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Dr. Chan: What was the golden phrase during your third year in medical school? How do you navigate experiences that may not be positive during third-year rotations? What makes one choose to go into child psychiatry? Today on Talking Admissions & Med Student Life, I interview Doug, a fourth-year medical student here at the �㽶��Ƶ of Utah, School of Medicine.

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

Dr. Chan: Well, welcome to another edition of Talking Admissions & Med Student Life. We've got a great guest today, Doug. How are you doing, Doug?

Doug: Good. How are you?

Dr. Chan: Oh, I'm doing great. Doug just wrapped up third year, and we're going to talk about third year. So when third year started, did you have an idea what kind of doctor you wanted to be?

Doug: Yeah. I came in thinking Pediatrics.

Dr. Chan: Why?

Doug: I think I've always liked kids. I don't know. I just, I guess I just leaned that way. I wasn't sure. I was open-minded during third year, because I didn't want to, you know, close myself off to anything. But, yeah, coming in, in med school in general I was thinking peds, so.

Dr. Chan: I know there's a strategy behind it, but when you got to plan your third-year schedule, did you try to strategically place Pediatrics in a certain part of the year, or how did that work out?

Doug: Yes and no. I mean, generally, they say whatever you want to do you don't want to do first or last. Supposedly, like in the beginning you're fresh. You don't really know what you're doing, so you want to like look good on the rotation. You want to do it well, and so. And then I've heard that some clutch of directors know that the last people in third year also don't want to do that. So that's just . . .

Dr. Chan: So kind of like Goldilocks. Not too hot, not too cold.

Doug: Yeah, exactly.

Dr. Chan: Just right. In the middle of the year. Okay. So where did Pediatrics end up being for you?

Doug: Oh, God. It was like third or fourth, I think. So it was a good place.

Dr. Chan: All right. So you're thinking peds, thinking peds, and then Pediatrics happened.

Doug: So I started out with psych, actually. That just kind of happened. And then I loved child psych, actually. And I totally wasn't expecting it, you know. Everyone says, "Oh, psych is easy. The schedule is easy," blah, blah, blah, but I really want to do child and . . .

Dr. Chan: So what do you like about child psych?

Doug: I don't know. Kids are just resilient, and they go through things that a lot of people don't go through. Even like I remember just some kids even, you know . . . Some kids go through a lot of things before they're 16 that I'll probably never go through in my entire life. And just seeing them go through that and seeing that it's not usually . . . Like 99% of the time it's not their fault usually. It's the family or the parents or other outside factors that play into why they are where they are. And I think that there's definitely a huge need for child psych and . . .

Dr. Chan: So it sounds like you like talking to them, getting to know them, their stories . . .

Doug: Yeah.

Dr. Chan: How they ended up at the hospital.

Doug: Mm-hmm. It was good.

Dr. Chan: It sounds like kind of nurtured this desire you had of working with kids.

Doug: Yeah, definitely. And it was very similar to the work I did prior to med school. So I guess it just makes sense, looking back, that ultimately that's what I've chosen.

Dr. Chan: So start off third year, you do psychiatry. You get introduced to child psych. And did you change your mind immediately, or were you just like, "Okay. This is like top three. I still want to do Pediatrics"?

Doug: Yeah. It was like top three, but I didn't, you know, I still wanted to keep an open mind. I still thought, "Okay, I really like this. Let's see how peds goes." I basically waited to decide until after peds, essentially.

Dr. Chan: And how was your experience in pediatrics?

Doug: It was good. I guess maybe I just didn't quite like it as much as child psych, not to say that it was bad, but some of the . . . I don't know. I didn't have the greatest experience with one of the residents, but I mean, that's just kind of as it goes. But even besides that I think I just enjoyed child psych more in general. So, yeah.

Dr. Chan: I think it's hard, because when I think back to what I went through and my peers went through, is that yeah, your experiences with different residents or different attendings on all the different services can really make or break medical students' desires to go in that field. I've had a lot of people on the other hand say, like, "Oh, I didn't think I wanted to be a surgeon, and then I started surgery." And they just are with this one resident or this one attending who just kind of made all the difference and kind of opened up the doors and opened up their eyes to the possibilities, so.

Doug: Yeah, definitely. I mean, talking to all my classmates, that's definitely how it goes, which is good and bad, right? It's good in that you can have different experiences. It's also bad in that one resident or an attending can ruin what you potentially want to do all your life, but that's just kind of how it goes and . . .

Dr. Chan: It's kind of the drawback . . . It's kind of the pluses and minuses of the apprenticeship model.

Doug: Exactly. But, yeah. Even like surgery, I actually really liked surgery, surprisingly. I was expecting to hate it, but the residents made it great. I work with great residents. I, for a hot second, considered it because of them, but, yeah. No, it was a great experience. And even internal med I wasn't really expecting to like, but I had some great, like awesome interns, and they made the experience great. I mean, looking back I don't want to do medicine. I don't necessarily like adults, but the interns, the residents made it a great rotation for me, so.

Dr. Chan: Did you ever think about pediatric surgery or . . . Because there's all these other like little pediatric sub-disciplines where you can also work with kids.

Doug: It's true. No, I never really considered pediatric surgery.

Dr. Chan: Or pediatric anesthesiology and . . .

Doug: No, not really. Yeah, maybe down the road, but I don't know. Yeah, I never really thought about . . . I know I don't want to do certain specialties of peds just because of my experience in like [ELOS 00:06:24] and stuff, but, yeah. I never really strongly consider any subspecialties necessarily. It's kind of hard doing your peds, because even when you have a subspecialty, you're only on there for like a week. Like I did PM&R for a week, and it's just like . . .

Dr. Chan: Physical Meds and Rehab.

Doug: Yeah. It's just kind of you're in and out, and you don't really see much of it, unfortunately.

Dr. Chan: So, Doug, as I've been listening to you, I'm kind of hearing like that you may have had some negative experiences in medical school, like it . . . Or the experiences that were not ideal, or what you were expecting.

Doug: Well, yeah. Nothing can be perfect.

Dr. Chan: To the people that are listening out there, like how do you navigate those? How do you get through them? Like what do you do?

Doug: I think a lot of it is you just have to expect it. I think I've talked to some classmates who thought third year would be just awesome, and like . . . Or I've heard stories of med students thinking they can leave when they want, or . . .

Dr. Chan: You mean walk away from the team at a certain hour or . . . ? Okay.

Doug: Yeah. Or like they can just go to certain events whenever they want, or . . . I don't know. I feel like for me a lot of it is knowing my place. You know as a third year you are bottom man on the totem pole, and you're going to work hard. You may not be recognized for it, but that's what we signed up for. When we're a fourth year, when we're residents, it's different. But as a third-year medical student, you should know where you stand.

And I think it kind of baffles me that a lot of people don't see that, and I think that plays into why they have a worse experience, because they think it's going to be something it's not. And like I came in knowing I'm not going to know when I can go home. I'm not going to know if I can go to like family events or things I want to go to as a normal person. You just know that that's kind of how it is. Or if an attending corrects you in a way you feel isn't the best, or a resident yells at you or something, like I expected all of these things in third year. And I think when you don't expect those things, then people have a worse experience.

I mean, granted, I had some bad experiences, but I expected to have some bad experiences. I didn't expect it to be perfect, so.

Dr. Chan: Hospitals can be very stressful places. Human behavior is often complex, and sometimes things don't go very well in hospitals, and you have bad outcomes and things. It's natural for sometimes people to, you know . . . And I don't like the word to say, like lash out, but they have high expectations, as we should in hospitals, and when people are not meeting those expectations, you know, tempers can kind of flare. And depending on the situation, strong words need to be said.

Doug: Definitely.

Dr. Chan: I think I like what you said, Doug, because you know I think students start third year . . . Not all students, you know, a certain percentage of students start third year and it's a huge change. Because I've heard people say repeatedly the first two years of med school it's very med student-focused. Almost everything is about the students . . .

Doug: Definitely.

Dr. Chan: . . . and ranging from professors, to lectures, to support services, wellness, tutoring, all that stuff.

Then third year starts and there's this kind of a big shift where the focus is on the patients, on patients' safety, patients getting better and getting treatment. And I still think medical education is important, but it's not like the be all, end all. It's further on the list of priorities.

Doug: Definitely.

Dr. Chan: And to make a hospital run and function, there's certain tasks that students do, that everyone kind of does, and I don't know. When I went through, it was always like the med students were expected to be the first to arrive and the last to leave. And like, woe be the students who try to leave before their attendings or their residents and not finish the work, because students are supposed to help out finishing that work. So I don't know. How does that strike you? Do you remember being taught this, or was it just kind of implicit or . . . ?

Doug: I think it's implicit. I don't think it necessarily needs to be outright said. I mean, I feel like that should be an obvious thing. Maybe it's not to some people, but, I mean . . . And like I think the culture of third year and fourth year is changing as well. Like the so-called pimping, where they ask you questions and people, you know, everyone is scared of that during third year. But I expected it. I expected to be under pressure. I expected to have that. I think residents are being a little bit better about it though. They're maybe a little nicer, or they're remembering what it was like to be a third year, instead of having this hierarchical system that we used to have.

Dr. Chan: I used to hate pimping. I remember I would just practice and practice, and I thought I knew my material, I knew my patients. But then you put me during rounds in front of all these other people, nurses, pharmacists, there was like 10 people in a circle. And then you start getting those questions like, "What's going on? Why do you think this is happening? What are the top three reasons that this patient's anemia is going on?"

I just remember my brain just like shutting down. It's a really hard way to learn, like, yeah.

Doug: It is. And it's very stressful, and I mean, I've definitely had those times where I just totally didn't know, and the attending maybe reamed me or the resident, whatever, but I think . . .

Dr. Chan: I remember I had this one attending and like he would always like follow up like, "Are you sure?" You know?

Doug: That's the worst.

Dr. Chan: And then it got so bad I remember like, "I think this person can talk me out of my name," you know. If he asked me my name, I'd say, "Oh, it's Dr. Chan." "Are you sure? Are you sure that's your name?" I was like, "Maybe it's not my name. I don't know. I've never really double-checked my birth certificate in this specific manner," yeah.

Doug: There's definitely attendings like that, and yeah. But I think that's part of third year as well, you know? Interacting with different personalities that's just, that's part of life, so yeah. I mean, it's stressful, but it's also I think a good way. Sometimes certain pimping times like I'll remember that, like forever because of that. Other times I'm like, "Man, that sucked," but so it is what it is.

Dr. Chan: One of the tips I always tell students during third year is like, going back to my time analogy, it's like always check in with your residents. Your residents can dismiss you. They can send you home. "Is there anything else I can do?" you know?

Doug: Exactly, that's . . .

Dr. Chan: "Can I help you fill out paperwork?" "Can I help you check this?" "Can I help you make a phone call?"

Doug: Those are like golden words.

Dr. Chan: And residents like med students who can be helpful, because then if their work list gets done, their to-do list gets smaller and smaller, they get to go home. So it's a team effort.

Doug: Definitely. And that's the golden phrase of third year, "Is there anything else I can help you with?"

Dr. Chan: Which is like code for . . .

Doug: "Can I go home?"

Dr. Chan: Yeah, "Can I go home soon?" All right. So let's talk about fourth year. So fourth year beckons, it's around the corner. So what kind of activities have you set up? What are you doing? What are you thinking of doing?

Doug: So I decided on child psych. I'm doing a bunch of psych electives. I have an away on one of the blocks. I'm waiting to hear about from a few other things, but I am going to do an away somewhere.

Dr. Chan: So away rotation?

Doug: Yes, away rotation.

Dr. Chan: Just talk about that. Like do these rotations . . . So these are other medical schools, other hospitals outside of Utah, but you can be inside Utah. I guess there's other hospitals you can do them at. Is there an application fee?

Doug: Yeah. There's an application. It's a whole another VSAS. It's a whole another thing you got to do, but . . .

Dr. Chan: Visiting Student Application Service. Yeah.

Doug: Yeah. So each school just has a different fee just when you're doing it. It's a lot easier than like . . .

Dr. Chan: Like 50 bucks, 20 bucks, how much? Yeah.

Doug: Yeah. It can be like 50 bucks. Some of them are like $300.

Dr. Chan: Wow.

Doug: It's like, yeah, it's a wide range. Some of them is you pay when you get accepted. Some of them you just pay outright, which I didn't apply to, but it's a much easier application than what's the . . .

Dr. Chan: Applying to medical school or applying to residency.

Doug: Yeah. Yes. Much, much easier.

Dr. Chan: [inaudible 00:14:40] a page, yeah.

Doug: Yeah.

Dr. Chan: And then do they provide housing, or how do you . . . Because to me it would be really hard to find a place for like four weeks or six weeks, other than staying in a hotel, which would be really expensive.

Doug: Yeah. Unfortunately, you kind of are on your own. I mean, there are some avenues, like I think there's like some random website for med students that are doing aways. But there's not like a set system, which would be nice, or if the institution itself set you up with housing, it would be nice, but that just doesn't exist so.

Dr. Chan: It's a lot of couch surfing.

Doug: Yeah, Air BnB, you know, seeing if you know people there, unfortunately.

Dr. Chan: And these experiences are more or less auditions, right?

Doug: Yes.

Dr. Chan: Because they get to know you, you get to know them. It's kind of like a de facto interview. And I've even heard that some programs they just will interview at the very end, and they will just count that, so.

Doug: Oh, I don't know that. I've never heard that. But yeah, that's what I've heard that, yeah, it's basically an interview, so you can either look at it as good or bad. If you do well, it's good. If you do bad, it's bad. But the point is to hopefully help you get into that institution for residency.

Dr. Chan: And then could we talk about potential couples match?

Doug: Yeah.

Dr. Chan: So what's the strategy, because it's like you're doing couples match, right?

Doug: Mm-hmm.

Dr. Chan: So what does that look like? Do you guys pore over the maps together, or . . . ?

Doug: We will. It is a complex situation. It does make it more difficult.

Dr. Chan: There's a lot to talk about though, right?

Doug: Uh-huh.

Dr. Chan: You're always talking about it.

Doug: Yeah.

Dr. Chan: Different ideas, different possibilities, you know.

Doug: You've got to look at places that have both your programs, first of all. Places that you're both comfortable with. You have to apply more broadly.

Dr. Chan: Kind of target bigger cities, bigger programs.

Doug: Mm-hmm: And that translates to more money.

Dr. Chan: So how much have you budgeted?

Doug: So I've tried talking to people who have already done it. Some people say like 5 grand, some people say 10.

Dr. Chan: That's a lot of dollar bills.

Doug: It is a lot of dollar bills. So probably closer to 10, but I honestly, I have no idea to be honest.

Dr. Chan: If everything breaks in your favor, would you try to do like a road trip? You know, try to hit a lot of programs, boom, boom, boom, stuff like flights?

Doug: Yeah. I mean, that would definitely save money, and they definitely . . . Everyone tells you if you're applying, especially couples matching, you should apply, you know, if there's three or whatever plus programs in one area, you should try to do all three and like interview at around the same time. That way you, you know, efficiency.

Dr. Chan: Efficiency. It's good. It's good.

Doug: So, yeah. Rack up the sky miles.

Dr. Chan: So how's it feel? Does it feel good to be a fourth year?

Doug: Oh, it feels . . . Yeah, it does. First and second year were rough. I actually I enjoyed third year a lot. It was better than first and second year, in my opinion, but I've heard that fourth year is even better because there's no . . . Well, yeah, there's no tests.

Dr. Chan: Well, there's Step 2.

Doug: There's Step 2. But after Step 2, it's basically done until residency. So once you're done with Step 2 and applying for residency, fourth year is supposed to be a much deserved break for med students, so looking forward to it.

Dr. Chan: Looking back, any regrets?

Doug: Any regrets? The end . . .

Dr. Chan: Would you do it again?

Doug: Would I do it again? Yes, I think. It has been a very hard road, I'll admit. I'm not the strongest test taker, and Step and shells and stuff were hard for me, I'll admit that. Med school is definitely the hardest thing I've ever done. But I've made a lot of great friends. I've had a great experience, and, like you say, there are always hundreds of people who would die to be in my place. And so, yeah, I would do it again, but it's definitely, definitely the hardest thing I've ever done.

Dr. Chan: Until you get to residency.

Doug: Yeah. Exactly. Then we'll have this conversation again.

Dr. Chan: Well, Doug, I appreciate you coming on. I appreciate you being so honest, and I wish you the very best. Let's keep touch during your fourth year.

Doug: Yeah, definitely.

Dr. Chan: Let's see what happens. There are some things that will probably start happening, like interviews, and flying, and road trips, and then the all-encompassing match, couple match, March 2018, so can't believe it.

Doug: It can't come soon enough.

Dr. Chan: Four years. Wow.

Doug: I know. I can't believe we're in the fourth year now.

Dr. Chan: Yeah, time flies. Cool. All right. Well, thanks Doug.

Doug: Thanks, Dr. Chan.

Announcer: Thanks for listening to Talking Admissions & 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.