Hitting the Wall, Then Scaling the Heights

The M1 Wall is Real. You’ll Probably Have to Climb It. TL;DR Taking the med ed bull by the horns in a purposeful way will get your through one of the toughest moments. Given any definition of “success,” a medical student who succeeds in medical school engages “like they paid for it.” The definition of “success” doesn’t necessarily include honors grades or high scores. If you choose what it means, you will succeed! Today’s show is sponsored by Panacea Financial, the digital bank created for doctors, by doctors. You can choose your metric for success! After hearing of a student’s struggles with the M1 wall–that point students get to when they’re exhausted, questioning their choices, and worrying how they’re going to get through this–got Dave thinking about the various ways medical school challenges the psyche. Whether it’s suddenly bumping up against ones’ limits, realizing some disturbing aspects of the hidden curriculum, or grappling with doubt, medical school is a real beast. It’s not uncommon to feel alone when you hit the wall. Everyone around you looks cool…but are they really? When you decide to open up about your struggles, what if no one reciprocates? And in a world where not everyone is above the very-high mean, what does it mean to be below average? MD/PhD students Aline Sandouk and Miranda Schene, M3 Nick Lind, and M1 Eric Boeshart have all run into the wall, and are on today’s show to tell the tale. We Want to Hear From You How’d we do on this week’s show? Did we miss anything in our conversation? Did we anger you? Did we make you smile? Call us at 347-SHORTCT anytime  or email theshortcoats@gmail.com.  It’s always a pleasure to hear from you! What an AI thinks we said 365 Active Medical Student Dave Etler: [00:00:00] Welcome back to the short code podcast, a production of the university of Iowa Carver college of medicine. I’m Dave Etler. with me in the studio today it’s a man who was as cute as a bug’s ear. It’s MP3, Nicklin, a bug’s ear. How bug’s ear she flies beyond fates control. It’s MD/PhD student  Miranda scheme. I’d rather doubt an article than question what she delivers. It’s MD/PhD student Alene, sand Duke. Very fair. And joining me in the form of ones and zeros. It’s the jammy, just bit of jam  Eric. Bozart. Feeling Eric Boeshart: [00:01:11] pretty one today. Over the zero? Yeah. Nick Lind: [00:01:13] Okay. That’s good. One. we’re also live streaming on our Facebook group, the short code student lounge. Dave Etler: [00:01:20] So why not check us out there? You can see all the things I say that we edit out of the show. Um, say like a week earlier than we posted, if that’s what the, I mean, if you’re into that If you Aline Sandouk: [00:01:28] just can’t live without us. Dave Etler: [00:01:32] Well, it’s also nice. You can participate. So that’s know hipster Miranda Schene: [00:01:35] vibes, being able to, when all your friends are listening to podcasts, you’d be like, I already knew that. I know that I know the punchline to that joke. That’s Dave Etler: [00:01:42] right. I’m not even gonna make you sign up for a Patrion to do it, you know? Cause that’s all right. That’s how giving I am Miranda Schene: [00:01:48] also because he doesn’t know how to set up a patriotic, Dave Etler: [00:01:53] main reason that I bet you could figure it out someday. today’s show sponsored by panacea financial. The digital bank created for doctors by doctors. I’m really happy to have them back. So we’ll talk more about them later on the show as for today’s. Topic, you guys don’t even know. I didn’t even tell you about today’s topic. You know, why in the dark, you know why I didn’t tell you about today’s Miranda Schene: [00:02:17] topic? Has he we’ve known you too long for us to pull that wool over our eyes. Dave Etler: [00:02:25] There is a student I heard about recently who was running up against a few problems. the M one wall, ah, you guys all immediately were like, ah, Does the ring ring a bell for you? But tell me about the . Miranda Schene: [00:02:37] Well, I feel like, I mean, I don’t know the specific student’s exact problem, but for me, the on wall was sort of when I realized, Oh no, I’m in trouble here. And this is a new experience it’s for me Dave Etler: [00:02:50] in trouble in terms Miranda Schene: [00:02:52] of in trouble in terms of like academics and the fact that. Like for a lot of people coming into my, and this again was my experience. I quite good academically I don’t mean to brag to anybody here. I’m quite good. humble, humble brag. Yeah, that wasn’t really humble though. That was just a straight up brag. I appreciate it though. but then once you hit a certain amount of med school and the pace has picked up, and you’re now into territory that you have never seen before and suddenly this feeling of, Oh, this. Like I am struggling and I haven’t in my previous academic career had this type of struggle before, so I’m both struggling and I don’t really know how to deal with it. Yeah. Dave Etler: [00:03:29] What, what about y’all’s M M one wall. Was there something for you guys? Aline Sandouk: [00:03:34] White coat imposter syndrome started at the white Aline Sandouk: [00:03:46] Yeah, no, I think yeah, I, of course I know the wall. Everyone knows the wall who doesn’t know the wall. I did notice everyone hits it at different points, I think. And that’s an interesting observation. The first one. And sometimes the second, some people don’t hit the wall until the second semester, but yeah, it really dawns on you that you’re in a whole new world and these are whole new stakes. and yeah, I don’t know. Miranda Schene: [00:04:09] Do we hit the wall? I students MSTP any Haiti’s town fans in our listenership are going nuts right now. Okay. Nick Lind: [00:04:17] Yeah. You know, it’s I think it’s because it’s such a new experience to any of us. Cause you know, The amount of material that you go through during that, for, during all of med school, to be honest, but especially that first semester I mean, you’re basically covering everything and that foundations class that you covered. And all of your preparation for medical school. And, and so you just covered it all and you know, one semester and half a semester and half a semester, and you even expounded on some topics that you didn’t even. No. Anything about Aline Sandouk: [00:04:54] all the extra credit stuff from undergrad is now core material. Like all of the stuff that you thought you were going to do for like, you know, brownie points to like suck up to the teacher. Like, no, you have to know all of that too. So yeah. Eric, what Eric Boeshart: [00:05:07] about you? Yeah, yeah. I, a hundred percent agree. It’s. I think kind of what Nick was saying where it’s like, so I did, I did a master’s program before coming here. It was just kind of like a, one-year kind of doing some more of the hard science type stuff. Cause my background’s in engineering. And so you, you know, I went through that master’s program. You’d take things like, you know, I did an anatomy course. I did, you know, some pretty in depth Physiology stuff. And then you come into med school and like, you cover that within the first two weeks. And you’re just like, okay, so that’s an entire master’s degree. So Dave Etler: [00:05:42] expedited. Yeah. I think there’s also for this student. It was all that. Yeah. And then I also think that they were concerned. They’re concerned about the hidden curriculum that they started to notice. Yes, this is so the hidden curriculum. If you’re not, if you don’t know what that is, I guess I would call it the, the part, Dave Etler: [00:06:03] the thing that isn’t actually part of the curriculum, but that you’re learning anyway. Like how to be like how to be a doctor. Sure. Like what it means to be a doctor in terms of things like professionalism. Yeah. Aline Sandouk: [00:06:17] Yeah. It’s it’s office politics for, for anyone who’s ever worked in an office, right? Like don’t use Linda’s mug. You never use Linda’s mom. She’ll lose her mind. But Dave Etler: [00:06:29] it’s uh, you know, things like, you know, how to, how to act like a doctor. Yeah. How to project that image. What is that image? Nick Lind: [00:06:38] I think that really picks up once you hit clinical clerkships, like in you, you know, you’re working with these people and you’re, you know, within the first day of working with them, you’re trying to figure out how they tick. Because like, you know, if you kind of do the wrong thing, you’re going to get called out pretty quickly. Depending on who the person Aline Sandouk: [00:06:58] is, figuring out where their sharp edges are and then how to stay away from them. Miranda Schene: [00:07:04] A lot of times when we talk about the hidden curriculum, we talk about it as well, in terms of like relating to patients in a way that isn’t, you’re my friend, I’m having a conversation, been in a way that is you are the patient, and I need to figure out what’s wrong with you. And that, that goes through things like anatomy lab, where you’re, you may be doing a cadaver dissection for the first time and having to deal with that, like emotionally, as well as learning all the material. Yeah. And then actually figuring out how to break a patient story down into constituent components, which you are then graded on. Yeah. Dave Etler: [00:07:33] Yeah. But I think it’s also about how to look like a doctor, you know, and, That there are problems with this because not everybody looks the same way. Yeah. That’s Aline Sandouk: [00:07:44] an interesting conversation. I think Danny had by a lot of people in healthcare right now, Miranda Schene: [00:07:49] like th this is the problem with the hidden curriculum is that it’s hidden. It’s never anything. I don’t think it’s ever been something that’s been intentionally taught. It’s just sort of generally accepted that odd. This is also things that people develop through their medical surgical time, Dave Etler: [00:08:01] sort of like the culture. It’s learning the culture of medicine, which means Miranda Schene: [00:08:06] it’s, which isn’t only influenced by things like unconscious bias. Right. Dave Etler: [00:08:10] Insanely it isn’t always great. The culture of medicine, you know, there, there is no culture that is always great. and medicine has its difficulties to, you know, basically, you know, how do, how do. You know, what are the aspects of the culture of medicine that I’m talking about? Like hard work all the time. grades is the most important thing. Yeah. Aline Sandouk: [00:08:29] looks do matter though. I don’t know if that’s Dave Etler: [00:08:31] where you’re, it’s not that they don’t matter. it’s just that they are perhaps matter more than they need. Aline Sandouk: [00:08:39] Oh, I did say they mattered. I don’t know if you misheard me. Oh, okay. Yes, Dave Etler: [00:08:42] but maybe I  it up. Is that because Aline Sandouk: [00:08:47] you said a bad Dave Etler: [00:08:49] part of the hidden curriculum don’t, don’t swear on the podcast. Miranda Schene: [00:08:57] Don’t swear in front of children. I mean, in front of patients Dave Etler: [00:09:02] repel against that, Aline Sandouk: [00:09:03] you know, I remember something in my first year with Ellen Franklin, it was like a small group and someone was like, Dave Etler: [00:09:10] Oh yeah, Are I guess they would, they used to call it the performance-based assessment. Aline Sandouk: [00:09:14] Yeah. She’s like the clinical skills assessment director for folks not at SeaComm, but I was in a small group and she was like, people were asking, you know, w what are the expectations for like, how we should look, how we should dress? Should it be like interview day? Which, you know, interviews, people are wearing full suits a little much. And she was like, well, you know, as long as you look clean and you’ve run a brush through your hair. And I thought that that was such like reasonable advice. And then I. Like I grew up a little and I realized that like I was, some people don’t consider like certain types of ethnic hair, clean looking. Right. So some people don’t consider certain. Looks or certain ways of dressing as like clean Dave Etler: [00:09:52] cut. Yeah. So like when, when somebody says run a brush through your hair, what does that really mean? I think that’s part of the hidden whose hair, right? That’s part of the hidden curriculum. I mean, there’s all kinds of problems with this hidden curriculum. precisely because it is, it is hidden. I think Aline Sandouk: [00:10:07] it’s changing for the better though. And people are talking about it. People are talking about talking about it, and I think patients are the. The demographics of patients is changing too, because I think historically doctors acted in such a way that was help patients expect, like patients expected to come to the doctor and maybe I’m wrong. I’m I don’t mean to generalize, not a hundred percent, but I think patients came to the doctor expecting to be told what was going to happen and what they should do. And they liked it that way. And then, you know, the next generation came along and was like, no, I want to be. Partners in care with you. I don’t want to be your employee in my care. And I think that’s where the older guard of medicine is like, what is this? No, no, no. I tell you what to do, but like now we’re coming up and like we’re a little bit more, I guess, like culturally congruent with that. Right. So Dave Etler: [00:10:56] there’s more to the hidden curriculum than we haven’t yet discussed. For instance, There is a S this, this particular student had observed the social currency that circulates around things like how much you study, how well you score on tests you know striving to get honors grades, as opposed to striving, to pass your course and striving to learn. Right. Which is an important distinction. Nick Lind: [00:11:20] Yeah, no, Dave Etler: [00:11:21] that’s very true. So F so for instance, like one of the things this person noticed was you know, professors will let you know, after the exam, what the average was. On the exam. and I’m not a professional, I’m not, I don’t, I’m certainly not an expert on educational theory. but I think to some extent it’s sort of a defensive maneuver by the professor who needs to prove to the population of medical students, that it was a successful exam. Yeah. Yup. that it was valid in some way. but what this student found is that those averages were a source of pressure. did I perform to the average and the message there being that your only value. Is the grade that you get. and by the way, push back at me, if you think, if you think I’m full of shit and anything Miranda Schene: [00:12:01] that I say, can I say very quickly? I actually still remember the first time I scored below the class average on an exam, because like the first like foundations in the first MD/PhD I was still like pretty doing okay. And then it hit like the spring semester and I was like, Oh crap. And I still remember it. The best thing I ever did was I found. Friend. And my friends were not in these lights. You must get honors or you will die type people. They were the chill people. And like, we both had a conversation and she was like, Oh yeah. I also scored below the average. And it was like, and we pointed out to each other that like 50% of the class got below the average. And we’re not a bad student for coming below the average. There can be a Dave Etler: [00:12:41] challenge to find that, that, friend. Yeah, Aline Sandouk: [00:12:44] it, it requires a little bit of vulnerability and it’s game. Like vulnerability, chicken, and you’re like, Oh, and then they give a little, and then you give a little, and then you get to the truth. Cause it’s, it’s hard. Like that’s not information you can just come out with and be like, I done failed that test. And then if no one was soliciting that information or if no one is comfortable sharing that, you know, you’re now in this weird vulnerability black hole. But yeah, those are real. I could not agree more. I love those moments in med school and just like in life, in general, when you’re like. Yeah, that was hard. And the other person’s like, yes, yes. That was hard and hard guys. And you both know exactly what you’re talking about. Nick Lind: [00:13:22] Yeah. I was just going to say, you know, you take a bunch of people who score in the top 10% You know, all through their lives and you put them in a room together and give them the same test. They, they still distribute into a bell-curve where you still have people at the bottom and you have people at the top and you have almost everybody else in the middle. and that’s that’s med school. I mean that that’s everything in life. And it it’s difficult to come because you’re used to being in that top 10% or higher. And it’s difficult to come to the fact that, Hey, maybe I’m average or maybe. I’m below average because you know, that exists too. And uh, Dave Etler: [00:13:57] I feel comfortable being below it I’m above average, in some Miranda Schene: [00:14:05] ways you’re in the you’re in the first core tile in our hearts, in the Eric Boeshart: [00:14:11] box and whisker plot, Dave Etler: [00:14:14] the error bars are just very large. Um,  Eric Boeshart: [00:14:17] I felt like, you know, we’re talking about averages and stuff. I would even go a step further to say, like, I feel like it. In my experience  we didn’t hit that point where I think a majority of people were able to say, like, be open about like, Hey, I didn’t do well on that test. Like, we didn’t hit that until probably this semester before clinicals. Dave Etler: [00:14:36] Interesting, Eric Boeshart: [00:14:36] where it’s just like, you know, I feel like most people were open about that. Dave Etler: [00:14:40] Does that ring true to you guys? Or did that happen earlier? Do you think. I, it kinda, it Miranda Schene: [00:14:46] kinda depends. Like I, I do remember in one of our learning communities, we would almost always have like group D not official group D brief, but informal group debrief, or it all just like come collapsed on the couches and be like, well, that sucked. And that just sort of like opened the floor to be, and it wasn’t necessarily like I scored this or I scored this. It was never, no one asked about grades, but it was just like that. Was rough. And that gives you exactly. That gives you like no information about how that it, maybe it was rough, but they still got like a hundred percent. You don’t know, but either way it’s still like commiserating about that was really hard. And that was tough. And now, wow. I did not even think that was going to be on there, but Oh, I guess this person really loves stomach ulcers. I just got more flashbacks. I think. Nick Lind: [00:15:29] I agree. I think the class is pretty good, even from early on. Like if you. Did poorly, there was at least for me, like I had a group of people I could easily go talk to. They were pretty open with like, Oh yeah. Like that was, that was rough. And I think that was really common. I think I Dave Etler: [00:15:47] should say, I should have said before, you know, and like, I’m getting, you know, when I, when I say I heard about the student, I’ve heard about them secondhand,, if the student happens to, you know, hear this, I want to say that I’m not like, yeah, I want to say that. I, well, I just want to say that this is, you know, th that, this is important to talk about this particular. Student, apparently had tried discussing with other students and felt some resistance to that vulnerability. And I was intrigued when you, Eric said that it took until just before going out into clinicals to open up you, it kind of makes sense Eric Boeshart: [00:16:21] to come into my own realization of getting a pulse on where the. we were You know, like I agree with Nick, like I did have a group of people that, you know, you could, I could go to and be like, Hey, I, you know, I’ve got a general pulse on my group, but I didn’t realize that that spread out farther to the class until probably before clinics. Miranda Schene: [00:16:40] And, and this unfortunately is, and I know we’re all sick of talking about how COVID has impacted medical education, but that’s a big problem where it’s like, it’s become essentially, like I’ve only now been seeing sort of like students back in the communities. And even then I imagine socialization is relatively down. so it’s hard to get that pulse on where your classes at it’s hard to get that collected. Like. Woof kind of moment where everyone sort of collects and shares and is a bit, and sort of debrief with each other. Dave Etler: [00:17:07] Cause even if exams were in person, you’d sort of run away from each other and go there. Miranda Schene: [00:17:11] So like we were just talking, I sat down and I instinctively picked the farthest chair away in the corner just because that’s how like, all right, six feet where it, we got to be distanced kind of thing. Dave Etler: [00:17:21] I Miranda Schene: [00:17:22] I’m sorry. I just want to run away from me, Dave. We’re actually trying to get away from you. Aline Sandouk: [00:17:26] Miranda’s Miranda Schene: [00:17:26] just being nice. I’m leaning back as that goes on, just getting as much bullying. He’s going to get Aline Sandouk: [00:17:39] some really bad mental health problems. If you don’t let them know, we’re joking. Once Miranda Schene: [00:17:43] in a while, I haven’t been on the podcast in so long. I forgot how much of it is just managing Aline Sandouk: [00:17:48] Dave’s emotions. Dave Etler: [00:17:53] I guess the upshot from what I understood is, and I think I’m paraphrasing here. So I hope I get it right. They felt kind of unprotected. and they’re, you know, they they’re sort of mental health was feeling precarious because of all this and, and, but they were afraid to seek help. Sure about it. in the form of, in the form of, you know, things like counseling yeah. Aline Sandouk: [00:18:16] In their defense around some people they should be afraid. No, that’s not to say, Miranda Schene: [00:18:22] hang Dave Etler: [00:18:22] on, hang on.  Aline Sandouk: [00:18:25] that’s all to say that like, Be extremely careful who you share that information with because it’s a 50, 50 chance that you’re sharing that with someone who’s going to go, Hey, I’m really sorry to hear that. Let me help you. And then the other 50% are going to go, all right, great information to have in my pocket. And I’m not joking about that. That’s something to be very mindful of, but like before you go spilling all your beans, like. Throw a crumb out there and see how they react and, you know, before you start really opening up. So Dave Etler: [00:18:57] I would argue that, I mean, I mean, first of all, th this hesitation brings up two questions for me personally. should the institution protect you? is there any value, I mean, yes, to some extent the institution should protect you, but is there any, any value long-term in being unprotected? So that’s question number one. Aline Sandouk: [00:19:15] What type of protection? Dave Etler: [00:19:17] I mean, I don’t know, like you know, because I, because I wasn’t able to ask follow up questions. Miranda Schene: [00:19:21] I’m sorry, but may I throw out a metaphor before I forget? Yes, I believe yes and no. The difference between like chucking someone in the deep end and then checking someone in the deep end, followed by chucking them a life ring. You know, where it’s like Dave Etler: [00:19:37] chucking them in the deep end and then throwing some chum Miranda Schene: [00:19:41] because I exactly like, I think there is definitely value in having to sort of like, In being vulnerable and being able to like getting that challenge and having to sort of climb out. But like, there should be a ladder where it’s like, if you’re like, okay, I have tried and I cannot, I’ve re I’m mixing my metaphors, but I have tried and I cannot climb out of this hole. It’s like, okay. Deploy the emergency ladder. Cause like to meet you halfway. Yeah. Aline Sandouk: [00:20:06] Adversity is character building. Right. And I’ll never forget this. This, I don’t know where I heard this, but I remember reading somewhere that like trees need when to grow. Otherwise they die. Like that’s so profound. Like they need the push of wind to kind of push the sapling down to motivate it, to grow big and strong. Like, Dave Etler: [00:20:24] but they don’t need a daily hurricane Aline Sandouk: [00:20:28] mercy. It doesn’t work if it’s like lethal. Right. It has to be up to a point where like, kind of like Miranda is saying that someone will step in and be like, okay, Hey, you strolled enough. Well, let’s bring you in and then we can talk some more. And I think Nick Lind: [00:20:43] what’s that Miranda Yeah.  Yeah. You know, I Nick Lind: [00:21:08] think in pre-clinicals too, it’s important to kind of have some of those situations where you’re struggling and, and kind of pushing your limits because once you get to the clinical side of things, You’re you’re much more independent. You have to like, not only balance the academic side, because you’re going to have an exam at the end on everything that you need to know for that clerkship, but you also have to be learning all of the practical hands-on things for that clerkship at the same time. And you’re going to be pushed even harder than you were in pre-clinicals. because there’s, there’s just a ton that you need to know. And if you’re not setting yourself up, you know, from, from the beginning, it’s going to be even more difficult. So I think the institution does need to push you. I do think that there needs to be safety nets, and I think that there are here you know, you’re going to get that email orcall or whatever from the counseling center about, you know, are you okay? Like What can we do to help you academically and, and you know, which Miranda Schene: [00:22:07] I think sometimes it might hurt more than it helps or it’s like, I think I’m doing okay. right. Aline Sandouk: [00:22:17] But I’m sorry, Dave, did you want to ask a Miranda Schene: [00:22:19] follow up questions? Right? Do you want to play on your phone? I’m trying Dave Etler: [00:22:22] to just make sure that Aline Sandouk: [00:22:30] The question was, Dave Etler: [00:22:31] I have no idea if the live stream worked or not I’ve know, seems to be working, but then it says you were Aline Sandouk: [00:22:37] well, we’re having fun. That’s all that matters.  Miranda Schene: [00:22:40] Voice cracked. I guess the other thing, Dave Etler: [00:22:48] the other question that it brings up to me is why are people still afraid of seeking help? Aline Sandouk: [00:22:52] Because people are still making other people feel bad. That’s why there are still those, sorry. Blood heads out there that are like, look at this loser. Pardon my French. No, no, no. Dave Etler: [00:23:04] There’s that there is that. I think there’s that risk. Nick Lind: [00:23:06] I think, you know, another aspect of it is our society, our culture, our, the way that we, especially as medical students, the way that. We’re raised. We, we often didn’t need help, you know, from Trump high school on the college, you know, some of us who might’ve had a career before med school you know Nick Lind: [00:23:27] we were able to do it. Well, without the help. And then you get here and it’s, it’s, you know, the heart of one of the harder things I’ve ever done, you know here in med school. Nick Lind: [00:23:36] And I think, you know, when you start hitting your limits you may be, have done that before, but not quite as often and is like, It doesn’t stop here and Nick Lind: [00:23:48] makes it back. Yeah. Yeah. That’s hard for, I think someone to really grasp ahold of and understand and understand when they need help, because they never needed help before. Dave Etler: [00:23:58] I think the thing though, is that school spend a lot of money and effort putting in place these efforts. and they really want you to use them, you know, like the counseling center, the You know, the tutoring groups, the you know, what, what are some other ones? The the, the mechanism to get accommodation? Yeah, I Miranda Schene: [00:24:19] think sometimes those accommodations are often framed as like. Oh, well, if you, and I don’t think that this is a bad thing, but it’s like, Oh, if you start like dropping back and failing, then you have to come to us and admit, Oh, I’m a failure. And I need cause which is not true at all. It’s just, those are things that happen sometimes. And occasionally you require it. Agreed Dave Etler: [00:24:41] agreed. Eric Boeshart: [00:24:41] But I can kind of speak to that too, if we want to talk about that. Cause I’m, you know, I think on top of that, you know, there there’s the general failures of, okay. You know, maybe you’re not studying correctly. Maybe, you know, maybe you’re not using all the tools available, but then there’s things that like life happens. And I know Nick had talked about, you know, before the podcast we were talking about. you know, sometimes people start families, you know, life kind of happens around med school. Well, I had an accident in the middle of first semester, second year, and now I’m kind of taking a step out. So, I mean, you kind of hit a point where, you know, I. For me, it was a concussion. And so I, you know, all of a sudden school becomes a lot harder and I, you know, there, it was a combination of my injury, but also a combination of, you know having to admit that I need to use the resources that are available. And, you know, I think that now. That’s kind of been put into perspective, but I think that, you know, there, you’re taking a group of people that haven’t had to use these resources and you’re like, you know, expecting them to just jump in. And I, I, you know, I just don’t Aline Sandouk: [00:25:52] too. And not Miranda Schene: [00:25:53] to mention, you’re also taking a group of people that have more or less defined themselves on not needing help before, where it’s like, like when you are the best student of the class, you don’t need a tutor. You don’t need additional support. That’s Dave Etler: [00:26:04] why I want to talk about this because. I think that needs to go away. Yeah, I agree. I think that that needs to go away. And I think that, you know, if, if, if this conversation was successful in any way, it would be that, you know, say a pre-med out there who is struggling. Really got the message that if you need help, go get it and don’t give a shit what anybody else thinks about you. because one of the things I think you guys know. And that I’ve noticed about medical education. Is this hot take, are you ready? React to this statement? Okay. There is no such thing as a passive and successful medical student.  Eric Boeshart: [00:26:44] Yeah, I wouldn’t, I mean, at the same rate, Dave Etler: [00:26:49] Okay. There is no such thing as a passive and successful medical student. And we’re going to delve into Miranda Schene: [00:26:54] that because I need like three things to find. Define success. Number one, define passive number two. Yes. I Nick Lind: [00:27:02] never find medical students. Dave Etler: [00:27:08] well, we’re going to delve into that. After this message from our sponsor, which is panacea financial, a company founded by two doctors that were frustrated as medical trainees, that banks didn’t seem to understand the unique needs of those in the medical field. So they weren’t passive. They built a company just for medical students and doctors. Excellent segue Dave Etler: [00:27:27] like that. with nationwide digital banking, panacea financial provides medical students with free checking. That includes no ATM fees, nationwide high yield savings accounts, a free personal banker around the clock customer supports. And with loans designed with you in mind? no one should borrow more than they need, but with panacea financial fourth year medical students can get money as needed in as little as 24 hours with their PRN personal. No, it has an interest rate half of that, of a year, a usual credit card and no co-signer requirement and it’s fully. Digital application. So instead of running up credit card debt, try their PRN personal loan that is designed to give you a better way to cover expenses, such as residency applications and relocation on board exams. Some customers actually use it to pay off toxic credit card debt. In addition, medical students can have a period of no or reduced payments on their PRN personal loan. Join the growing number of medical students and physicians nationwide that expect more from their bank. Go to panacea financial.com to open your free account. Panacea financial is a division of premise. Member FDI C thank you, Pam financial. It’s nice of you to help, help us out. Nice of you to help med students out. Very cool.   by successful, let’s start there. I mean, wringing, everything you can out of medical education. Sure. Oh, well, yeah. Okay. Not getting honors or getting into ortho or getting into ortho. That’s not what I mean. I mean, if that’s your goal, that’s fine. That’s fine. Be successful in that. Yeah. Yeah. Miranda Schene: [00:28:56] So I was going to say, I can think of multiple medical students that have been what I would call passive, and who’ve gotten like straight honors and higher grades and everything, Dave Etler: [00:29:05] you know what? Okay. So then we’ve got to get to pass it, right? passive, I mean, a passive consumer of what medical school has to offer. So you sit there and you Hoover up knowledge and then you spit it back out. That is what I think of as a passive medical student. All right. Nick Lind: [00:29:21] Go. You know what, one thing I wanted to mention after you you kind of define things there. One of my peers, I had asked about a rotation one time and he said, Hey, it’ll be great. Dave Etler: [00:29:33] If you Nick Lind: [00:29:34] treat it, like you paid for it. And I was, which, you know, I Nick Lind: [00:29:39] did good and I should really treat this rotation. Like I paid for it. And, you know it’s a way I’ve kind of been trying to handle the rest of my clinical clerkships. Like I’m going to treat this, like I paid for it. Like, I’m going to go in and I’m going to ask to do the cool things. And I’m going to try to like, do the things that I want to do and learn the things that I want to learn. And you know, it, it’s kind of been fun. Did Dave Etler: [00:30:04] that change anything for you or did it just give you a new perspective on what you were doing? It Nick Lind: [00:30:09] gave me a new perspective, but I think it did change, you know, cause some clerkships you have the opportunity to kind of pick and choose a little more of what you want to do. like, like say like emergency medicine that’s a good one because you get to sign up for patients and you kind of get to pick what you know, who you want to see. And, you know, if you want to go to that trauma, that’s on the other team that you’re not assigned to, you can go to that trauma and yeah. You know, it, it’s a good way to, to look at a clerkship and, and kind of. You know, there are things that you’re going to be asked to do no matter what. but there might be some options where you get to go in and, you know, even just ask like when I was on OB GYN, I you know, was in a room and there was an attending that was going to work independently in another room. And I said, Hey, can I go work with that attending? it was in the, or, and he didn’t have any residents, no fellows. So it was just me and him. And I got to do way more, but I bet you had a Dave Etler: [00:31:03] great experience. Yeah, yeah. Yeah. Miranda Schene: [00:31:06] One thing I’ll say is that when you are sort of more like assertive and asking people, you will be surprised when people will say yes to where it’s like, there’s a lot of things where like, I’ve had people express to me, like, man, I wish I could do this. And then they are. You know, people are like, okay, well, why don’t you do that? And they’re like, Oh, good point. And then it’s I never thought of it that way. Oh, I didn’t. Yeah. Cause there’s sort of this assumption. It’s like the it’s like that one picture of a horse that’s like tied to a kid’s deck chair where it’s like your limits are. Yes. So I th it’s one of those things where I think sometimes people are passive because they don’t know they have an option. It’s like, you can just like ask for things that you want. I think Dave Etler: [00:31:49] also, I mean, that’s, that’s amazing insight and I think that’s something that That is directly applicable to the clinical part of your education. And I think it’s also directly, I can see how it’s directly applicable to an MD/PhD education because those two things, while there are. You know, set things that you need to do. And you’ll be asked to do things specifically. There’s also an element at some point of self-determination it’s a little harder to see that in the preclinical curriculum, because you can’t just go up to the course director, who’s put together this, you know, this Mo you know, semester long course and say, yeah, but I want to look at them. Yeah. but there are things that you can do. During the preclinical phase to sort of. You know, be more active. I mean, good. I think the best students that I’ve seen you know, they, they organize that vacuuming up of knowledge, right? They organize the actual process of consuming it. They organize the organization of the actual prop, you know, process of consuming it. Do they do this? Organize the organization? Miranda Schene: [00:32:57] Not only do they organize, but they organized their organizer. Yeah, it’s a little obsessive, but Dave Etler: [00:33:02] I, you know, and I hope that part of that process is realizing that no plan survives the first engagement with the enemy. So sometimes you have to, you know be willing to rejigger your plan, but they seek solutions to problems rather than just waiting for them, waiting for those solutions to, to arrive. And I think that’s important. They also participate to the extent that they can. And I don’t want to say that you, you know, I don’t want to say that. You absolutely must join every student organization and you absolutely must become a leader of those student organizations and things like that. That’s gravy. but they’re the, I think the people who my guess is that the people who get the most out of medical education actively participate in it beyond just going to class. Absolutely. Aline Sandouk: [00:33:49] I think to add to that, I think the people who get the most out of it are the people who are making decisions based on their values and what really matters to them, not what they should do, but what they’re excited to do. Dave Etler: [00:34:01] Yeah. And I think this feeds into something that I often say when any, whenever anybody gives me the chance, which is defining your own metric, Aline Sandouk: [00:34:08] Totally. Yeah. What does success look like to you? What are the issues that are important to you? Nick Lind: [00:34:13] And I think that’s going to change after, you know, your first few months of medical school. Yeah, exactly. Because you might think that, Oh, I’m going to be the top of the class and I’m going to. And somebody is going to be, and they might be able to meet that. But most of the class will not Miranda Schene: [00:34:30] fun fact. There’s only one person that could be the top of the class. So if you’re Aline Sandouk: [00:34:37] number one, Miranda Schene: [00:34:38] they are can be old. Late Dave Etler: [00:34:39] one. Yeah. The, the student I was talking about earlier with not being passive, right. They’re examining the world around them. Yeah. Which is. Important. they were noting its shortcomings. they reached out to other students, they made themselves vulnerable and I am all for this as you know Aline Sandouk: [00:34:56] You, you, you do have to try, like, you have to put yourself out there a little bit to find out, you know, what your environment is like, right. You are a little bit in the dark until something really big happens. And then you’re like, Oh, I need to find out the landscape of the place that I’m in. And it sounds like this person is really in tune with how they’re feeling like they’re aware of what they need and what they’re looking for and are aware of the fact like, Oh, I’m not getting it here now. I’m going to go somewhere else. Yeah. I think I’m curious to hear more of like, what Eric’s experience is like. Cause I think I cut you off, but you were, you were kind of getting to the part of talking about how you slayed this dragon of passivity, I think. Eric Boeshart: [00:35:35] Oh yeah. Well I think that, and it sounds like I agreed. That this person sounds like they’re kind of reprioritizing is what, needs to happen. And I think that I, you know, in my own kind of personal, you know, what’s in the last six months, that’s kind of what’s happening me. And it’s a lot of, it took me a concussion, some academic MCAT failures to realize, you know, that. I was, I was passively taking in information, you know, and then all of a sudden you’re like, you have this kind of come to Jesus moment of, I need this information to help people, you know, like that’s what I’m here to do. That was my ultimate goal. And so I think that. It sounds like this student is kind of in a similar situation where it’s like, okay, what is your definition of success? And for me, my success death’s definition has changed. And, you have to take the steps to find the help that you need, And I think that kind of like what we were talking about earlier that I think that the, you know, there’s adversity, but. I agree with the idea that the institution needs to be able to throw out these, you know, life rafts or the, you know, and they are available. It just, it sucks that we, as a student mindset are like, nah, I, I don’t want to use it. Miranda Schene: [00:36:54] I don’t need your boring life. I’d love to Dave Etler: [00:36:57] tease, you know, this, this sort of reminds me of a conversation I recently had with my mom. you know, they’re getting older, they need a little bit more help. And I was trying to suggest some things and my mother said, Oh, we’re not that kind of people. Yep. And the two things, things about that, I’m like ma. You are now. Okay. And number two, I’m that kind of person? What do you, what, what kind of person are you talking about? Miranda Schene: [00:37:26] It’s actually kind of reminds me of, I went to a movie screening last night outdoors. it was out by the river is Dave Etler: [00:37:34] really pretty good. I get to stop like, like putting asterisks after the things we do, like Miranda Schene: [00:37:41] six feet away, Dave Etler: [00:37:42] Jeff really was wearing a bow and I was outside. And I was bathed Nick Lind: [00:37:47] in hands. I Dave Etler: [00:37:48] was wrapped in plastic. Miranda Schene: [00:37:54] You’re fine. well I was at this movie screening and at the end of it one of the guys said something where it’s like the world needs people who are willing to reinvent themselves. That’s a paraphrase. but that was one, I mean, the documentary as a whole was a tad pretentious, but it’s okay. I liked it. but that was one of the things that sort of stuck with me where it’s like, you know, that’s, people will get stuck in this thing of like, no, this is just the person I am. And all you have to do is be like, well, why, why are you that way? And then just, if you can’t come up with a good reason, then. Be willing to change that. Like you are not defined in a single Aline Sandouk: [00:38:28] aspect. Yeah.  I saw a quote somewhere recently on the internet. I can’t remember where, but it would have been a Brene. Brown quote, I’m not sure. She she’s like a big vulnerability researcher. but the quote was something like a lot of people. and in this case, as I think they were talking about like relatives, Choose to see you as the version, they had the most power over and they refused to recognize your personal growth, you know, into a person they can’t control. And they get really annoyed around that. And I haven’t been able to forget it cause I. I mean, I’ve never articulated it that way, but I have personally experienced that and to piggyback off what Miranda is saying, don’t just be afraid to change who you are and reinvent yourself and kind of move the goalposts round, but also get away from people who don’t let you change. Yes. Get away from the people who were like, no, get back in this box that I put you in. I don’t like how you’re trying to squeeze out of my control and that’s okay. Like I think as people get older and this is harder to see, I think when you’re under 25, but when you get to be like, I think in your thirties and forties, you realize that like, Friendships come and go. Like, just because someone’s your best friend now, and they’re not going to be your best friend forever, but maybe you step away and then you come back to them in a few years. Like when your life priorities realign, you know, and things like that. So everything changes. So feel free to change with it.  Oh, wow. Dave Etler: [00:39:55] I was thinking back to To my childhood. Aline Sandouk: [00:39:57] You had to read it to me moment where I Miranda Schene: [00:40:00] farmhouse.  Nick Lind: [00:40:18] You know, I think for the first-year medical student, who’s struggling academically. you know, I would encourage them to keep at it because this information is all coming back again. Like I, I just took step two yesterday. and you know, like, step one, step two, like all these things that you learn, they just keep coming back. So if you’re not getting it now, you’re not going to get it. Then you put the time in to truly understand, you know, where, where you’re missing it. And so you know, if you have that test that you either failed or did poorly on, or didn’t quite do where you wanted, you know, score where you wanted to be. You, you kind of have to keep at that material. Dave Etler: [00:40:58] It’s not so important. I think what you’re saying is it’s not so important that you got a bad grade. Yes. What’s important. Is that you, you use that information to inform what you did next. Yes. Aline Sandouk: [00:41:12] Yes. And also like, look at the information said, okay, what of this really matters to my future? I’ll never forget this. There’s a doctor who used to work at student health. And I remember I went to her as my doctor and. Because I was a med student, he came up and she was like, Elaine, let me tell you when I was in med school, you know, sh she’s an OB now. And she was like, when I was in a med school, I didn’t learn the foot, not a big deal. I didn’t learn about the spleen, not a big deal. I became an OB. So ovaries became critically important for me. So try to look at it that way you don’t have, like, they’re only the only two specialties in medicine where you really do need to know everything is family med and emergency med and everything else. You’re going to lose, like not lose, but like six. You’re going Dave Etler: [00:41:53] to step away from it a little bit Aline Sandouk: [00:41:56] away and make room for really in-depth knowledge for the stuff that’s really important for the people you see. So, yep. Dave Etler: [00:42:03] There is one thing I wanted to say, you know, schools are going to be proactive by offering things like mental health support system or services tutoring. A structure for mentoring, learning, our learning communities are important. but it’s up to you to seek those things out. Again, we’re getting back to that active student.  I’m going to punch you for gesturing  with me. , Miranda Schene: [00:42:26] I swear to God that one was actually unintentional. That was early. Empathizing. I was, cause I was like, I was like, all right, get in. Dave’s head. What is he saying? Dave Etler: [00:42:39] Or like firing. But the point is like, we, you know, the schools go to a lot of trouble to do this and you have to be willing to sort of take advantage of them. I mean, yes, your school may reach out to you and say, Oh, I see you got a bad grade on this test. Let us know if you need any help. Sorry, Miranda Schene: [00:42:58] that just made me think of like, you’re paying for it. Aline Sandouk: [00:43:00] I was about to say I’m a little pissed Miranda Schene: [00:43:03] off.  Aline Sandouk: [00:43:05] such a great call back, but I was thinking, I was like, you’re paying like Doreen go use Doreen, you know, any of the other people, but yeah, you’re Miranda Schene: [00:43:14] ups. You want to put Dorian into context? Dave Etler: [00:43:16] Cause I feel like that’s the head. Yeah, Miranda Schene: [00:43:20] I can just imagine some poor like med student, like Chicago and it’d be like Yeah. I mean, the Aline Sandouk: [00:43:39] Doreen. Miranda Schene: [00:43:40] Yeah, I know that, you know, like you have to be willing to say in those cases,  Dave Etler: [00:43:44] what other people think I’m afraid. I’m afraid of what the Dean or my peers will think, Dave Etler: [00:43:49] who the heck cares, what they think you have a right to seek resolution to your part. Aline Sandouk: [00:43:53] And you know what, for anyone who cause something, I think Eric brought up that was so perfectly articulated is that you’re really kind of expected to, just to jump right into being vulnerable. Whereas for a lot of people they’ve never been vulnerable and that’s really scary. And so. Like, but no one ever teaches you like what the baby steps are. So like, I want to share a little bit of advice here. There’s a lot of safety in curiosity, confusion and concern. Like in that order, like whenever I have to have a difficult conversation, I never come at it from like, here’s how you are letting me down. Here’s how I’m unsatisfied. I always come at it with like, Hey, I’m curious about this. Can we talk more about that? And then that’s number one, it puts the person you’re talking to much less on the defensive and keeps expectations low. Like you’re having kind of a very equal conversation with like very low stakes. So yeah. I don’t know, someone told me that once I’m like, Hey, there’s a lot of safety and confusion. I was like, Oh, okay. I like, I like that a lot or curiosity Dave Etler: [00:44:53] if this, if this fits into that, I mean, kind of what I was thinking of, and this is what I’ve been trying to sort of remind myself over and over and over again in recent years. When you have these interactions, if you come at them with love and respect, correct. That’s part of it. I think Aline Sandouk: [00:45:07] respect always love. I don’t know. Like, Dave Etler: [00:45:10] I mean, love in the sense of like, I’m, you know, I understand, I understand that things are different for you. Yeah. Yeah. They’re not the same as they are for me. Let’s talk about this. Yeah. There’s Eric Boeshart: [00:45:22] an understanding there, Dave Etler: [00:45:24] right? Yeah. I know some people are wor you know, when they’re having trouble worried about the confidentiality of seeking out mental health services from your medical. Cool. Hmm. That’s hard. Yeah. do it anyway. Yeah. Like, I Dave Etler: [00:45:36] mean, ask the question in your first meeting with a counselor. Well, how are you going to treat this information? What are you going to do with this information going to give you, even before you begin talking about your problems, they’re going to say, and you down in a, in a, in a discussion, they’re going to sit you down and say, so what brings you here today? And the very first thing, if you’re worried about this, the very first thing that can come out of your mouth isn’t well, I haven’t having all these problems, the very first thing that could come out of your mouth before you reveal all that. Is I’m afraid of any repercussions that might come from sitting down with you. and these are normal fears and they know it. So let the counselor address those fears in that first session. And remember that they do have a legal obligation for confidentiality, the same obligation that you have as a healthcare professional, by the way. Yeah, but make them work for your openness. That’s totally fair. Aline Sandouk: [00:46:25] Absolutely. And that’s, that’s good advice in life in general.  Dave Etler: [00:46:31] for it Aline Sandouk: [00:46:31] I thought you’re joking, but I’m like, yeah, hell yeah. You know, people, people should deserve to hear the details of your life. That that’s, that’s rich and that’s intimate and that’s. You know, that has a value. And sometimes people will hear these like very personal stories and be like, Oh, that sucks. And then what’s for lunch. And you’re like, I just opened my heart up to yeah. Miranda Schene: [00:46:54] Or like, that’s almost more devastating than them using it against you as being like, Oh, wow. That’s some really deep personal information. Yeah, exactly. Get some coffee, like, Aw, come on. Dave Etler: [00:47:08] One more thing about that piece of advice is, okay, so they’ve reassured you right. Feel free to say, okay, I’ll talk to you next week about this. Take yourself, take a minute to sort of internalize that information and process it. And then you can come back next week and then start the real work if that’s what you want. Miranda Schene: [00:47:26] It is a thousand percent okay. To be selfish when you’re asking for like personal help, when you’re asking for help, it is a thousand, because I think sometimes we have this. Thing of being like, well, I came to them, even though I’m being vulnerable, it’s still like, Oh, it’s their time. That is their job. They are there for you. You can be selfish that is allowed and is permissible and acceptable and great. Aline Sandouk: [00:47:47] Yeah. And can I add to that with one more thing? Nope. Nick Lind: [00:47:53] Dave Aline Sandouk: [00:47:53] forgot his place up in Miranda Schene: [00:48:01] I don’t need to, I’m just back here watching popcorn, Eric Boeshart: [00:48:04] try to assert myself. Aline Sandouk: [00:48:08] We’re still friends at school. it’s okay to put, you know, eggs in different baskets. So like feel free to shop around. And I it’s something I was thinking about is. A lot of med schools sometimes feel detached from like the main Institute, if they’re part of an institution with an undergrad and like other, like, you know, faculties, other schools. so like something I never thought of doing is like talking to the university counseling services. Yeah. They don’t talk to the med school counseling services. Yeah. So feel free to shop privately. That’s also very hard because a lot of psychiatrist, psychologist have full patient loads. They’re not taking on new patients, but like, yeah. But look for that chemistry, like Miranda was saying like, Take it with a grain of salt. Don’t immediately close the door on someone who gives you a you know, a not perfect vibe immediately, but you do need that chemistry. And if it’s not there, then you’re never really going to feel comfortable Miranda Schene: [00:48:54] opening up. Yeah. And it’s perfectly fine. Even if you’re a med student to seek help outside of the med school. Like if you, if obviously if you have the resources to but like that is also allowed, you don’t have to be restricted to Dave Etler: [00:49:07] which your insurance Miranda Schene: [00:49:07] cover that. mine would cover it, I believe through UHC. So I could go to like the like UHC psychologist, psychiatrist stuff. And I think it covers some, like, I think blue cross blue shield. There are a few therapists in the area that also, cause I’ve looked into this there are a few therapists in the area that would also take my insurance. So it’s possible. Aline Sandouk: [00:49:27] Yeah. I mean the point the Miranda is bringing up. Is that check your coverage? Yes, absolutely make sure. Miranda Schene: [00:49:35] Because some insurances will cover mental health care. Some only cover 50%. Some won’t cover it, but a lot will, and they might cover it, but only for specific providers that specific locations or for only certain types of things. Dave Etler: [00:49:50] Yeah. Should Eric Boeshart: [00:49:51] I just say something real quick? You know, speaking from personal experience, if you, in that kind of a situation as a med student, you know, obviously in our context as the short coat, but, you know, just make sure that you’re looking at resources that are available to you and it’s, it’s better to use the resources than not use them much. Like big said, act like you’re paying. Aline Sandouk: [00:50:10] Yeah, totally agree. Yep. Excellent. All right Eric Boeshart: [00:50:14] guys. Aline Sandouk: [00:50:14] Can I share one more thought? Absolutely. I was reading about Audrey Lorde recently who is she was a black lesbian activist from the seventies who I think had breast cancer, had a one-sided mastectomy. And like, I guess at that time it was like even more stigmatized to not have a double mastectomy or get an implant. And she was like, no, I’m not going to protect the world from my, you know, one missing boop. You have like really forced people to accept her as she is. And I really admired that. And I think something I was reading about her is that in a capitalist system, self care is almost subversive and that really resonates like taking care of yourself as revolutionary, the most. Right. So Miranda Schene: [00:50:57] treat, I agree. Like there’s a certain element to where you’re expected to have earned it. There’s, there’s a concept of like, if I work hard during the week that I’ve earned a day off or I’ve earned, like treating myself by going out, it’s like, you don’t have to, you could just do that if you need it. Like, if you’re like, I haven’t worked that hard, but I’ve, I really need a break. And it’s like, Dave Etler: [00:51:15] I see this to people all the time. Like people are like, Oh, it’s come up recently in the context of vaccinations. Like not necessarily the urn thing, but that. Oh, I can’t do that. I have something to do at work. geez. It’s not, you know, the thing at work is Dave Etler: [00:51:32] not that important, you know, let your coworkers to handle it. Aline Sandouk: [00:51:40] Your, your job, your boss would not die for you. Miranda Schene: [00:51:47] Yeah. Dave Etler: [00:51:48] Yeah. Well, I guess you have anything else you want to say before we close the show? It’s good to be Miranda Schene: [00:51:52] back. Aline Sandouk: [00:51:56] I am happy to have you Dave Etler: [00:51:57] here. That’s our show though. Got to go. I gotta go eat lunch. I’m Miranda Schene: [00:52:01] hungry. That’s fair. I think my Aline Sandouk: [00:52:02] boss, he acts like we don’t pay for him. Miranda Schene: [00:52:06] My gosh for us Miranda Schene: [00:52:12] a lot, the only things in your lives, how dare you have to eat lunch Aline Sandouk: [00:52:18] if it’ll make you a better, Dave. Okay. Dave Etler: [00:52:23] There’s so much work to be done Miranda Schene: [00:52:26] in case anyone is wondering, playing along at home. That’s called hypocrisy Dave Etler: [00:52:33] guys. Thank you for being on the show with me today. Thanks, Dave. Thanks. This is fun. And what kind of slug would I be if I didn’t? Thank you. Chef coats for making us a part of your week. If you’re new here and you like what you heard today, subscribe to our show. Wherever fine podcasts are, podcasts are available. Our editors are AJ Chowdhury and Erik Bozart or. Aline Sandouk: [00:52:50] Take your time. Sound it out. Miranda Schene: [00:52:55] It’s actually my favorite editor. I’m a very big fan of their work because there is our marketing Dave Etler: [00:53:00] coordinator. The show’s made possible by a generous donation by Carver college of medicine, student government, and ongoing support from the writing and humanities program. Our music is by Dr. Voxin canvas fear. I’m Dave, Etler saying don’t let the bastards get you down. Talk to you in one week. Bye.   365 Active Medical Student Dave Etler: [00:00:00] Welcome back to the short code podcast, a production of the university of Iowa Carver college of medicine. I’m Dave Etler. with me in the studio today it’s a man who was as cute as a bug’s ear. It’s MP3, Nicklin, a bug’s ear. How bug’s ear she flies beyond fates control. It’s MD/PhD student  Miranda scheme. I’d rather doubt an article than question what she delivers. It’s MD/PhD student Alene, sand Duke. Very fair. And joining me in the form of ones and zeros. It’s the jammy, just bit of jam  Eric. Bozart. Feeling Eric Boeshart: [00:01:11] pretty one today. Over the zero? Yeah. Nick Lind: [00:01:13] Okay. That’s good. One. we’re also live streaming on our Facebook group, the short code student lounge. Dave Etler: [00:01:20] So why not check us out there? You can see all the things I say that we edit out of the show. Um, say like a week earlier than we posted, if that’s what the, I mean, if you’re into that If you Aline Sandouk: [00:01:28] just can’t live without us. Dave Etler: [00:01:32] Well, it’s also nice. You can participate. So that’s know hipster Miranda Schene: [00:01:35] vibes, being able to, when all your friends are listening to podcasts, you’d be like, I already knew that. I know that I know the punchline to that joke. That’s Dave Etler: [00:01:42] right. I’m not even gonna make you sign up for a Patrion to do it, you know? Cause that’s all right. That’s how giving I am Miranda Schene: [00:01:48] also because he doesn’t know how to set up a patriotic, Dave Etler: [00:01:53] main reason that I bet you could figure it out someday. today’s show sponsored by panacea financial. The digital bank created for doctors by doctors. I’m really happy to have them back. So we’ll talk more about them later on the show as for today’s. Topic, you guys don’t even know. I didn’t even tell you about today’s topic. You know, why in the dark, you know why I didn’t tell you about today’s Miranda Schene: [00:02:17] topic? Has he we’ve known you too long for us to pull that wool over our eyes. Dave Etler: [00:02:25] There is a student I heard about recently who was running up against a few problems. the M one wall, ah, you guys all immediately were like, ah, Does the ring ring a bell for you? But tell me about the . Miranda Schene: [00:02:37] Well, I feel like, I mean, I don’t know the specific student’s exact problem, but for me, the on wall was sort of when I realized, Oh no, I’m in trouble here. And this is a new experience it’s for me Dave Etler: [00:02:50] in trouble in terms Miranda Schene: [00:02:52] of in trouble in terms of like academics and the fact that. Like for a lot of people coming into my, and this again was my experience. I quite good academically I don’t mean to brag to anybody here. I’m quite good. humble, humble brag. Yeah, that wasn’t really humble though. That was just a straight up brag. I appreciate it though. but then once you hit a certain amount of med school and the pace has picked up, and you’re now into territory that you have never seen before and suddenly this feeling of, Oh, this. Like I am struggling and I haven’t in my previous academic career had this type of struggle before, so I’m both struggling and I don’t really know how to deal with it. Yeah. Dave Etler: [00:03:29] What, what about y’all’s M M one wall. Was there something for you guys? Aline Sandouk: [00:03:34] White coat imposter syndrome started at the white Aline Sandouk: [00:03:46] Yeah, no, I think yeah, I, of course I know the wall. Everyone knows the wall who doesn’t know the wall. I did notice everyone hits it at different points, I think. And that’s an interesting observation. The first one. And sometimes the second, some people don’t hit the wall until the second semester, but yeah, it really dawns on you that you’re in a whole new world and these are whole new stakes. and yeah, I don’t know. Miranda Schene: [00:04:09] Do we hit the wall? I students MSTP any Haiti’s town fans in our listenership are going nuts right now. Okay. Nick Lind: [00:04:17] Yeah. You know, it’s I think it’s because it’s such a new experience to any of us. Cause you know, The amount of material that you go through during that, for, during all of med school, to be honest, but especially that first semester I mean, you’re basically covering everything and that foundations class that you covered. And all of your preparation for medical school. And, and so you just covered it all and you know, one semester and half a semester and half a semester, and you even expounded on some topics that you didn’t even. No. Anything about Aline Sandouk: [00:04:54] all the extra credit stuff from undergrad is now core material. Like all of the stuff that you thought you were going to do for like, you know, brownie points to like suck up to the teacher. Like, no, you have to know all of that too. So yeah. Eric, what Eric Boeshart: [00:05:07] about you? Yeah, yeah. I, a hundred percent agree. It’s. I think kind of what Nick was saying where it’s like, so I did, I did a master’s program before coming here. It was just kind of like a, one-year kind of doing some more of the hard science type stuff. Cause my background’s in engineering. And so you, you know, I went through that master’s program. You’d take things like, you know, I did an anatomy course. I did, you know, some pretty in depth Physiology stuff. And then you come into med school and like, you cover that within the first two weeks. And you’re just like, okay, so that’s an entire master’s degree. So Dave Etler: [00:05:42] expedited. Yeah. I think there’s also for this student. It was all that. Yeah. And then I also think that they were concerned. They’re concerned about the hidden curriculum that they started to notice. Yes, this is so the hidden curriculum. If you’re not, if you don’t know what that is, I guess I would call it the, the part, Dave Etler: [00:06:03] the thing that isn’t actually part of the curriculum, but that you’re learning anyway. Like how to be like how to be a doctor. Sure. Like what it means to be a doctor in terms of things like professionalism. Yeah. Aline Sandouk: [00:06:17] Yeah. It’s it’s office politics for, for anyone who’s ever worked in an office, right? Like don’t use Linda’s mug. You never use Linda’s mom. She’ll lose her mind. But Dave Etler: [00:06:29] it’s uh, you know, things like, you know, how to, how to act like a doctor. Yeah. How to project that image. What is that image? Nick Lind: [00:06:38] I think that really picks up once you hit clinical clerkships, like in you, you know, you’re working with these people and you’re, you know, within the first day of working with them, you’re trying to figure out how they tick. Because like, you know, if you kind of do the wrong thing, you’re going to get called out pretty quickly. Depending on who the person Aline Sandouk: [00:06:58] is, figuring out where their sharp edges are and then how to stay away from them. Miranda Schene: [00:07:04] A lot of times when we talk about the hidden curriculum, we talk about it as well, in terms of like relating to patients in a way that isn’t, you’re my friend, I’m having a conversation, been in a way that is you are the patient, and I need to figure out what’s wrong with you. And that, that goes through things like anatomy lab, where you’re, you may be doing a cadaver dissection for the first time and having to deal with that, like emotionally, as well as learning all the material. Yeah. And then actually figuring out how to break a patient story down into constituent components, which you are then graded on. Yeah. Dave Etler: [00:07:33] Yeah. But I think it’s also about how to look like a doctor, you know, and, That there are problems with this because not everybody looks the same way. Yeah. That’s Aline Sandouk: [00:07:44] an interesting conversation. I think Danny had by a lot of people in healthcare right now, Miranda Schene: [00:07:49] like th this is the problem with the hidden curriculum is that it’s hidden. It’s never anything. I don’t think it’s ever been something that’s been intentionally taught. It’s just sort of generally accepted that odd. This is also things that people develop through their medical surgical time, Dave Etler: [00:08:01] sort of like the culture. It’s learning the culture of medicine, which means Miranda Schene: [00:08:06] it’s, which isn’t only influenced by things like unconscious bias. Right. Dave Etler: [00:08:10] Insanely it isn’t always great. The culture of medicine, you know, there, there is no culture that is always great. and medicine has its difficulties to, you know, basically, you know, how do, how do. You know, what are the aspects of the culture of medicine that I’m talking about? Like hard work all the time. grades is the most important thing. Yeah. Aline Sandouk: [00:08:29] looks do matter though. I don’t know if that’s Dave Etler: [00:08:31] where you’re, it’s not that they don’t matter. it’s just that they are perhaps matter more than they need. Aline Sandouk: [00:08:39] Oh, I did say they mattered. I don’t know if you misheard me. Oh, okay. Yes, Dave Etler: [00:08:42] but maybe I  it up. Is that because Aline Sandouk: [00:08:47] you said a bad Dave Etler: [00:08:49] part of the hidden curriculum don’t, don’t swear on the podcast. Miranda Schene: [00:08:57] Don’t swear in front of children. I mean, in front of patients Dave Etler: [00:09:02] repel against that, Aline Sandouk: [00:09:03] you know, I remember something in my first year with Ellen Franklin, it was like a small group and someone was like, Dave Etler: [00:09:10] Oh yeah, Are I guess they would, they used to call it the performance-based assessment. Aline Sandouk: [00:09:14] Yeah. She’s like the clinical skills assessment director for folks not at SeaComm, but I was in a small group and she was like, people were asking, you know, w what are the expectations for like, how we should look, how we should dress? Should it be like interview day? Which, you know, interviews, people are wearing full suits a little much. And she was like, well, you know, as long as you look clean and you’ve run a brush through your hair. And I thought that that was such like reasonable advice. And then I. Like I grew up a little and I realized that like I was, some people don’t consider like certain types of ethnic hair, clean looking. Right. So some people don’t consider certain. Looks or certain ways of dressing as like clean Dave Etler: [00:09:52] cut. Yeah. So like when, when somebody says run a brush through your hair, what does that really mean? I think that’s part of the hidden whose hair, right? That’s part of the hidden curriculum. I mean, there’s all kinds of problems with this hidden curriculum. precisely because it is, it is hidden. I think Aline Sandouk: [00:10:07] it’s changing for the better though. And people are talking about it. People are talking about talking about it, and I think patients are the. The demographics of patients is changing too, because I think historically doctors acted in such a way that was help patients expect, like patients expected to come to the doctor and maybe I’m wrong. I’m I don’t mean to generalize, not a hundred percent, but I think patients came to the doctor expecting to be told what was going to happen and what they should do. And they liked it that way. And then, you know, the next generation came along and was like, no, I want to be. Partners in care with you. I don’t want to be your employee in my care. And I think that’s where the older guard of medicine is like, what is this? No, no, no. I tell you what to do, but like now we’re coming up and like we’re a little bit more, I guess, like culturally congruent with that. Right. So Dave Etler: [00:10:56] there’s more to the hidden curriculum than we haven’t yet discussed. For instance, There is a S this, this particular student had observed the social currency that circulates around things like how much you study, how well you score on tests you know striving to get honors grades, as opposed to striving, to pass your course and striving to learn. Right. Which is an important distinction. Nick Lind: [00:11:20] Yeah, no, Dave Etler: [00:11:21] that’s very true. So F so for instance, like one of the things this person noticed was you know, professors will let you know, after the exam, what the average was. On the exam. and I’m not a professional, I’m not, I don’t, I’m certainly not an expert on educational theory. but I think to some extent it’s sort of a defensive maneuver by the professor who needs to prove to the population of medical students, that it was a successful exam. Yeah. Yup. that it was valid in some way. but what this student found is that those averages were a source of pressure. did I perform to the average and the message there being that your only value. Is the grade that you get. and by the way, push back at me, if you think, if you think I’m full of shit and anything Miranda Schene: [00:12:01] that I say, can I say very quickly? I actually still remember the first time I scored below the class average on an exam, because like the first like foundations in the first MD/PhD I was still like pretty doing okay. And then it hit like the spring semester and I was like, Oh crap. And I still remember it. The best thing I ever did was I found. Friend. And my friends were not in these lights. You must get honors or you will die type people. They were the chill people. And like, we both had a conversation and she was like, Oh yeah. I also scored below the average. And it was like, and we pointed out to each other that like 50% of the class got below the average. And we’re not a bad student for coming below the average. There can be a Dave Etler: [00:12:41] challenge to find that, that, friend. Yeah, Aline Sandouk: [00:12:44] it, it requires a little bit of vulnerability and it’s game. Like vulnerability, chicken, and you’re like, Oh, and then they give a little, and then you give a little, and then you get to the truth. Cause it’s, it’s hard. Like that’s not information you can just come out with and be like, I done failed that test. And then if no one was soliciting that information or if no one is comfortable sharing that, you know, you’re now in this weird vulnerability black hole. But yeah, those are real. I could not agree more. I love those moments in med school and just like in life, in general, when you’re like. Yeah, that was hard. And the other person’s like, yes, yes. That was hard and hard guys. And you both know exactly what you’re talking about. Nick Lind: [00:13:22] Yeah. I was just going to say, you know, you take a bunch of people who score in the top 10% You know, all through their lives and you put them in a room together and give them the same test. They, they still distribute into a bell-curve where you still have people at the bottom and you have people at the top and you have almost everybody else in the middle. and that’s that’s med school. I mean that that’s everything in life. And it it’s difficult to come because you’re used to being in that top 10% or higher. And it’s difficult to come to the fact that, Hey, maybe I’m average or maybe. I’m below average because you know, that exists too. And uh, Dave Etler: [00:13:57] I feel comfortable being below it I’m above average, in some Miranda Schene: [00:14:05] ways you’re in the you’re in the first core tile in our hearts, in the Eric Boeshart: [00:14:11] box and whisker plot, Dave Etler: [00:14:14] the error bars are just very large. Um,  Eric Boeshart: [00:14:17] I felt like, you know, we’re talking about averages and stuff. I would even go a step further to say, like, I feel like it. In my experience  we didn’t hit that point where I think a majority of people were able to say, like, be open about like, Hey, I didn’t do well on that test. Like, we didn’t hit that until probably this semester before clinicals. Dave Etler: [00:14:36] Interesting, Eric Boeshart: [00:14:36] where it’s just like, you know, I feel like most people were open about that. Dave Etler: [00:14:40] Does that ring true to you guys? Or did that happen earlier? Do you think. I, it kinda, it Miranda Schene: [00:14:46] kinda depends. Like I, I do remember in one of our learning communities, we would almost always have like group D not official group D brief, but informal group debrief, or it all just like come collapsed on the couches and be like, well, that sucked. And that just sort of like opened the floor to be, and it wasn’t necessarily like I scored this or I scored this. It was never, no one asked about grades, but it was just like that. Was rough. And that gives you exactly. That gives you like no information about how that it, maybe it was rough, but they still got like a hundred percent. You don’t know, but either way it’s still like commiserating about that was really hard. And that was tough. And now, wow. I did not even think that was going to be on there, but Oh, I guess this person really loves stomach ulcers. I just got more flashbacks. I think. Nick Lind: [00:15:29] I agree. I think the class is pretty good, even from early on. Like if you. Did poorly, there was at least for me, like I had a group of people I could easily go talk to. They were pretty open with like, Oh yeah. Like that was, that was rough. And I think that was really common. I think I Dave Etler: [00:15:47] should say, I should have said before, you know, and like, I’m getting, you know, when I, when I say I heard about the student, I’ve heard about them secondhand,, if the student happens to, you know, hear this, I want to say that I’m not like, yeah, I want to say that. I, well, I just want to say that this is, you know, th that, this is important to talk about this particular. Student, apparently had tried discussing with other students and felt some resistance to that vulnerability. And I was intrigued when you, Eric said that it took until just before going out into clinicals to open up you, it kind of makes sense Eric Boeshart: [00:16:21] to come into my own realization of getting a pulse on where the. we were You know, like I agree with Nick, like I did have a group of people that, you know, you could, I could go to and be like, Hey, I, you know, I’ve got a general pulse on my group, but I didn’t realize that that spread out farther to the class until probably before clinics. Miranda Schene: [00:16:40] And, and this unfortunately is, and I know we’re all sick of talking about how COVID has impacted medical education, but that’s a big problem where it’s like, it’s become essentially, like I’ve only now been seeing sort of like students back in the communities. And even then I imagine socialization is relatively down. so it’s hard to get that pulse on where your classes at it’s hard to get that collected. Like. Woof kind of moment where everyone sort of collects and shares and is a bit, and sort of debrief with each other. Dave Etler: [00:17:07] Cause even if exams were in person, you’d sort of run away from each other and go there. Miranda Schene: [00:17:11] So like we were just talking, I sat down and I instinctively picked the farthest chair away in the corner just because that’s how like, all right, six feet where it, we got to be distanced kind of thing. Dave Etler: [00:17:21] I Miranda Schene: [00:17:22] I’m sorry. I just want to run away from me, Dave. We’re actually trying to get away from you. Aline Sandouk: [00:17:26] Miranda’s Miranda Schene: [00:17:26] just being nice. I’m leaning back as that goes on, just getting as much bullying. He’s going to get Aline Sandouk: [00:17:39] some really bad mental health problems. If you don’t let them know, we’re joking. Once Miranda Schene: [00:17:43] in a while, I haven’t been on the podcast in so long. I forgot how much of it is just managing Aline Sandouk: [00:17:48] Dave’s emotions. Dave Etler: [00:17:53] I guess the upshot from what I understood is, and I think I’m paraphrasing here. So I hope I get it right. They felt kind of unprotected. and they’re, you know, they they’re sort of mental health was feeling precarious because of all this and, and, but they were afraid to seek help. Sure about it. in the form of, in the form of, you know, things like counseling yeah. Aline Sandouk: [00:18:16] In their defense around some people they should be afraid. No, that’s not to say, Miranda Schene: [00:18:22] hang Dave Etler: [00:18:22] on, hang on.  Aline Sandouk: [00:18:25] that’s all to say that like, Be extremely careful who you share that information with because it’s a 50, 50 chance that you’re sharing that with someone who’s going to go, Hey, I’m really sorry to hear that. Let me help you. And then the other 50% are going to go, all right, great information to have in my pocket. And I’m not joking about that. That’s something to be very mindful of, but like before you go spilling all your beans, like. Throw a crumb out there and see how they react and, you know, before you start really opening up. So Dave Etler: [00:18:57] I would argue that, I mean, I mean, first of all, th this hesitation brings up two questions for me personally. should the institution protect you? is there any value, I mean, yes, to some extent the institution should protect you, but is there any, any value long-term in being unprotected? So that’s question number one. Aline Sandouk: [00:19:15] What type of protection? Dave Etler: [00:19:17] I mean, I don’t know, like you know, because I, because I wasn’t able to ask follow up questions. Miranda Schene: [00:19:21] I’m sorry, but may I throw out a metaphor before I forget? Yes, I believe yes and no. The difference between like chucking someone in the deep end and then checking someone in the deep end, followed by chucking them a life ring. You know, where it’s like Dave Etler: [00:19:37] chucking them in the deep end and then throwing some chum Miranda Schene: [00:19:41] because I exactly like, I think there is definitely value in having to sort of like, In being vulnerable and being able to like getting that challenge and having to sort of climb out. But like, there should be a ladder where it’s like, if you’re like, okay, I have tried and I cannot, I’ve re I’m mixing my metaphors, but I have tried and I cannot climb out of this hole. It’s like, okay. Deploy the emergency ladder. Cause like to meet you halfway. Yeah. Aline Sandouk: [00:20:06] Adversity is character building. Right. And I’ll never forget this. This, I don’t know where I heard this, but I remember reading somewhere that like trees need when to grow. Otherwise they die. Like that’s so profound. Like they need the push of wind to kind of push the sapling down to motivate it, to grow big and strong. Like, Dave Etler: [00:20:24] but they don’t need a daily hurricane Aline Sandouk: [00:20:28] mercy. It doesn’t work if it’s like lethal. Right. It has to be up to a point where like, kind of like Miranda is saying that someone will step in and be like, okay, Hey, you strolled enough. Well, let’s bring you in and then we can talk some more. And I think Nick Lind: [00:20:43] what’s that Miranda Yeah.  Yeah. You know, I Nick Lind: [00:21:08] think in pre-clinicals too, it’s important to kind of have some of those situations where you’re struggling and, and kind of pushing your limits because once you get to the clinical side of things, You’re you’re much more independent. You have to like, not only balance the academic side, because you’re going to have an exam at the end on everything that you need to know for that clerkship, but you also have to be learning all of the practical hands-on things for that clerkship at the same time. And you’re going to be pushed even harder than you were in pre-clinicals. because there’s, there’s just a ton that you need to know. And if you’re not setting yourself up, you know, from, from the beginning, it’s going to be even more difficult. So I think the institution does need to push you. I do think that there needs to be safety nets, and I think that there are here you know, you’re going to get that email orcall or whatever from the counseling center about, you know, are you okay? Like What can we do to help you academically and, and you know, which Miranda Schene: [00:22:07] I think sometimes it might hurt more than it helps or it’s like, I think I’m doing okay. right. Aline Sandouk: [00:22:17] But I’m sorry, Dave, did you want to ask a Miranda Schene: [00:22:19] follow up questions? Right? Do you want to play on your phone? I’m trying Dave Etler: [00:22:22] to just make sure that Aline Sandouk: [00:22:30] The question was, Dave Etler: [00:22:31] I have no idea if the live stream worked or not I’ve know, seems to be working, but then it says you were Aline Sandouk: [00:22:37] well, we’re having fun. That’s all that matters.  Miranda Schene: [00:22:40] Voice cracked. I guess the other thing, Dave Etler: [00:22:48] the other question that it brings up to me is why are people still afraid of seeking help? Aline Sandouk: [00:22:52] Because people are still making other people feel bad. That’s why there are still those, sorry. Blood heads out there that are like, look at this loser. Pardon my French. No, no, no. Dave Etler: [00:23:04] There’s that there is that. I think there’s that risk. Nick Lind: [00:23:06] I think, you know, another aspect of it is our society, our culture, our, the way that we, especially as medical students, the way that. We’re raised. We, we often didn’t need help, you know, from Trump high school on the college, you know, some of us who might’ve had a career before med school you know Nick Lind: [00:23:27] we were able to do it. Well, without the help. And then you get here and it’s, it’s, you know, the heart of one of the harder things I’ve ever done, you know here in med school. Nick Lind: [00:23:36] And I think, you know, when you start hitting your limits you may be, have done that before, but not quite as often and is like, It doesn’t stop here and Nick Lind: [00:23:48] makes it back. Yeah. Yeah. That’s hard for, I think someone to really grasp ahold of and understand and understand when they need help, because they never needed help before. Dave Etler: [00:23:58] I think the thing though, is that school spend a lot of money and effort putting in place these efforts. and they really want you to use them, you know, like the counseling center, the You know, the tutoring groups, the you know, what, what are some other ones? The the, the mechanism to get accommodation? Yeah, I Miranda Schene: [00:24:19] think sometimes those accommodations are often framed as like. Oh, well, if you, and I don’t think that this is a bad thing, but it’s like, Oh, if you start like dropping back and failing, then you have to come to us and admit, Oh, I’m a failure. And I need cause which is not true at all. It’s just, those are things that happen sometimes. And occasionally you require it. Agreed Dave Etler: [00:24:41] agreed. Eric Boeshart: [00:24:41] But I can kind of speak to that too, if we want to talk about that. Cause I’m, you know, I think on top of that, you know, there there’s the general failures of, okay. You know, maybe you’re not studying correctly. Maybe, you know, maybe you’re not using all the tools available, but then there’s things that like life happens. And I know Nick had talked about, you know, before the podcast we were talking about. you know, sometimes people start families, you know, life kind of happens around med school. Well, I had an accident in the middle of first semester, second year, and now I’m kind of taking a step out. So, I mean, you kind of hit a point where, you know, I. For me, it was a concussion. And so I, you know, all of a sudden school becomes a lot harder and I, you know, there, it was a combination of my injury, but also a combination of, you know having to admit that I need to use the resources that are available. And, you know, I think that now. That’s kind of been put into perspective, but I think that, you know, there, you’re taking a group of people that haven’t had to use these resources and you’re like, you know, expecting them to just jump in. And I, I, you know, I just don’t Aline Sandouk: [00:25:52] too. And not Miranda Schene: [00:25:53] to mention, you’re also taking a group of people that have more or less defined themselves on not needing help before, where it’s like, like when you are the best student of the class, you don’t need a tutor. You don’t need additional support. That’s Dave Etler: [00:26:04] why I want to talk about this because. I think that needs to go away. Yeah, I agree. I think that that needs to go away. And I think that, you know, if, if, if this conversation was successful in any way, it would be that, you know, say a pre-med out there who is struggling. Really got the message that if you need help, go get it and don’t give a shit what anybody else thinks about you. because one of the things I think you guys know. And that I’ve noticed about medical education. Is this hot take, are you ready? React to this statement? Okay. There is no such thing as a passive and successful medical student.  Eric Boeshart: [00:26:44] Yeah, I wouldn’t, I mean, at the same rate, Dave Etler: [00:26:49] Okay. There is no such thing as a passive and successful medical student. And we’re going to delve into Miranda Schene: [00:26:54] that because I need like three things to find. Define success. Number one, define passive number two. Yes. I Nick Lind: [00:27:02] never find medical students. Dave Etler: [00:27:08] well, we’re going to delve into that. After this message from our sponsor, which is panacea financial, a company founded by two doctors that were frustrated as medical trainees, that banks didn’t seem to understand the unique needs of those in the medical field. So they weren’t passive. They built a company just for medical students and doctors. Excellent segue Dave Etler: [00:27:27] like that. with nationwide digital banking, panacea financial provides medical students with free checking. That includes no ATM fees, nationwide high yield savings accounts, a free personal banker around the clock customer supports. And with loans designed with you in mind? no one should borrow more than they need, but with panacea financial fourth year medical students can get money as needed in as little as 24 hours with their PRN personal. No, it has an interest rate half of that, of a year, a usual credit card and no co-signer requirement and it’s fully. Digital application. So instead of running up credit card debt, try their PRN personal loan that is designed to give you a better way to cover expenses, such as residency applications and relocation on board exams. Some customers actually use it to pay off toxic credit card debt. In addition, medical students can have a period of no or reduced payments on their PRN personal loan. Join the growing number of medical students and physicians nationwide that expect more from their bank. Go to panacea financial.com to open your free account. Panacea financial is a division of premise. Member FDI C thank you, Pam financial. It’s nice of you to help, help us out. Nice of you to help med students out. Very cool.   by successful, let’s start there. I mean, wringing, everything you can out of medical education. Sure. Oh, well, yeah. Okay. Not getting honors or getting into ortho or getting into ortho. That’s not what I mean. I mean, if that’s your goal, that’s fine. That’s fine. Be successful in that. Yeah. Yeah. Miranda Schene: [00:28:56] So I was going to say, I can think of multiple medical students that have been what I would call passive, and who’ve gotten like straight honors and higher grades and everything, Dave Etler: [00:29:05] you know what? Okay. So then we’ve got to get to pass it, right? passive, I mean, a passive consumer of what medical school has to offer. So you sit there and you Hoover up knowledge and then you spit it back out. That is what I think of as a passive medical student. All right. Nick Lind: [00:29:21] Go. You know what, one thing I wanted to mention after you you kind of define things there. One of my peers, I had asked about a rotation one time and he said, Hey, it’ll be great. Dave Etler: [00:29:33] If you Nick Lind: [00:29:34] treat it, like you paid for it. And I was, which, you know, I Nick Lind: [00:29:39] did good and I should really treat this rotation. Like I paid for it. And, you know it’s a way I’ve kind of been trying to handle the rest of my clinical clerkships. Like I’m going to treat this, like I paid for it. Like, I’m going to go in and I’m going to ask to do the cool things. And I’m going to try to like, do the things that I want to do and learn the things that I want to learn. And you know, it, it’s kind of been fun. Did Dave Etler: [00:30:04] that change anything for you or did it just give you a new perspective on what you were doing? It Nick Lind: [00:30:09] gave me a new perspective, but I think it did change, you know, cause some clerkships you have the opportunity to kind of pick and choose a little more of what you want to do. like, like say like emergency medicine that’s a good one because you get to sign up for patients and you kind of get to pick what you know, who you want to see. And, you know, if you want to go to that trauma, that’s on the other team that you’re not assigned to, you can go to that trauma and yeah. You know, it, it’s a good way to, to look at a clerkship and, and kind of. You know, there are things that you’re going to be asked to do no matter what. but there might be some options where you get to go in and, you know, even just ask like when I was on OB GYN, I you know, was in a room and there was an attending that was going to work independently in another room. And I said, Hey, can I go work with that attending? it was in the, or, and he didn’t have any residents, no fellows. So it was just me and him. And I got to do way more, but I bet you had a Dave Etler: [00:31:03] great experience. Yeah, yeah. Yeah. Miranda Schene: [00:31:06] One thing I’ll say is that when you are sort of more like assertive and asking people, you will be surprised when people will say yes to where it’s like, there’s a lot of things where like, I’ve had people express to me, like, man, I wish I could do this. And then they are. You know, people are like, okay, well, why don’t you do that? And they’re like, Oh, good point. And then it’s I never thought of it that way. Oh, I didn’t. Yeah. Cause there’s sort of this assumption. It’s like the it’s like that one picture of a horse that’s like tied to a kid’s deck chair where it’s like your limits are. Yes. So I th it’s one of those things where I think sometimes people are passive because they don’t know they have an option. It’s like, you can just like ask for things that you want. I think Dave Etler: [00:31:49] also, I mean, that’s, that’s amazing insight and I think that’s something that That is directly applicable to the clinical part of your education. And I think it’s also directly, I can see how it’s directly applicable to an MD/PhD education because those two things, while there are. You know, set things that you need to do. And you’ll be asked to do things specifically. There’s also an element at some point of self-determination it’s a little harder to see that in the preclinical curriculum, because you can’t just go up to the course director, who’s put together this, you know, this Mo you know, semester long course and say, yeah, but I want to look at them. Yeah. but there are things that you can do. During the preclinical phase to sort of. You know, be more active. I mean, good. I think the best students that I’ve seen you know, they, they organize that vacuuming up of knowledge, right? They organize the actual process of consuming it. They organize the organization of the actual prop, you know, process of consuming it. Do they do this? Organize the organization? Miranda Schene: [00:32:57] Not only do they organize, but they organized their organizer. Yeah, it’s a little obsessive, but Dave Etler: [00:33:02] I, you know, and I hope that part of that process is realizing that no plan survives the first engagement with the enemy. So sometimes you have to, you know be willing to rejigger your plan, but they seek solutions to problems rather than just waiting for them, waiting for those solutions to, to arrive. And I think that’s important. They also participate to the extent that they can. And I don’t want to say that you, you know, I don’t want to say that. You absolutely must join every student organization and you absolutely must become a leader of those student organizations and things like that. That’s gravy. but they’re the, I think the people who my guess is that the people who get the most out of medical education actively participate in it beyond just going to class. Absolutely. Aline Sandouk: [00:33:49] I think to add to that, I think the people who get the most out of it are the people who are making decisions based on their values and what really matters to them, not what they should do, but what they’re excited to do. Dave Etler: [00:34:01] Yeah. And I think this feeds into something that I often say when any, whenever anybody gives me the chance, which is defining your own metric, Aline Sandouk: [00:34:08] Totally. Yeah. What does success look like to you? What are the issues that are important to you? Nick Lind: [00:34:13] And I think that’s going to change after, you know, your first few months of medical school. Yeah, exactly. Because you might think that, Oh, I’m going to be the top of the class and I’m going to. And somebody is going to be, and they might be able to meet that. But most of the class will not Miranda Schene: [00:34:30] fun fact. There’s only one person that could be the top of the class. So if you’re Aline Sandouk: [00:34:37] number one, Miranda Schene: [00:34:38] they are can be old. Late Dave Etler: [00:34:39] one. Yeah. The, the student I was talking about earlier with not being passive, right. They’re examining the world around them. Yeah. Which is. Important. they were noting its shortcomings. they reached out to other students, they made themselves vulnerable and I am all for this as you know Aline Sandouk: [00:34:56] You, you, you do have to try, like, you have to put yourself out there a little bit to find out, you know, what your environment is like, right. You are a little bit in the dark until something really big happens. And then you’re like, Oh, I need to find out the landscape of the place that I’m in. And it sounds like this person is really in tune with how they’re feeling like they’re aware of what they need and what they’re looking for and are aware of the fact like, Oh, I’m not getting it here now. I’m going to go somewhere else. Yeah. I think I’m curious to hear more of like, what Eric’s experience is like. Cause I think I cut you off, but you were, you were kind of getting to the part of talking about how you slayed this dragon of passivity, I think. Eric Boeshart: [00:35:35] Oh yeah. Well I think that, and it sounds like I agreed. That this person sounds like they’re kind of reprioritizing is what, needs to happen. And I think that I, you know, in my own kind of personal, you know, what’s in the last six months, that’s kind of what’s happening me. And it’s a lot of, it took me a concussion, some academic MCAT failures to realize, you know, that. I was, I was passively taking in information, you know, and then all of a sudden you’re like, you have this kind of come to Jesus moment of, I need this information to help people, you know, like that’s what I’m here to do. That was my ultimate goal. And so I think that. It sounds like this student is kind of in a similar situation where it’s like, okay, what is your definition of success? And for me, my success death’s definition has changed. And, you have to take the steps to find the help that you need, And I think that kind of like what we were talking about earlier that I think that the, you know, there’s adversity, but. I agree with the idea that the institution needs to be able to throw out these, you know, life rafts or the, you know, and they are available. It just, it sucks that we, as a student mindset are like, nah, I, I don’t want to use it. Miranda Schene: [00:36:54] I don’t need your boring life. I’d love to Dave Etler: [00:36:57] tease, you know, this, this sort of reminds me of a conversation I recently had with my mom. you know, they’re getting older, they need a little bit more help. And I was trying to suggest some things and my mother said, Oh, we’re not that kind of people. Yep. And the two things, things about that, I’m like ma. You are now. Okay. And number two, I’m that kind of person? What do you, what, what kind of person are you talking about? Miranda Schene: [00:37:26] It’s actually kind of reminds me of, I went to a movie screening last night outdoors. it was out by the river is Dave Etler: [00:37:34] really pretty good. I get to stop like, like putting asterisks after the things we do, like Miranda Schene: [00:37:41] six feet away, Dave Etler: [00:37:42] Jeff really was wearing a bow and I was outside. And I was bathed Nick Lind: [00:37:47] in hands. I Dave Etler: [00:37:48] was wrapped in plastic. Miranda Schene: [00:37:54] You’re fine. well I was at this movie screening and at the end of it one of the guys said something where it’s like the world needs people who are willing to reinvent themselves. That’s a paraphrase. but that was one, I mean, the documentary as a whole was a tad pretentious, but it’s okay. I liked it. but that was one of the things that sort of stuck with me where it’s like, you know, that’s, people will get stuck in this thing of like, no, this is just the person I am. And all you have to do is be like, well, why, why are you that way? And then just, if you can’t come up with a good reason, then. Be willing to change that. Like you are not defined in a single Aline Sandouk: [00:38:28] aspect. Yeah.  I saw a quote somewhere recently on the internet. I can’t remember where, but it would have been a Brene. Brown quote, I’m not sure. She she’s like a big vulnerability researcher. but the quote was something like a lot of people. and in this case, as I think they were talking about like relatives, Choose to see you as the version, they had the most power over and they refused to recognize your personal growth, you know, into a person they can’t control. And they get really annoyed around that. And I haven’t been able to forget it cause I. I mean, I’ve never articulated it that way, but I have personally experienced that and to piggyback off what Miranda is saying, don’t just be afraid to change who you are and reinvent yourself and kind of move the goalposts round, but also get away from people who don’t let you change. Yes. Get away from the people who were like, no, get back in this box that I put you in. I don’t like how you’re trying to squeeze out of my control and that’s okay. Like I think as people get older and this is harder to see, I think when you’re under 25, but when you get to be like, I think in your thirties and forties, you realize that like, Friendships come and go. Like, just because someone’s your best friend now, and they’re not going to be your best friend forever, but maybe you step away and then you come back to them in a few years. Like when your life priorities realign, you know, and things like that. So everything changes. So feel free to change with it.  Oh, wow. Dave Etler: [00:39:55] I was thinking back to To my childhood. Aline Sandouk: [00:39:57] You had to read it to me moment where I Miranda Schene: [00:40:00] farmhouse.  Nick Lind: [00:40:18] You know, I think for the first-year medical student, who’s struggling academically. you know, I would encourage them to keep at it because this information is all coming back again. Like I, I just took step two yesterday. and you know, like, step one, step two, like all these things that you learn, they just keep coming back. So if you’re not getting it now, you’re not going to get it. Then you put the time in to truly understand, you know, where, where you’re missing it. And so you know, if you have that test that you either failed or did poorly on, or didn’t quite do where you wanted, you know, score where you wanted to be. You, you kind of have to keep at that material. Dave Etler: [00:40:58] It’s not so important. I think what you’re saying is it’s not so important that you got a bad grade. Yes. What’s important. Is that you, you use that information to inform what you did next. Yes. Aline Sandouk: [00:41:12] Yes. And also like, look at the information said, okay, what of this really matters to my future? I’ll never forget this. There’s a doctor who used to work at student health. And I remember I went to her as my doctor and. Because I was a med student, he came up and she was like, Elaine, let me tell you when I was in med school, you know, sh she’s an OB now. And she was like, when I was in a med school, I didn’t learn the foot, not a big deal. I didn’t learn about the spleen, not a big deal. I became an OB. So ovaries became critically important for me. So try to look at it that way you don’t have, like, they’re only the only two specialties in medicine where you really do need to know everything is family med and emergency med and everything else. You’re going to lose, like not lose, but like six. You’re going Dave Etler: [00:41:53] to step away from it a little bit Aline Sandouk: [00:41:56] away and make room for really in-depth knowledge for the stuff that’s really important for the people you see. So, yep. Dave Etler: [00:42:03] There is one thing I wanted to say, you know, schools are going to be proactive by offering things like mental health support system or services tutoring. A structure for mentoring, learning, our learning communities are important. but it’s up to you to seek those things out. Again, we’re getting back to that active student.  I’m going to punch you for gesturing  with me. , Miranda Schene: [00:42:26] I swear to God that one was actually unintentional. That was early. Empathizing. I was, cause I was like, I was like, all right, get in. Dave’s head. What is he saying? Dave Etler: [00:42:39] Or like firing. But the point is like, we, you know, the schools go to a lot of trouble to do this and you have to be willing to sort of take advantage of them. I mean, yes, your school may reach out to you and say, Oh, I see you got a bad grade on this test. Let us know if you need any help. Sorry, Miranda Schene: [00:42:58] that just made me think of like, you’re paying for it. Aline Sandouk: [00:43:00] I was about to say I’m a little pissed Miranda Schene: [00:43:03] off.  Aline Sandouk: [00:43:05] such a great call back, but I was thinking, I was like, you’re paying like Doreen go use Doreen, you know, any of the other people, but yeah, you’re Miranda Schene: [00:43:14] ups. You want to put Dorian into context? Dave Etler: [00:43:16] Cause I feel like that’s the head. Yeah, Miranda Schene: [00:43:20] I can just imagine some poor like med student, like Chicago and it’d be like Yeah. I mean, the Aline Sandouk: [00:43:39] Doreen. Miranda Schene: [00:43:40] Yeah, I know that, you know, like you have to be willing to say in those cases,  Dave Etler: [00:43:44] what other people think I’m afraid. I’m afraid of what the Dean or my peers will think, Dave Etler: [00:43:49] who the heck cares, what they think you have a right to seek resolution to your part. Aline Sandouk: [00:43:53] And you know what, for anyone who cause something, I think Eric brought up that was so perfectly articulated is that you’re really kind of expected to, just to jump right into being vulnerable. Whereas for a lot of people they’ve never been vulnerable and that’s really scary. And so. Like, but no one ever teaches you like what the baby steps are. So like, I want to share a little bit of advice here. There’s a lot of safety in curiosity, confusion and concern. Like in that order, like whenever I have to have a difficult conversation, I never come at it from like, here’s how you are letting me down. Here’s how I’m unsatisfied. I always come at it with like, Hey, I’m curious about this. Can we talk more about that? And then that’s number one, it puts the person you’re talking to much less on the defensive and keeps expectations low. Like you’re having kind of a very equal conversation with like very low stakes. So yeah. I don’t know, someone told me that once I’m like, Hey, there’s a lot of safety and confusion. I was like, Oh, okay. I like, I like that a lot or curiosity Dave Etler: [00:44:53] if this, if this fits into that, I mean, kind of what I was thinking of, and this is what I’ve been trying to sort of remind myself over and over and over again in recent years. When you have these interactions, if you come at them with love and respect, correct. That’s part of it. I think Aline Sandouk: [00:45:07] respect always love. I don’t know. Like, Dave Etler: [00:45:10] I mean, love in the sense of like, I’m, you know, I understand, I understand that things are different for you. Yeah. Yeah. They’re not the same as they are for me. Let’s talk about this. Yeah. There’s Eric Boeshart: [00:45:22] an understanding there, Dave Etler: [00:45:24] right? Yeah. I know some people are wor you know, when they’re having trouble worried about the confidentiality of seeking out mental health services from your medical. Cool. Hmm. That’s hard. Yeah. do it anyway. Yeah. Like, I Dave Etler: [00:45:36] mean, ask the question in your first meeting with a counselor. Well, how are you going to treat this information? What are you going to do with this information going to give you, even before you begin talking about your problems, they’re going to say, and you down in a, in a, in a discussion, they’re going to sit you down and say, so what brings you here today? And the very first thing, if you’re worried about this, the very first thing that can come out of your mouth isn’t well, I haven’t having all these problems, the very first thing that could come out of your mouth before you reveal all that. Is I’m afraid of any repercussions that might come from sitting down with you. and these are normal fears and they know it. So let the counselor address those fears in that first session. And remember that they do have a legal obligation for confidentiality, the same obligation that you have as a healthcare professional, by the way. Yeah, but make them work for your openness. That’s totally fair. Aline Sandouk: [00:46:25] Absolutely. And that’s, that’s good advice in life in general.  Dave Etler: [00:46:31] for it Aline Sandouk: [00:46:31] I thought you’re joking, but I’m like, yeah, hell yeah. You know, people, people should deserve to hear the details of your life. That that’s, that’s rich and that’s intimate and that’s. You know, that has a value. And sometimes people will hear these like very personal stories and be like, Oh, that sucks. And then what’s for lunch. And you’re like, I just opened my heart up to yeah. Miranda Schene: [00:46:54] Or like, that’s almost more devastating than them using it against you as being like, Oh, wow. That’s some really deep personal information. Yeah, exactly. Get some coffee, like, Aw, come on. Dave Etler: [00:47:08] One more thing about that piece of advice is, okay, so they’ve reassured you right. Feel free to say, okay, I’ll talk to you next week about this. Take yourself, take a minute to sort of internalize that information and process it. And then you can come back next week and then start the real work if that’s what you want. Miranda Schene: [00:47:26] It is a thousand percent okay. To be selfish when you’re asking for like personal help, when you’re asking for help, it is a thousand, because I think sometimes we have this. Thing of being like, well, I came to them, even though I’m being vulnerable, it’s still like, Oh, it’s their time. That is their job. They are there for you. You can be selfish that is allowed and is permissible and acceptable and great. Aline Sandouk: [00:47:47] Yeah. And can I add to that with one more thing? Nope. Nick Lind: [00:47:53] Dave Aline Sandouk: [00:47:53] forgot his place up in Miranda Schene: [00:48:01] I don’t need to, I’m just back here watching popcorn, Eric Boeshart: [00:48:04] try to assert myself. Aline Sandouk: [00:48:08] We’re still friends at school. it’s okay to put, you know, eggs in different baskets. So like feel free to shop around. And I it’s something I was thinking about is. A lot of med schools sometimes feel detached from like the main Institute, if they’re part of an institution with an undergrad and like other, like, you know, faculties, other schools. so like something I never thought of doing is like talking to the university counseling services. Yeah. They don’t talk to the med school counseling services. Yeah. So feel free to shop privately. That’s also very hard because a lot of psychiatrist, psychologist have full patient loads. They’re not taking on new patients, but like, yeah. But look for that chemistry, like Miranda was saying like, Take it with a grain of salt. Don’t immediately close the door on someone who gives you a you know, a not perfect vibe immediately, but you do need that chemistry. And if it’s not there, then you’re never really going to feel comfortable Miranda Schene: [00:48:54] opening up. Yeah. And it’s perfectly fine. Even if you’re a med student to seek help outside of the med school. Like if you, if obviously if you have the resources to but like that is also allowed, you don’t have to be restricted to Dave Etler: [00:49:07] which your insurance Miranda Schene: [00:49:07] cover that. mine would cover it, I believe through UHC. So I could go to like the like UHC psychologist, psychiatrist stuff. And I think it covers some, like, I think blue cross blue shield. There are a few therapists in the area that also, cause I’ve looked into this there are a few therapists in the area that would also take my insurance. So it’s possible. Aline Sandouk: [00:49:27] Yeah. I mean the point the Miranda is bringing up. Is that check your coverage? Yes, absolutely make sure. Miranda Schene: [00:49:35] Because some insurances will cover mental health care. Some only cover 50%. Some won’t cover it, but a lot will, and they might cover it, but only for specific providers that specific locations or for only certain types of things. Dave Etler: [00:49:50] Yeah. Should Eric Boeshart: [00:49:51] I just say something real quick? You know, speaking from personal experience, if you, in that kind of a situation as a med student, you know, obviously in our context as the short coat, but, you know, just make sure that you’re looking at resources that are available to you and it’s, it’s better to use the resources than not use them much. Like big said, act like you’re paying. Aline Sandouk: [00:50:10] Yeah, totally agree. Yep. Excellent. All right Eric Boeshart: [00:50:14] guys. Aline Sandouk: [00:50:14] Can I share one more thought? Absolutely. I was reading about Audrey Lorde recently who is she was a black lesbian activist from the seventies who I think had breast cancer, had a one-sided mastectomy. And like, I guess at that time it was like even more stigmatized to not have a double mastectomy or get an implant. And she was like, no, I’m not going to protect the world from my, you know, one missing boop. You have like really forced people to accept her as she is. And I really admired that. And I think something I was reading about her is that in a capitalist system, self care is almost subversive and that really resonates like taking care of yourself as revolutionary, the most. Right. So Miranda Schene: [00:50:57] treat, I agree. Like there’s a certain element to where you’re expected to have earned it. There’s, there’s a concept of like, if I work hard during the week that I’ve earned a day off or I’ve earned, like treating myself by going out, it’s like, you don’t have to, you could just do that if you need it. Like, if you’re like, I haven’t worked that hard, but I’ve, I really need a break. And it’s like, Dave Etler: [00:51:15] I see this to people all the time. Like people are like, Oh, it’s come up recently in the context of vaccinations. Like not necessarily the urn thing, but that. Oh, I can’t do that. I have something to do at work. geez. It’s not, you know, the thing at work is Dave Etler: [00:51:32] not that important, you know, let your coworkers to handle it. Aline Sandouk: [00:51:40] Your, your job, your boss would not die for you. Miranda Schene: [00:51:47] Yeah. Dave Etler: [00:51:48] Yeah. Well, I guess you have anything else you want to say before we close the show? It’s good to be Miranda Schene: [00:51:52] back. Aline Sandouk: [00:51:56] I am happy to have you Dave Etler: [00:51:57] here. That’s our show though. Got to go. I gotta go eat lunch. I’m Miranda Schene: [00:52:01] hungry. That’s fair. I think my Aline Sandouk: [00:52:02] boss, he acts like we don’t pay for him. Miranda Schene: [00:52:06] My gosh for us Miranda Schene: [00:52:12] a lot, the only things in your lives, how dare you have to eat lunch Aline Sandouk: [00:52:18] if it’ll make you a better, Dave. Okay. Dave Etler: [00:52:23] There’s so much work to be done Miranda Schene: [00:52:26] in case anyone is wondering, playing along at home. That’s called hypocrisy Dave Etler: [00:52:33] guys. Thank you for being on the show with me today. Thanks, Dave. Thanks. This is fun. And what kind of slug would I be if I didn’t? Thank you. Chef coats for making us a part of your week. If you’re new here and you like what you heard today, subscribe to our show. Wherever fine podcasts are, podcasts are available. Our editors are AJ Chowdhury and Erik Bozart or. Aline Sandouk: [00:52:50] Take your time. Sound it out. Miranda Schene: [00:52:55] It’s actually my favorite editor. I’m a very big fan of their work because there is our marketing Dave Etler: [00:53:00] coordinator. The show’s made possible by a generous donation by Carver college of medicine, student government, and ongoing support from the writing and humanities program. Our music is by Dr. Voxin canvas fear. I’m Dave, Etler saying don’t let the bastards get you down. Talk to you in one week. Bye.   365 Active Medical Student Dave Etler: [00:00:00] Welcome back to the short code podcast, a production of the university of Iowa Carver college of medicine. I’m Dave Etler. with me in the studio today it’s a man who was as cute as a bug’s ear. It’s MP3, Nicklin, a bug’s ear. How bug’s ear she flies beyond fates control. It’s MD/PhD student  Miranda scheme. I’d rather doubt an article than question what she delivers. It’s MD/PhD student Alene, sand Duke. Very fair. And joining me in the form of ones and zeros. It’s the jammy, just bit of jam  Eric. Bozart. Feeling Eric Boeshart: [00:01:11] pretty one today. Over the zero? Yeah. Nick Lind: [00:01:13] Okay. That’s good. One. we’re also live streaming on our Facebook group, the short code student lounge. Dave Etler: [00:01:20] So why not check us out there? You can see all the things I say that we edit out of the show. Um, say like a week earlier than we posted, if that’s what the, I mean, if you’re into that If you Aline Sandouk: [00:01:28] just can’t live without us. Dave Etler: [00:01:32] Well, it’s also nice. You can participate. So that’s know hipster Miranda Schene: [00:01:35] vibes, being able to, when all your friends are listening to podcasts, you’d be like, I already knew that. I know that I know the punchline to that joke. That’s Dave Etler: [00:01:42] right. I’m not even gonna make you sign up for a Patrion to do it, you know? Cause that’s all right. That’s how giving I am Miranda Schene: [00:01:48] also because he doesn’t know how to set up a patriotic, Dave Etler: [00:01:53] main reason that I bet you could figure it out someday. today’s show sponsored by panacea financial. The digital bank created for doctors by doctors. I’m really happy to have them back. So we’ll talk more about them later on the show as for today’s. Topic, you guys don’t even know. I didn’t even tell you about today’s topic. You know, why in the dark, you know why I didn’t tell you about today’s Miranda Schene: [00:02:17] topic? Has he we’ve known you too long for us to pull that wool over our eyes. Dave Etler: [00:02:25] There is a student I heard about recently who was running up against a few problems. the M one wall, ah, you guys all immediately were like, ah, Does the ring ring a bell for you? But tell me about the . Miranda Schene: [00:02:37] Well, I feel like, I mean, I don’t know the specific student’s exact problem, but for me, the on wall was sort of when I realized, Oh no, I’m in trouble here. And this is a new experience it’s for me Dave Etler: [00:02:50] in trouble in terms Miranda Schene: [00:02:52] of in trouble in terms of like academics and the fact that. Like for a lot of people coming into my, and this again was my experience. I quite good academically I don’t mean to brag to anybody here. I’m quite good. humble, humble brag. Yeah, that wasn’t really humble though. That was just a straight up brag. I appreciate it though. but then once you hit a certain amount of med school and the pace has picked up, and you’re now into territory that you have never seen before and suddenly this feeling of, Oh, this. Like I am struggling and I haven’t in my previous academic career had this type of struggle before, so I’m both struggling and I don’t really know how to deal with it. Yeah. Dave Etler: [00:03:29] What, what about y’all’s M M one wall. Was there something for you guys? Aline Sandouk: [00:03:34] White coat imposter syndrome started at the white Aline Sandouk: [00:03:46] Yeah, no, I think yeah, I, of course I know the wall. Everyone knows the wall who doesn’t know the wall. I did notice everyone hits it at different points, I think. And that’s an interesting observation. The first one. And sometimes the second, some people don’t hit the wall until the second semester, but yeah, it really dawns on you that you’re in a whole new world and these are whole new stakes. and yeah, I don’t know. Miranda Schene: [00:04:09] Do we hit the wall? I students MSTP any Haiti’s town fans in our listenership are going nuts right now. Okay. Nick Lind: [00:04:17] Yeah. You know, it’s I think it’s because it’s such a new experience to any of us. Cause you know, The amount of material that you go through during that, for, during all of med school, to be honest, but especially that first semester I mean, you’re basically covering everything and that foundations class that you covered. And all of your preparation for medical school. And, and so you just covered it all and you know, one semester and half a semester and half a semester, and you even expounded on some topics that you didn’t even. No. Anything about Aline Sandouk: [00:04:54] all the extra credit stuff from undergrad is now core material. Like all of the stuff that you thought you were going to do for like, you know, brownie points to like suck up to the teacher. Like, no, you have to know all of that too. So yeah. Eric, what Eric Boeshart: [00:05:07] about you? Yeah, yeah. I, a hundred percent agree. It’s. I think kind of what Nick was saying where it’s like, so I did, I did a master’s program before coming here. It was just kind of like a, one-year kind of doing some more of the hard science type stuff. Cause my background’s in engineering. And so you, you know, I went through that master’s program. You’d take things like, you know, I did an anatomy course. I did, you know, some pretty in depth Physiology stuff. And then you come into med school and like, you cover that within the first two weeks. And you’re just like, okay, so that’s an entire master’s degree. So Dave Etler: [00:05:42] expedited. Yeah. I think there’s also for this student. It was all that. Yeah. And then I also think that they were concerned. They’re concerned about the hidden curriculum that they started to notice. Yes, this is so the hidden curriculum. If you’re not, if you don’t know what that is, I guess I would call it the, the part, Dave Etler: [00:06:03] the thing that isn’t actually part of the curriculum, but that you’re learning anyway. Like how to be like how to be a doctor. Sure. Like what it means to be a doctor in terms of things like professionalism. Yeah. Aline Sandouk: [00:06:17] Yeah. It’s it’s office politics for, for anyone who’s ever worked in an office, right? Like don’t use Linda’s mug. You never use Linda’s mom. She’ll lose her mind. But Dave Etler: [00:06:29] it’s uh, you know, things like, you know, how to, how to act like a doctor. Yeah. How to project that image. What is that image? Nick Lind: [00:06:38] I think that really picks up once you hit clinical clerkships, like in you, you know, you’re working with these people and you’re, you know, within the first day of working with them, you’re trying to figure out how they tick. Because like, you know, if you kind of do the wrong thing, you’re going to get called out pretty quickly. Depending on who the person Aline Sandouk: [00:06:58] is, figuring out where their sharp edges are and then how to stay away from them. Miranda Schene: [00:07:04] A lot of times when we talk about the hidden curriculum, we talk about it as well, in terms of like relating to patients in a way that isn’t, you’re my friend, I’m having a conversation, been in a way that is you are the patient, and I need to figure out what’s wrong with you. And that, that goes through things like anatomy lab, where you’re, you may be doing a cadaver dissection for the first time and having to deal with that, like emotionally, as well as learning all the material. Yeah. And then actually figuring out how to break a patient story down into constituent components, which you are then graded on. Yeah. Dave Etler: [00:07:33] Yeah. But I think it’s also about how to look like a doctor, you know, and, That there are problems with this because not everybody looks the same way. Yeah. That’s Aline Sandouk: [00:07:44] an interesting conversation. I think Danny had by a lot of people in healthcare right now, Miranda Schene: [00:07:49] like th this is the problem with the hidden curriculum is that it’s hidden. It’s never anything. I don’t think it’s ever been something that’s been intentionally taught. It’s just sort of generally accepted that odd. This is also things that people develop through their medical surgical time, Dave Etler: [00:08:01] sort of like the culture. It’s learning the culture of medicine, which means Miranda Schene: [00:08:06] it’s, which isn’t only influenced by things like unconscious bias. Right. Dave Etler: [00:08:10] Insanely it isn’t always great. The culture of medicine, you know, there, there is no culture that is always great. and medicine has its difficulties to, you know, basically, you know, how do, how do. You know, what are the aspects of the culture of medicine that I’m talking about? Like hard work all the time. grades is the most important thing. Yeah. Aline Sandouk: [00:08:29] looks do matter though. I don’t know if that’s Dave Etler: [00:08:31] where you’re, it’s not that they don’t matter. it’s just that they are perhaps matter more than they need. Aline Sandouk: [00:08:39] Oh, I did say they mattered. I don’t know if you misheard me. Oh, okay. Yes, Dave Etler: [00:08:42] but maybe I  it up. Is that because Aline Sandouk: [00:08:47] you said a bad Dave Etler: [00:08:49] part of the hidden curriculum don’t, don’t swear on the podcast. Miranda Schene: [00:08:57] Don’t swear in front of children. I mean, in front of patients Dave Etler: [00:09:02] repel against that, Aline Sandouk: [00:09:03] you know, I remember something in my first year with Ellen Franklin, it was like a small group and someone was like, Dave Etler: [00:09:10] Oh yeah, Are I guess they would, they used to call it the performance-based assessment. Aline Sandouk: [00:09:14] Yeah. She’s like the clinical skills assessment director for folks not at SeaComm, but I was in a small group and she was like, people were asking, you know, w what are the expectations for like, how we should look, how we should dress? Should it be like interview day? Which, you know, interviews, people are wearing full suits a little much. And she was like, well, you know, as long as you look clean and you’ve run a brush through your hair. And I thought that that was such like reasonable advice. And then I. Like I grew up a little and I realized that like I was, some people don’t consider like certain types of ethnic hair, clean looking. Right. So some people don’t consider certain. Looks or certain ways of dressing as like clean Dave Etler: [00:09:52] cut. Yeah. So like when, when somebody says run a brush through your hair, what does that really mean? I think that’s part of the hidden whose hair, right? That’s part of the hidden curriculum. I mean, there’s all kinds of problems with this hidden curriculum. precisely because it is, it is hidden. I think Aline Sandouk: [00:10:07] it’s changing for the better though. And people are talking about it. People are talking about talking about it, and I think patients are the. The demographics of patients is changing too, because I think historically doctors acted in such a way that was help patients expect, like patients expected to come to the doctor and maybe I’m wrong. I’m I don’t mean to generalize, not a hundred percent, but I think patients came to the doctor expecting to be told what was going to happen and what they should do. And they liked it that way. And then, you know, the next generation came along and was like, no, I want to be. Partners in care with you. I don’t want to be your employee in my care. And I think that’s where the older guard of medicine is like, what is this? No, no, no. I tell you what to do, but like now we’re coming up and like we’re a little bit more, I guess, like culturally congruent with that. Right. So Dave Etler: [00:10:56] there’s more to the hidden curriculum than we haven’t yet discussed. For instance, There is a S this, this particular student had observed the social currency that circulates around things like how much you study, how well you score on tests you know striving to get honors grades, as opposed to striving, to pass your course and striving to learn. Right. Which is an important distinction. Nick Lind: [00:11:20] Yeah, no, Dave Etler: [00:11:21] that’s very true. So F so for instance, like one of the things this person noticed was you know, professors will let you know, after the exam, what the average was. On the exam. and I’m not a professional, I’m not, I don’t, I’m certainly not an expert on educational theory. but I think to some extent it’s sort of a defensive maneuver by the professor who needs to prove to the population of medical students, that it was a successful exam. Yeah. Yup. that it was valid in some way. but what this student found is that those averages were a source of pressure. did I perform to the average and the message there being that your only value. Is the grade that you get. and by the way, push back at me, if you think, if you think I’m full of shit and anything Miranda Schene: [00:12:01] that I say, can I say very quickly? I actually still remember the first time I scored below the class average on an exam, because like the first like foundations in the first MD/PhD I was still like pretty doing okay. And then it hit like the spring semester and I was like, Oh crap. And I still remember it. The best thing I ever did was I found. Friend. And my friends were not in these lights. You must get honors or you will die type people. They were the chill people. And like, we both had a conversation and she was like, Oh yeah. I also scored below the average. And it was like, and we pointed out to each other that like 50% of the class got below the average. And we’re not a bad student for coming below the average. There can be a Dave Etler: [00:12:41] challenge to find that, that, friend. Yeah, Aline Sandouk: [00:12:44] it, it requires a little bit of vulnerability and it’s game. Like vulnerability, chicken, and you’re like, Oh, and then they give a little, and then you give a little, and then you get to the truth. Cause it’s, it’s hard. Like that’s not information you can just come out with and be like, I done failed that test. And then if no one was soliciting that information or if no one is comfortable sharing that, you know, you’re now in this weird vulnerability black hole. But yeah, those are real. I could not agree more. I love those moments in med school and just like in life, in general, when you’re like. Yeah, that was hard. And the other person’s like, yes, yes. That was hard and hard guys. And you both know exactly what you’re talking about. Nick Lind: [00:13:22] Yeah. I was just going to say, you know, you take a bunch of people who score in the top 10% You know, all through their lives and you put them in a room together and give them the same test. They, they still distribute into a bell-curve where you still have people at the bottom and you have people at the top and you have almost everybody else in the middle. and that’s that’s med school. I mean that that’s everything in life. And it it’s difficult to come because you’re used to being in that top 10% or higher. And it’s difficult to come to the fact that, Hey, maybe I’m average or maybe. I’m below average because you know, that exists too. And uh, Dave Etler: [00:13:57] I feel comfortable being below it I’m above average, in some Miranda Schene: [00:14:05] ways you’re in the you’re in the first core tile in our hearts, in the Eric Boeshart: [00:14:11] box and whisker plot, Dave Etler: [00:14:14] the error bars are just very large. Um,  Eric Boeshart: [00:14:17] I felt like, you know, we’re talking about averages and stuff. I would even go a step further to say, like, I feel like it. In my experience  we didn’t hit that point where I think a majority of people were able to say, like, be open about like, Hey, I didn’t do well on that test. Like, we didn’t hit that until probably this semester before clinicals. Dave Etler: [00:14:36] Interesting, Eric Boeshart: [00:14:36] where it’s just like, you know, I feel like most people were open about that. Dave Etler: [00:14:40] Does that ring true to you guys? Or did that happen earlier? Do you think. I, it kinda, it Miranda Schene: [00:14:46] kinda depends. Like I, I do remember in one of our learning communities, we would almost always have like group D not official group D brief, but informal group debrief, or it all just like come collapsed on the couches and be like, well, that sucked. And that just sort of like opened the floor to be, and it wasn’t necessarily like I scored this or I scored this. It was never, no one asked about grades, but it was just like that. Was rough. And that gives you exactly. That gives you like no information about how that it, maybe it was rough, but they still got like a hundred percent. You don’t know, but either way it’s still like commiserating about that was really hard. And that was tough. And now, wow. I did not even think that was going to be on there, but Oh, I guess this person really loves stomach ulcers. I just got more flashbacks. I think. Nick Lind: [00:15:29] I agree. I think the class is pretty good, even from early on. Like if you. Did poorly, there was at least for me, like I had a group of people I could easily go talk to. They were pretty open with like, Oh yeah. Like that was, that was rough. And I think that was really common. I think I Dave Etler: [00:15:47] should say, I should have said before, you know, and like, I’m getting, you know, when I, when I say I heard about the student, I’ve heard about them secondhand,, if the student happens to, you know, hear this, I want to say that I’m not like, yeah, I want to say that. I, well, I just want to say that this is, you know, th that, this is important to talk about this particular. Student, apparently had tried discussing with other students and felt some resistance to that vulnerability. And I was intrigued when you, Eric said that it took until just before going out into clinicals to open up you, it kind of makes sense Eric Boeshart: [00:16:21] to come into my own realization of getting a pulse on where the. we were You know, like I agree with Nick, like I did have a group of people that, you know, you could, I could go to and be like, Hey, I, you know, I’ve got a general pulse on my group, but I didn’t realize that that spread out farther to the class until probably before clinics. Miranda Schene: [00:16:40] And, and this unfortunately is, and I know we’re all sick of talking about how COVID has impacted medical education, but that’s a big problem where it’s like, it’s become essentially, like I’ve only now been seeing sort of like students back in the communities. And even then I imagine socialization is relatively down. so it’s hard to get that pulse on where your classes at it’s hard to get that collected. Like. Woof kind of moment where everyone sort of collects and shares and is a bit, and sort of debrief with each other. Dave Etler: [00:17:07] Cause even if exams were in person, you’d sort of run away from each other and go there. Miranda Schene: [00:17:11] So like we were just talking, I sat down and I instinctively picked the farthest chair away in the corner just because that’s how like, all right, six feet where it, we got to be distanced kind of thing. Dave Etler: [00:17:21] I Miranda Schene: [00:17:22] I’m sorry. I just want to run away from me, Dave. We’re actually trying to get away from you. Aline Sandouk: [00:17:26] Miranda’s Miranda Schene: [00:17:26] just being nice. I’m leaning back as that goes on, just getting as much bullying. He’s going to get Aline Sandouk: [00:17:39] some really bad mental health problems. If you don’t let them know, we’re joking. Once Miranda Schene: [00:17:43] in a while, I haven’t been on the podcast in so long. I forgot how much of it is just managing Aline Sandouk: [00:17:48] Dave’s emotions. Dave Etler: [00:17:53] I guess the upshot from what I understood is, and I think I’m paraphrasing here. So I hope I get it right. They felt kind of unprotected. and they’re, you know, they they’re sort of mental health was feeling precarious because of all this and, and, but they were afraid to seek help. Sure about it. in the form of, in the form of, you know, things like counseling yeah. Aline Sandouk: [00:18:16] In their defense around some people they should be afraid. No, that’s not to say, Miranda Schene: [00:18:22] hang Dave Etler: [00:18:22] on, hang on.  Aline Sandouk: [00:18:25] that’s all to say that like, Be extremely careful who you share that information with because it’s a 50, 50 chance that you’re sharing that with someone who’s going to go, Hey, I’m really sorry to hear that. Let me help you. And then the other 50% are going to go, all right, great information to have in my pocket. And I’m not joking about that. That’s something to be very mindful of, but like before you go spilling all your beans, like. Throw a crumb out there and see how they react and, you know, before you start really opening up. So Dave Etler: [00:18:57] I would argue that, I mean, I mean, first of all, th this hesitation brings up two questions for me personally. should the institution protect you? is there any value, I mean, yes, to some extent the institution should protect you, but is there any, any value long-term in being unprotected? So that’s question number one. Aline Sandouk: [00:19:15] What type of protection? Dave Etler: [00:19:17] I mean, I don’t know, like you know, because I, because I wasn’t able to ask follow up questions. Miranda Schene: [00:19:21] I’m sorry, but may I throw out a metaphor before I forget? Yes, I believe yes and no. The difference between like chucking someone in the deep end and then checking someone in the deep end, followed by chucking them a life ring. You know, where it’s like Dave Etler: [00:19:37] chucking them in the deep end and then throwing some chum Miranda Schene: [00:19:41] because I exactly like, I think there is definitely value in having to sort of like, In being vulnerable and being able to like getting that challenge and having to sort of climb out. But like, there should be a ladder where it’s like, if you’re like, okay, I have tried and I cannot, I’ve re I’m mixing my metaphors, but I have tried and I cannot climb out of this hole. It’s like, okay. Deploy the emergency ladder. Cause like to meet you halfway. Yeah. Aline Sandouk: [00:20:06] Adversity is character building. Right. And I’ll never forget this. This, I don’t know where I heard this, but I remember reading somewhere that like trees need when to grow. Otherwise they die. Like that’s so profound. Like they need the push of wind to kind of push the sapling down to motivate it, to grow big and strong. Like, Dave Etler: [00:20:24] but they don’t need a daily hurricane Aline Sandouk: [00:20:28] mercy. It doesn’t work if it’s like lethal. Right. It has to be up to a point where like, kind of like Miranda is saying that someone will step in and be like, okay, Hey, you strolled enough. Well, let’s bring you in and then we can talk some more. And I think Nick Lind: [00:20:43] what’s that Miranda Yeah.  Yeah. You know, I Nick Lind: [00:21:08] think in pre-clinicals too, it’s important to kind of have some of those situations where you’re struggling and, and kind of pushing your limits because once you get to the clinical side of things, You’re you’re much more independent. You have to like, not only balance the academic side, because you’re going to have an exam at the end on everything that you need to know for that clerkship, but you also have to be learning all of the practical hands-on things for that clerkship at the same time. And you’re going to be pushed even harder than you were in pre-clinicals. because there’s, there’s just a ton that you need to know. And if you’re not setting yourself up, you know, from, from the beginning, it’s going to be even more difficult. So I think the institution does need to push you. I do think that there needs to be safety nets, and I think that there are here you know, you’re going to get that email orcall or whatever from the counseling center about, you know, are you okay? Like What can we do to help you academically and, and you know, which Miranda Schene: [00:22:07] I think sometimes it might hurt more than it helps or it’s like, I think I’m doing okay. right. Aline Sandouk: [00:22:17] But I’m sorry, Dave, did you want to ask a Miranda Schene: [00:22:19] follow up questions? Right? Do you want to play on your phone? I’m trying Dave Etler: [00:22:22] to just make sure that Aline Sandouk: [00:22:30] The question was, Dave Etler: [00:22:31] I have no idea if the live stream worked or not I’ve know, seems to be working, but then it says you were Aline Sandouk: [00:22:37] well, we’re having fun. That’s all that matters.  Miranda Schene: [00:22:40] Voice cracked. I guess the other thing, Dave Etler: [00:22:48] the other question that it brings up to me is why are people still afraid of seeking help? Aline Sandouk: [00:22:52] Because people are still making other people feel bad. That’s why there are still those, sorry. Blood heads out there that are like, look at this loser. Pardon my French. No, no, no. Dave Etler: [00:23:04] There’s that there is that. I think there’s that risk. Nick Lind: [00:23:06] I think, you know, another aspect of it is our society, our culture, our, the way that we, especially as medical students, the way that. We’re raised. We, we often didn’t need help, you know, from Trump high school on the college, you know, some of us who might’ve had a career before med school you know Nick Lind: [00:23:27] we were able to do it. Well, without the help. And then you get here and it’s, it’s, you know, the heart of one of the harder things I’ve ever done, you know here in med school. Nick Lind: [00:23:36] And I think, you know, when you start hitting your limits you may be, have done that before, but not quite as often and is like, It doesn’t stop here and Nick Lind: [00:23:48] makes it back. Yeah. Yeah. That’s hard for, I think someone to really grasp ahold of and understand and understand when they need help, because they never needed help before. Dave Etler: [00:23:58] I think the thing though, is that school spend a lot of money and effort putting in place these efforts. and they really want you to use them, you know, like the counseling center, the You know, the tutoring groups, the you know, what, what are some other ones? The the, the mechanism to get accommodation? Yeah, I Miranda Schene: [00:24:19] think sometimes those accommodations are often framed as like. Oh, well, if you, and I don’t think that this is a bad thing, but it’s like, Oh, if you start like dropping back and failing, then you have to come to us and admit, Oh, I’m a failure. And I need cause which is not true at all. It’s just, those are things that happen sometimes. And occasionally you require it. Agreed Dave Etler: [00:24:41] agreed. Eric Boeshart: [00:24:41] But I can kind of speak to that too, if we want to talk about that. Cause I’m, you know, I think on top of that, you know, there there’s the general failures of, okay. You know, maybe you’re not studying correctly. Maybe, you know, maybe you’re not using all the tools available, but then there’s things that like life happens. And I know Nick had talked about, you know, before the podcast we were talking about. you know, sometimes people start families, you know, life kind of happens around med school. Well, I had an accident in the middle of first semester, second year, and now I’m kind of taking a step out. So, I mean, you kind of hit a point where, you know, I. For me, it was a concussion. And so I, you know, all of a sudden school becomes a lot harder and I, you know, there, it was a combination of my injury, but also a combination of, you know having to admit that I need to use the resources that are available. And, you know, I think that now. That’s kind of been put into perspective, but I think that, you know, there, you’re taking a group of people that haven’t had to use these resources and you’re like, you know, expecting them to just jump in. And I, I, you know, I just don’t Aline Sandouk: [00:25:52] too. And not Miranda Schene: [00:25:53] to mention, you’re also taking a group of people that have more or less defined themselves on not needing help before, where it’s like, like when you are the best student of the class, you don’t need a tutor. You don’t need additional support. That’s Dave Etler: [00:26:04] why I want to talk about this because. I think that needs to go away. Yeah, I agree. I think that that needs to go away. And I think that, you know, if, if, if this conversation was successful in any way, it would be that, you know, say a pre-med out there who is struggling. Really got the message that if you need help, go get it and don’t give a shit what anybody else thinks about you. because one of the things I think you guys know. And that I’ve noticed about medical education. Is this hot take, are you ready? React to this statement? Okay. There is no such thing as a passive and successful medical student.  Eric Boeshart: [00:26:44] Yeah, I wouldn’t, I mean, at the same rate, Dave Etler: [00:26:49] Okay. There is no such thing as a passive and successful medical student. And we’re going to delve into Miranda Schene: [00:26:54] that because I need like three things to find. Define success. Number one, define passive number two. Yes. I Nick Lind: [00:27:02] never find medical students. Dave Etler: [00:27:08] well, we’re going to delve into that. After this message from our sponsor, which is panacea financial, a company founded by two doctors that were frustrated as medical trainees, that banks didn’t seem to understand the unique needs of those in the medical field. So they weren’t passive. They built a company just for medical students and doctors. Excellent segue Dave Etler: [00:27:27] like that. with nationwide digital banking, panacea financial provides medical students with free checking. That includes no ATM fees, nationwide high yield savings accounts, a free personal banker around the clock customer supports. And with loans designed with you in mind? no one should borrow more than they need, but with panacea financial fourth year medical students can get money as needed in as little as 24 hours with their PRN personal. No, it has an interest rate half of that, of a year, a usual credit card and no co-signer requirement and it’s fully. Digital application. So instead of running up credit card debt, try their PRN personal loan that is designed to give you a better way to cover expenses, such as residency applications and relocation on board exams. Some customers actually use it to pay off toxic credit card debt. In addition, medical students can have a period of no or reduced payments on their PRN personal loan. Join the growing number of medical students and physicians nationwide that expect more from their bank. Go to panacea financial.com to open your free account. Panacea financial is a division of premise. Member FDI C thank you, Pam financial. It’s nice of you to help, help us out. Nice of you to help med students out. Very cool.   by successful, let’s start there. I mean, wringing, everything you can out of medical education. Sure. Oh, well, yeah. Okay. Not getting honors or getting into ortho or getting into ortho. That’s not what I mean. I mean, if that’s your goal, that’s fine. That’s fine. Be successful in that. Yeah. Yeah. Miranda Schene: [00:28:56] So I was going to say, I can think of multiple medical students that have been what I would call passive, and who’ve gotten like straight honors and higher grades and everything, Dave Etler: [00:29:05] you know what? Okay. So then we’ve got to get to pass it, right? passive, I mean, a passive consumer of what medical school has to offer. So you sit there and you Hoover up knowledge and then you spit it back out. That is what I think of as a passive medical student. All right. Nick Lind: [00:29:21] Go. You know what, one thing I wanted to mention after you you kind of define things there. One of my peers, I had asked about a rotation one time and he said, Hey, it’ll be great. Dave Etler: [00:29:33] If you Nick Lind: [00:29:34] treat it, like you paid for it. And I was, which, you know, I Nick Lind: [00:29:39] did good and I should really treat this rotation. Like I paid for it. And, you know it’s a way I’ve kind of been trying to handle the rest of my clinical clerkships. Like I’m going to treat this, like I paid for it. Like, I’m going to go in and I’m going to ask to do the cool things. And I’m going to try to like, do the things that I want to do and learn the things that I want to learn. And you know, it, it’s kind of been fun. Did Dave Etler: [00:30:04] that change anything for you or did it just give you a new perspective on what you were doing? It Nick Lind: [00:30:09] gave me a new perspective, but I think it did change, you know, cause some clerkships you have the opportunity to kind of pick and choose a little more of what you want to do. like, like say like emergency medicine that’s a good one because you get to sign up for patients and you kind of get to pick what you know, who you want to see. And, you know, if you want to go to that trauma, that’s on the other team that you’re not assigned to, you can go to that trauma and yeah. You know, it, it’s a good way to, to look at a clerkship and, and kind of. You know, there are things that you’re going to be asked to do no matter what. but there might be some options where you get to go in and, you know, even just ask like when I was on OB GYN, I you know, was in a room and there was an attending that was going to work independently in another room. And I said, Hey, can I go work with that attending? it was in the, or, and he didn’t have any residents, no fellows. So it was just me and him. And I got to do way more, but I bet you had a Dave Etler: [00:31:03] great experience. Yeah, yeah. Yeah. Miranda Schene: [00:31:06] One thing I’ll say is that when you are sort of more like assertive and asking people, you will be surprised when people will say yes to where it’s like, there’s a lot of things where like, I’ve had people express to me, like, man, I wish I could do this. And then they are. You know, people are like, okay, well, why don’t you do that? And they’re like, Oh, good point. And then it’s I never thought of it that way. Oh, I didn’t. Yeah. Cause there’s sort of this assumption. It’s like the it’s like that one picture of a horse that’s like tied to a kid’s deck chair where it’s like your limits are. Yes. So I th it’s one of those things where I think sometimes people are passive because they don’t know they have an option. It’s like, you can just like ask for things that you want. I think Dave Etler: [00:31:49] also, I mean, that’s, that’s amazing insight and I think that’s something that That is directly applicable to the clinical part of your education. And I think it’s also directly, I can see how it’s directly applicable to an MD/PhD education because those two things, while there are. You know, set things that you need to do. And you’ll be asked to do things specifically. There’s also an element at some point of self-determination it’s a little harder to see that in the preclinical curriculum, because you can’t just go up to the course director, who’s put together this, you know, this Mo you know, semester long course and say, yeah, but I want to look at them. Yeah. but there are things that you can do. During the preclinical phase to sort of. You know, be more active. I mean, good. I think the best students that I’ve seen you know, they, they organize that vacuuming up of knowledge, right? They organize the actual process of consuming it. They organize the organization of the actual prop, you know, process of consuming it. Do they do this? Organize the organization? Miranda Schene: [00:32:57] Not only do they organize, but they organized their organizer. Yeah, it’s a little obsessive, but Dave Etler: [00:33:02] I, you know, and I hope that part of that process is realizing that no plan survives the first engagement with the enemy. So sometimes you have to, you know be willing to rejigger your plan, but they seek solutions to problems rather than just waiting for them, waiting for those solutions to, to arrive. And I think that’s important. They also participate to the extent that they can. And I don’t want to say that you, you know, I don’t want to say that. You absolutely must join every student organization and you absolutely must become a leader of those student organizations and things like that. That’s gravy. but they’re the, I think the people who my guess is that the people who get the most out of medical education actively participate in it beyond just going to class. Absolutely. Aline Sandouk: [00:33:49] I think to add to that, I think the people who get the most out of it are the people who are making decisions based on their values and what really matters to them, not what they should do, but what they’re excited to do. Dave Etler: [00:34:01] Yeah. And I think this feeds into something that I often say when any, whenever anybody gives me the chance, which is defining your own metric, Aline Sandouk: [00:34:08] Totally. Yeah. What does success look like to you? What are the issues that are important to you? Nick Lind: [00:34:13] And I think that’s going to change after, you know, your first few months of medical school. Yeah, exactly. Because you might think that, Oh, I’m going to be the top of the class and I’m going to. And somebody is going to be, and they might be able to meet that. But most of the class will not Miranda Schene: [00:34:30] fun fact. There’s only one person that could be the top of the class. So if you’re Aline Sandouk: [00:34:37] number one, Miranda Schene: [00:34:38] they are can be old. Late Dave Etler: [00:34:39] one. Yeah. The, the student I was talking about earlier with not being passive, right. They’re examining the world around them. Yeah. Which is. Important. they were noting its shortcomings. they reached out to other students, they made themselves vulnerable and I am all for this as you know Aline Sandouk: [00:34:56] You, you, you do have to try, like, you have to put yourself out there a little bit to find out, you know, what your environment is like, right. You are a little bit in the dark until something really big happens. And then you’re like, Oh, I need to find out the landscape of the place that I’m in. And it sounds like this person is really in tune with how they’re feeling like they’re aware of what they need and what they’re looking for and are aware of the fact like, Oh, I’m not getting it here now. I’m going to go somewhere else. Yeah. I think I’m curious to hear more of like, what Eric’s experience is like. Cause I think I cut you off, but you were, you were kind of getting to the part of talking about how you slayed this dragon of passivity, I think. Eric Boeshart: [00:35:35] Oh yeah. Well I think that, and it sounds like I agreed. That this person sounds like they’re kind of reprioritizing is what, needs to happen. And I think that I, you know, in my own kind of personal, you know, what’s in the last six months, that’s kind of what’s happening me. And it’s a lot of, it took me a concussion, some academic MCAT failures to realize, you know, that. I was, I was passively taking in information, you know, and then all of a sudden you’re like, you have this kind of come to Jesus moment of, I need this information to help people, you know, like that’s what I’m here to do. That was my ultimate goal. And so I think that. It sounds like this student is kind of in a similar situation where it’s like, okay, what is your definition of success? And for me, my success death’s definition has changed. And, you have to take the steps to find the help that you need, And I think that kind of like what we were talking about earlier that I think that the, you know, there’s adversity, but. I agree with the idea that the institution needs to be able to throw out these, you know, life rafts or the, you know, and they are available. It just, it sucks that we, as a student mindset are like, nah, I, I don’t want to use it. Miranda Schene: [00:36:54] I don’t need your boring life. I’d love to Dave Etler: [00:36:57] tease, you know, this, this sort of reminds me of a conversation I recently had with my mom. you know, they’re getting older, they need a little bit more help. And I was trying to suggest some things and my mother said, Oh, we’re not that kind of people. Yep. And the two things, things about that, I’m like ma. You are now. Okay. And number two, I’m that kind of person? What do you, what, what kind of person are you talking about? Miranda Schene: [00:37:26] It’s actually kind of reminds me of, I went to a movie screening last night outdoors. it was out by the river is Dave Etler: [00:37:34] really pretty good. I get to stop like, like putting asterisks after the things we do, like Miranda Schene: [00:37:41] six feet away, Dave Etler: [00:37:42] Jeff really was wearing a bow and I was outside. And I was bathed Nick Lind: [00:37:47] in hands. I Dave Etler: [00:37:48] was wrapped in plastic. Miranda Schene: [00:37:54] You’re fine. well I was at this movie screening and at the end of it one of the guys said something where it’s like the world needs people who are willing to reinvent themselves. That’s a paraphrase. but that was one, I mean, the documentary as a whole was a tad pretentious, but it’s okay. I liked it. but that was one of the things that sort of stuck with me where it’s like, you know, that’s, people will get stuck in this thing of like, no, this is just the person I am. And all you have to do is be like, well, why, why are you that way? And then just, if you can’t come up with a good reason, then. Be willing to change that. Like you are not defined in a single Aline Sandouk: [00:38:28] aspect. Yeah.  I saw a quote somewhere recently on the internet. I can’t remember where, but it would have been a Brene. Brown quote, I’m not sure. She she’s like a big vulnerability researcher. but the quote was something like a lot of people. and in this case, as I think they were talking about like relatives, Choose to see you as the version, they had the most power over and they refused to recognize your personal growth, you know, into a person they can’t control. And they get really annoyed around that. And I haven’t been able to forget it cause I. I mean, I’ve never articulated it that way, but I have personally experienced that and to piggyback off what Miranda is saying, don’t just be afraid to change who you are and reinvent yourself and kind of move the goalposts round, but also get away from people who don’t let you change. Yes. Get away from the people who were like, no, get back in this box that I put you in. I don’t like how you’re trying to squeeze out of my control and that’s okay. Like I think as people get older and this is harder to see, I think when you’re under 25, but when you get to be like, I think in your thirties and forties, you realize that like, Friendships come and go. Like, just because someone’s your best friend now, and they’re not going to be your best friend forever, but maybe you step away and then you come back to them in a few years. Like when your life priorities realign, you know, and things like that. So everything changes. So feel free to change with it.  Oh, wow. Dave Etler: [00:39:55] I was thinking back to To my childhood. Aline Sandouk: [00:39:57] You had to read it to me moment where I Miranda Schene: [00:40:00] farmhouse.  Nick Lind: [00:40:18] You know, I think for the first-year medical student, who’s struggling academically. you know, I would encourage them to keep at it because this information is all coming back again. Like I, I just took step two yesterday. and you know, like, step one, step two, like all these things that you learn, they just keep coming back. So if you’re not getting it now, you’re not going to get it. Then you put the time in to truly understand, you know, where, where you’re missing it. And so you know, if you have that test that you either failed or did poorly on, or didn’t quite do where you wanted, you know, score where you wanted to be. You, you kind of have to keep at that material. Dave Etler: [00:40:58] It’s not so important. I think what you’re saying is it’s not so important that you got a bad grade. Yes. What’s important. Is that you, you use that information to inform what you did next. Yes. Aline Sandouk: [00:41:12] Yes. And also like, look at the information said, okay, what of this really matters to my future? I’ll never forget this. There’s a doctor who used to work at student health. And I remember I went to her as my doctor and. Because I was a med student, he came up and she was like, Elaine, let me tell you when I was in med school, you know, sh she’s an OB now. And she was like, when I was in a med school, I didn’t learn the foot, not a big deal. I didn’t learn about the spleen, not a big deal. I became an OB. So ovaries became critically important for me. So try to look at it that way you don’t have, like, they’re only the only two specialties in medicine where you really do need to know everything is family med and emergency med and everything else. You’re going to lose, like not lose, but like six. You’re going Dave Etler: [00:41:53] to step away from it a little bit Aline Sandouk: [00:41:56] away and make room for really in-depth knowledge for the stuff that’s really important for the people you see. So, yep. Dave Etler: [00:42:03] There is one thing I wanted to say, you know, schools are going to be proactive by offering things like mental health support system or services tutoring. A structure for mentoring, learning, our learning communities are important. but it’s up to you to seek those things out. Again, we’re getting back to that active student.  I’m going to punch you for gesturing  with me. , Miranda Schene: [00:42:26] I swear to God that one was actually unintentional. That was early. Empathizing. I was, cause I was like, I was like, all right, get in. Dave’s head. What is he saying? Dave Etler: [00:42:39] Or like firing. But the point is like, we, you know, the schools go to a lot of trouble to do this and you have to be willing to sort of take advantage of them. I mean, yes, your school may reach out to you and say, Oh, I see you got a bad grade on this test. Let us know if you need any help. Sorry, Miranda Schene: [00:42:58] that just made me think of like, you’re paying for it. Aline Sandouk: [00:43:00] I was about to say I’m a little pissed Miranda Schene: [00:43:03] off.  Aline Sandouk: [00:43:05] such a great call back, but I was thinking, I was like, you’re paying like Doreen go use Doreen, you know, any of the other people, but yeah, you’re Miranda Schene: [00:43:14] ups. You want to put Dorian into context? Dave Etler: [00:43:16] Cause I feel like that’s the head. Yeah, Miranda Schene: [00:43:20] I can just imagine some poor like med student, like Chicago and it’d be like Yeah. I mean, the Aline Sandouk: [00:43:39] Doreen. Miranda Schene: [00:43:40] Yeah, I know that, you know, like you have to be willing to say in those cases,  Dave Etler: [00:43:44] what other people think I’m afraid. I’m afraid of what the Dean or my peers will think, Dave Etler: [00:43:49] who the heck cares, what they think you have a right to seek resolution to your part. Aline Sandouk: [00:43:53] And you know what, for anyone who cause something, I think Eric brought up that was so perfectly articulated is that you’re really kind of expected to, just to jump right into being vulnerable. Whereas for a lot of people they’ve never been vulnerable and that’s really scary. And so. Like, but no one ever teaches you like what the baby steps are. So like, I want to share a little bit of advice here. There’s a lot of safety in curiosity, confusion and concern. Like in that order, like whenever I have to have a difficult conversation, I never come at it from like, here’s how you are letting me down. Here’s how I’m unsatisfied. I always come at it with like, Hey, I’m curious about this. Can we talk more about that? And then that’s number one, it puts the person you’re talking to much less on the defensive and keeps expectations low. Like you’re having kind of a very equal conversation with like very low stakes. So yeah. I don’t know, someone told me that once I’m like, Hey, there’s a lot of safety and confusion. I was like, Oh, okay. I like, I like that a lot or curiosity Dave Etler: [00:44:53] if this, if this fits into that, I mean, kind of what I was thinking of, and this is what I’ve been trying to sort of remind myself over and over and over again in recent years. When you have these interactions, if you come at them with love and respect, correct. That’s part of it. I think Aline Sandouk: [00:45:07] respect always love. I don’t know. Like, Dave Etler: [00:45:10] I mean, love in the sense of like, I’m, you know, I understand, I understand that things are different for you. Yeah. Yeah. They’re not the same as they are for me. Let’s talk about this. Yeah. There’s Eric Boeshart: [00:45:22] an understanding there, Dave Etler: [00:45:24] right? Yeah. I know some people are wor you know, when they’re having trouble worried about the confidentiality of seeking out mental health services from your medical. Cool. Hmm. That’s hard. Yeah. do it anyway. Yeah. Like, I Dave Etler: [00:45:36] mean, ask the question in your first meeting with a counselor. Well, how are you going to treat this information? What are you going to do with this information going to give you, even before you begin talking about your problems, they’re going to say, and you down in a, in a, in a discussion, they’re going to sit you down and say, so what brings you here today? And the very first thing, if you’re worried about this, the very first thing that can come out of your mouth isn’t well, I haven’t having all these problems, the very first thing that could come out of your mouth before you reveal all that. Is I’m afraid of any repercussions that might come from sitting down with you. and these are normal fears and they know it. So let the counselor address those fears in that first session. And remember that they do have a legal obligation for confidentiality, the same obligation that you have as a healthcare professional, by the way. Yeah, but make them work for your openness. That’s totally fair. Aline Sandouk: [00:46:25] Absolutely. And that’s, that’s good advice in life in general.  Dave Etler: [00:46:31] for it Aline Sandouk: [00:46:31] I thought you’re joking, but I’m like, yeah, hell yeah. You know, people, people should deserve to hear the details of your life. That that’s, that’s rich and that’s intimate and that’s. You know, that has a value. And sometimes people will hear these like very personal stories and be like, Oh, that sucks. And then what’s for lunch. And you’re like, I just opened my heart up to yeah. Miranda Schene: [00:46:54] Or like, that’s almost more devastating than them using it against you as being like, Oh, wow. That’s some really deep personal information. Yeah, exactly. Get some coffee, like, Aw, come on. Dave Etler: [00:47:08] One more thing about that piece of advice is, okay, so they’ve reassured you right. Feel free to say, okay, I’ll talk to you next week about this. Take yourself, take a minute to sort of internalize that information and process it. And then you can come back next week and then start the real work if that’s what you want. Miranda Schene: [00:47:26] It is a thousand percent okay. To be selfish when you’re asking for like personal help, when you’re asking for help, it is a thousand, because I think sometimes we have this. Thing of being like, well, I came to them, even though I’m being vulnerable, it’s still like, Oh, it’s their time. That is their job. They are there for you. You can be selfish that is allowed and is permissible and acceptable and great. Aline Sandouk: [00:47:47] Yeah. And can I add to that with one more thing? Nope. Nick Lind: [00:47:53] Dave Aline Sandouk: [00:47:53] forgot his place up in Miranda Schene: [00:48:01] I don’t need to, I’m just back here watching popcorn, Eric Boeshart: [00:48:04] try to assert myself. Aline Sandouk: [00:48:08] We’re still friends at school. it’s okay to put, you know, eggs in different baskets. So like feel free to shop around. And I it’s something I was thinking about is. A lot of med schools sometimes feel detached from like the main Institute, if they’re part of an institution with an undergrad and like other, like, you know, faculties, other schools. so like something I never thought of doing is like talking to the university counseling services. Yeah. They don’t talk to the med school counseling services. Yeah. So feel free to shop privately. That’s also very hard because a lot of psychiatrist, psychologist have full patient loads. They’re not taking on new patients, but like, yeah. But look for that chemistry, like Miranda was saying like, Take it with a grain of salt. Don’t immediately close the door on someone who gives you a you know, a not perfect vibe immediately, but you do need that chemistry. And if it’s not there, then you’re never really going to feel comfortable Miranda Schene: [00:48:54] opening up. Yeah. And it’s perfectly fine. Even if you’re a med student to seek help outside of the med school. Like if you, if obviously if you have the resources to but like that is also allowed, you don’t have to be restricted to Dave Etler: [00:49:07] which your insurance Miranda Schene: [00:49:07] cover that. mine would cover it, I believe through UHC. So I could go to like the like UHC psychologist, psychiatrist stuff. And I think it covers some, like, I think blue cross blue shield. There are a few therapists in the area that also, cause I’ve looked into this there are a few therapists in the area that would also take my insurance. So it’s possible. Aline Sandouk: [00:49:27] Yeah. I mean the point the Miranda is bringing up. Is that check your coverage? Yes, absolutely make sure. Miranda Schene: [00:49:35] Because some insurances will cover mental health care. Some only cover 50%. Some won’t cover it, but a lot will, and they might cover it, but only for specific providers that specific locations or for only certain types of things. Dave Etler: [00:49:50] Yeah. Should Eric Boeshart: [00:49:51] I just say something real quick? You know, speaking from personal experience, if you, in that kind of a situation as a med student, you know, obviously in our context as the short coat, but, you know, just make sure that you’re looking at resources that are available to you and it’s, it’s better to use the resources than not use them much. Like big said, act like you’re paying. Aline Sandouk: [00:50:10] Yeah, totally agree. Yep. Excellent. All right Eric Boeshart: [00:50:14] guys. Aline Sandouk: [00:50:14] Can I share one more thought? Absolutely. I was reading about Audrey Lorde recently who is she was a black lesbian activist from the seventies who I think had breast cancer, had a one-sided mastectomy. And like, I guess at that time it was like even more stigmatized to not have a double mastectomy or get an implant. And she was like, no, I’m not going to protect the world from my, you know, one missing boop. You have like really forced people to accept her as she is. And I really admired that. And I think something I was reading about her is that in a capitalist system, self care is almost subversive and that really resonates like taking care of yourself as revolutionary, the most. Right. So Miranda Schene: [00:50:57] treat, I agree. Like there’s a certain element to where you’re expected to have earned it. There’s, there’s a concept of like, if I work hard during the week that I’ve earned a day off or I’ve earned, like treating myself by going out, it’s like, you don’t have to, you could just do that if you need it. Like, if you’re like, I haven’t worked that hard, but I’ve, I really need a break. And it’s like, Dave Etler: [00:51:15] I see this to people all the time. Like people are like, Oh, it’s come up recently in the context of vaccinations. Like not necessarily the urn thing, but that. Oh, I can’t do that. I have something to do at work. geez. It’s not, you know, the thing at work is Dave Etler: [00:51:32] not that important, you know, let your coworkers to handle it. Aline Sandouk: [00:51:40] Your, your job, your boss would not die for you. Miranda Schene: [00:51:47] Yeah. Dave Etler: [00:51:48] Yeah. Well, I guess you have anything else you want to say before we close the show? It’s good to be Miranda Schene: [00:51:52] back. Aline Sandouk: [00:51:56] I am happy to have you Dave Etler: [00:51:57] here. That’s our show though. Got to go. I gotta go eat lunch. I’m Miranda Schene: [00:52:01] hungry. That’s fair. I think my Aline Sandouk: [00:52:02] boss, he acts like we don’t pay for him. Miranda Schene: [00:52:06] My gosh for us Miranda Schene: [00:52:12] a lot, the only things in your lives, how dare you have to eat lunch Aline Sandouk: [00:52:18] if it’ll make you a better, Dave. Okay. Dave Etler: [00:52:23] There’s so much work to be done Miranda Schene: [00:52:26] in case anyone is wondering, playing along at home. That’s called hypocrisy Dave Etler: [00:52:33] guys. Thank you for being on the show with me today. Thanks, Dave. Thanks. This is fun. And what kind of slug would I be if I didn’t? Thank you. Chef coats for making us a part of your week. If you’re new here and you like what you heard today, subscribe to our show. Wherever fine podcasts are, podcasts are available. Our editors are AJ Chowdhury and Erik Bozart or. Aline Sandouk: [00:52:50] Take your time. Sound it out. Miranda Schene: [00:52:55] It’s actually my favorite editor. I’m a very big fan of their work because there is our marketing Dave Etler: [00:53:00] coordinator. The show’s made possible by a generous donation by Carver college of medicine, student government, and ongoing support from the writing and humanities program. Our music is by Dr. Voxin canvas fear. I’m Dave, Etler saying don’t let the bastards get you down. Talk to you in one week. Bye.   You deserve to be happy and healthy. If you’re struggling with racism, harassment, hate, your mental health, or some other crisis, visit http://theshortcoat.com/help, and send additions to the resources there to theshortcoats@gmail.com. We love you. 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