday morning at 4:00 a.m., and where you're supposed to be and what resident you're supposed to contact. And you show up and you get to work. And so, you know, your entire, at least, hopefully it gets better, but initially in medicine and the teaching or learning years in particular I should say, it is about getting comfortable with being uncomfortable. I mean, I think about this often.

Medicine is obviously embedded in science and research and evidence-based medicine, but at the end of the day medicine is really being able to get along with people. If you cannot get along with people and be able to work on a team, and you work with new people, I mean, truly, even day to day new people. You know, your resident teams will change, your attending will change. I mean, I was on the ICU a couple months ago and the first week, and this isn't normal because you usually have, you know, consistent attending for, you know, a week. But I had four different attendings on four consecutive days. So you very quickly learn to kind of get comfortable with these situations.

You know, luckily though, walking into these other programs on away rotations. I do think Utah prepares us well. You know, I was, quite frankly, confident walking in, you know. It's not that I knew . . . you don't know what you're doing at all times, but, you know, you, I know how to present a patient. I know how to round on a patient, and if I don't know something, I know where to look it up. So I think if you've done third year of medical school right, and if you work hard, honestly that's just the most important thing. If you just work hard and show up on time, hopefully earlier, but if you show up on time and, you know, be meticulous and try your best. I mean, that's medicine to me. You know, this is coming, of course, I'm a little biased so this is coming from a person who wasn't as into, like, intro to biology as the next person. But I think that's why medicine is redeeming for me. It's because you can work your butt off and, you know, if you care about people, you care about communicating with people, then that right there will set you up for success.

Dr. Chan: So in your mind right now, because you're done with almost all your interviews. Do you know what your rank list looks like or is it still kind of in flux? And where does your top fit into that?

Lily: You can't ask me this question.

Dr. Chan: Well, I'm not asking for details.

Lily: It's okay, you can. Well, how do I vaguely convey? Let me just say this. Because I know that you have such a broad audience and I never know who's listening. I would go anywhere. And I say that in the sense, I mean, who wouldn't to match?

Dr. Chan: You really are a politician. I love it.

Lily: I am a politician. Yes, exactly.

Dr. Chan: You are Student Body Officer, President.

Lily: I will say though, I do have, you know, some people have strong preferences just based off of where they have family, where they grew up or where they're trying to get back to or away to, I guess you could say. I actually don't have really any geographic preference in the sense that I, you know, have been fortunate to live in different parts of the country. And so that's honestly a strength. You know, it can be, I think it's a strength at least. I've been able to plop myself down and start over multiple times in my life in new places where I had nobody, no family, nothing. And Utah was one of those and it's worked out well. I love it here and I truly mean that. It would be an ultimate privilege to stay here for residency. And I mean it too. You know, we have a fantastic program here. The institution is fantastic. There are, you know, details that, or factors I should say, that do influence one's preferences. Everyone . . . having just got back from the interview trail, you know, they're fresh in my mind. People will tell you about case numbers and the call schedule and, you know, whether meals are paid for and whether parking's paid for.

Dr. Chan: My own bias is like, at the end of the day, all operating rooms look the same to me.

Lily: Exactly, yeah.

Dr. Chan: Because of like accreditation.

Lily: Well, it's true, yeah. Exactly, yeah. You have to fulfill certain . . .

Dr. Chan: They always with these tours like, "Oh, look at ours." And it looks like all the other operating rooms, yeah.

Lily: Well, that's exactly it though. That's what I'm getting to is that at the end of the day, like, all these residencies, most of them, but all these residencies are going to fulfill the requirements of becoming, you know, a doctor. A licensed doctor I should say. And board certified. You know, and so, for me, the question I actually have asked in these interviews, and they, who knows? This is maybe a dumb question. This is the first person I'm telling that I asked this question. But for me, a question I asked these programs, sometimes even the chair themselves, I would ask them about the culture. You know, because you can ask, like, how many, you know, total abdominal hysterectomies they do, but at the end of the day, you're going to get those numbers in. But I want to know, you know, do the residents enjoy being with each other? Do the attendings respect the residents and trust them, and vice versa? Is the chair excited to be there? And you very quickly do learn, you get a sense of the culture of places.

Dr. Chan: Yeah. Well, because I think it's important you ask the chairman, chairperson that.

Lily: Yeah, yeah.

Dr. Chan: But I don't think there's a single department chair who's going to say, "Well, actually our culture is kind of bad."

Lily: It's true though.

Dr. Chan: But you're probably looking for other clues throughout the day.

Lily: Yeah, there are other clues, yeah.

Dr. Chan: The dinner the night before, how the residents interact with each other.

Lily: You know, the caveat of course, people show you more than they tell you, of course. I don't think it hurts to ask them to tell you. You know, if they don't, that's a problem. You know, that being said, I was fortunate to interview at some wonderful places where, you know, wonderful departments, and it seems like they have great communities as you hopefully . . . well, you know me. I understand not every day is going to be an easy day at work or a happy day. Who knows? There may be more days not than, you know, than that. But, you know, I'm invigorated by coming to work every day. I love being in medicine for that reason. So I am looking for a place that does kind of fulfill that for me, culturally I guess you could say.

Dr. Chan: This has been great, Lily. Last question and I'm going to put you on the spot.

Lily: Go ahead.

Dr. Chan: What's, like, what's your anxiety about not matching?

Lily: You know . . .

Dr. Chan: Because, like, is that still, I mean, you know, because like, you, I think you're in this place where you're good.

Lily: Yeah, I don't have any. Maybe this is . . . honestly, this is not so much about not matching but, honestly, I just think of places where it's their loss if they don't get me.

Dr. Chan: Well, good.

Lily: Maybe that sounds a little arrogant but, you know, I don't really have . . . I think I have, you know, enough interviews that I'll be just fine, enough places to rank. You know, that does happen and it's happened to friends. It happens to people every single year. And I have seen people, you know, prevail through it. I think the biggest thing is that, you know, hopefully with fingers crossed, it doesn't happen.

You know, we have although getting to this point have had, you know, bumps in the road. It's not the first time, I don't think, that, you know, for myself and also my peers, other things that happened that have made us take a U-turn or, you know, adapt to the situation. There have been too many hoops to jump through and hurdles to go over to get to this point. So, you know, obviously it would be upsetting but there are ways to get through it. As you know, there's the SOAP process and some people get into residency that way. You know, it happens, but I am confident and hopeful it does not.

Dr. Chan: All right, my last question, I lied.

Lily: Yes.

Dr. Chan: Will you come back before, after you match?

Lily: What do you mean "come back?"

Dr. Chan: Come back on the podcast.

Lily: Oh, of course.

Dr. Chan: I want to talk to you some more.

Lily: Absolutely. I thought you meant just to say hi to you when I . . .

Dr. Chan: Because I still have all these questions in my mind and you're so busy.

Lily: Oh, my god. I love it.

Dr. Chan: For the listeners, I didn't touch upon Oklahoma's Sooner football.

Lily: Oh, gosh.

Dr. Chan: We have been playing phone tag to get this.

Lily: Yes.

Dr. Chan: Or email tag.

Lily: We have so many issues we need to talk about.

Dr. Chan: And you, like, no-showed me because, like you went off the grid for a couple months there.

Lily: Oh my gosh. Well, I should've shared . . .

Dr. Chan: You're a difficult person to track down.

Lily: I know. I should've shared too. And I, Dr. Chan, you emailed me to ask me the ultimate privilege, to get on this podcast. I mean, truly. Because when I was applying to med school this was a thing. I obviously couldn't have imagined the day when I would get to be on it. But, like you were saying, I admit last year, and it was during my surgery rotation though. It was this time last year you emailed me. And I forgot to email you back.

Dr. Chan: It's okay, I understand. But it's like, "Oh, Lily must be either really busy or she just really is like . . . she just passed on Chan."

Lily: It was certainly the former because I would never pass on an opportunity to talk with you, Dr. Chan.

Dr. Chan: Well, we want you to come back.

Lily: I will, absolutely. Looking forward to it.

Dr. Chan: Thanks, Lily.

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

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

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

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

Dr. Timme: Great. Good to be here.

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

Dr. Timme: I'm a pediatric endocrinologist.

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

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

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

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

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

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

Dr. Chan: Okay.

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

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

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

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

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

Dr. Timme: I did.

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

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

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

Dr. Timme: Yeah.

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

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

Dr. Chan: And GME is Graduate Medical Education?

Dr. Timme: Graduate Medical Education.

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

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

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

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

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

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

Dr. Chan: Okay.

Dr. Timme: Yeah.

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

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

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

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

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

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

Dr. Timme: Three years.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Chan: Because it seems really dangerous.

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

Dr. Chan: Cheering it on.

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

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

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

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

Dr. Timme: More type 2. Yeah.

Dr. Chan: Okay.

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

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

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

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

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

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

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

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

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

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

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

Dr. Chan: Okay. Interesting.

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

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

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

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

Dr. Timme: I hope so.

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

Dr. Timme: Thank you.

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