The Short Coat: An Inside Look at Getting Into and Getting Through Medical School

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. Music provided by Argofox.  License: bit.ly/CCAttributionDOCTOR VOX – Heatstroke: youtu.be/j1n1zlxzyRE Catmosphere – Candy-Coloured Sky: youtu.be/AZjYZ8Kjgs8 ;Hexalyte – Wandering Hours: youtu.be/FOAo2zsYnvA;

How Gaming Can Help You Learn Medicine Better TL;DR Rote memorization is part of medical education, but drawing deeper connections between concepts is what makes you a physician.Medical school emphasizes finding the correct answer, but when you begin to practice medicine you’ll find that the answers are much more complex than that. Although moving from med school to residency can be scary–as with any transition–Paulius found it to be easier than he expected. Dr. Paulius Mui is a first-year family medicine resident in Virginia, and a long-time listener (since before med school!). He wrote to Dave not long ago because he had published a game called Table Rounds. It’s a game he and his friends in med school had made up, and now he’s working to bring it into the world as an actual product. Paulius sent Dave a copy of the game [for free, he’s not a sponsor. –Dave], and M1s AJ Chowdhury, Alex Belzer, Nolan Redetzke, and M4 Joyce Wahba play the game. Players use cards–each with a medical term or concept on it–to draw connections between them. The connections can be deep or they can be spurious, but if you can make your case you’re a winner. But perhaps more importantly, it’s a game that you can make your own, coming up with rules that make it even more interesting and helpful. Paulius also gives his advice to Joyce, who’s about to start her residency in Emergency Medicine, and discusses his first-year as a resident beginning while the pandemic raged. 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 364 Gamifying Med Ed Dave Etler: [00:00:00] Welcome back to the Short Coat Podcast. a production of the University of Iowa Carver College of Medicine. I’m Dave Etler joining me in the studio and in our live stream on Facebook’s. The Short Coat Student Lounge is a fine slate of medical student co-hosts, say hello to an illustrious M4, Joyce Wahba. Joyce Wahba: [00:00:50] Hey everyone. Dave Etler: [00:00:51] Over there is a  fine young M1 who’s really going places.  AJ Chowdhury. Hello. Next to him is his virtually identical twin and a fascinating M1 himself. Alex Belzer. Howdy. Howdy. Holy smokes. A new co-host is entered the chat it’s  Nolan Redetzke. Hello. But if you thought that was all that I had to offer you today on today’s show, I would ordinarily say isn’t that enough for you listeners, but yes, I do have more, Dr.Paulius Mui  is a first year family medicine resident now in Winchester, Virginia. Is that right? That’s right. I did a little research. He’s the co-inventor of a new game called table rounds. Which I think you’re going to like short coats. Hello. Thank you for, thank you for joining us on the show. So we’re gonna play this game a little bit first. The story I want to get into the story, you sort of the origin story  of this game. Is that you and your med student friends sort of invented this game while you were, a med student at, , BU Boston university VCU. Okay. I don’t know why I thought it was B U I F I swear to God. I looked it up. I think he’s actually, I found your, I found your resident page on the website and I think it says, BU dude, Paulius Mui: [00:01:57] I went to BU for undergrad Dave Etler: [00:02:00] okay. So I read it wrong. Joyce Wahba: [00:02:03] You tried though. It’s fine Dave Etler: [00:02:04] I do try. I do try to do my job. Yeah. It sounds like your effort was there. Yeah. Not focused. I think you said , you sort of invented or came up with this game while you were in med school… Paulius Mui: [00:02:15] Yes. Yes. So you know, thanks for having me on the show. I’ve actually listened to you all since, um, at least Dave Etler: [00:02:21] September 2016, I went back and looked through my emails in the first time you emailed me was September of 2016. Paulius Mui: [00:02:28] So this is even before. I knew for certain that I was going to be a doctor. So, , yeah, I’ve been following along your work for some time and it’s been really exciting now, full circle, kind of crazy. Dave Etler: [00:02:41] Now you’re now you’re the real thing and you’re on the show. I love it. This is great. So yeah. How did you come up with this game? Paulius Mui: [00:02:46] Well, I mean, it was harder to not make the game, I think, than actually make it and share it with my  colleagues. It really came out of how we studied, and with my friends and the study group. I think it was step one dedicated period when it really clicked. And, I think kind of realizing, going through medicine and medical school, realizing that, medicine is just a lot about identifying connections that seem to be hidden, and there are all sorts of clues that the patient tells you and you’re supposed to kind of piece them together and  make the connections visible for others. And I can get into kind of more of the maybe not the so exciting part, but you know, like my friend Graham, he would quiz me about different things. For example, Dave, we’re going to get a little medical here. Dave Etler: [00:03:34] I can handle it. I’m going to gird my loins. Paulius Mui: [00:03:38] Girded. So, you know,  he would, Say. Okay. So tell me what you know about cellulitis. Like what’s the first thing that comes to mind and I don’t know. I think of like an antibiotic, like clindamycin and , he’s like, okay, what else is associated with clindamycin? And I would say, okay, maybe C-diff. Okay. And then he’s like, what about C diff? And then I would say a vancomycin and then we just kind of go down the path of one thing makes you think of another thing. And then we’d kind of see how far we can take each other’s knowledge. And so that’s really the idea that, you know, there are these things that you’re, you know, you think of one thing and then it’s connected to the other and we’ve built off of that and created this, this game. Dave Etler: [00:04:16] I don’t know about you guys, but I like this approach because , it seems kind of an obvious approach because a lot of med school is about memorization, but that’s not where the real sort of learning,  is done. Right. I mean, that’s just basic sort of surface level. Paulius Mui: [00:04:29] Yeah, exactly. And I mean, I think, you know, this  is, certainly a game in a way to play.  But really, I think it’s more of a symbol for why we. Actually took the effort to produce it and make it available and go through some of the steps that are not just purely fun. Cause it , took, , a lot of time to make sure that it’s a good experience for everybody is because, we’re really hoped to nudge the culture of medical education to create a space for playfulness and human connection.  In a place that I think doesn’t welcome it all the time. I think just broadly speaking, obviously. That’s great. I like that. Yeah. every medical school experience is different for everybody, but, and so this is kind of coming from my experience and, you know, medical education is full of amazing people.  But some things exist that I think could be improved and whether this is just. kind of leftover or,  unintended consequences of well-meaning efforts or just historical inertia, but they’re definitely a few things that. Could be changed about the way our training happens in terms of it matching up with the reality of practicing medicine. And I think that our game really tries to bridge the gap between what’s what’s not available right now in terms of developing some of these more emotional intelligence skills. Dave Etler: [00:05:49] Any reactions to that, you guys? AJ Chowdhury: [00:05:51] That sounds very high yield. Alex Belzer: [00:05:55] I’m going to go, I’m going to go ahead and file that in the good take file folder, AJ Chowdhury: [00:06:00] indeed. Dave Etler: [00:06:02] So you had this idea,  and what was it like to bring. An idea from something you do with your buds to a physical product, I’m kind of always fascinated by this, by this process because it’s not, it’s not just like have an idea, make it profit. Paulius Mui: [00:06:18] Yeah, that’s true. Exactly. And I mean, I think this is not something that is going to make us wealthy or,  have us, pay off our student loans. I think this is just a fun thing that hopefully we’re not going to lose money and be net neutral or so in the end. ,  we launched officially and made it available for sale early in 2021, but have been working on it.  Really, I think for about two years now. And so we first developed the concept for the game and then tested it with our friends and refine the rules. And then we , tested it some more, got feedback and went through a lot of iterations and kind of handmade the cards ourselves.   First we created everything by hand. Then we take it to the next. Phase of printing it at Kinko’s. , then when things were kind of evolving, as we were expecting, you know, we ordered some prototypes research, the different companies they could place the order with, and then kept testing it. And then eventually when we  felt comfortable that this is a. Worthwhile pursuing, you know, we took somewhat of a risk and,  bought an inventory and, , created a website, you know, like a whole production, I think. And I don’t, I honestly don’t know why it happened.  But it did. Dave Etler: [00:07:34] Yeah. Because I was going to ask, like, what was that signal that you were like, Oh yeah, This, this has legs. I can, we can do this. I mean, Paulius Mui: [00:07:40] so, because I think, I believe in what it represents. So, so there, you know, I didn’t get into the specific issues that are wrong with, I think, medical training, but I’m happy to highlight a couple of times do it. Dave Etler: [00:07:53] Nope. There’s nothing Paulius Mui: [00:07:54] wrong with that actually. You know, I’ve only, I only know my experience and,  the few people that I know outside of my medical school who have gone through the same thing, and I’ve heard it echoed, but if you guys feel that this is not really true to you,  let me know. So what I think, for example, there, there are a couple of things. The,  biggest thing that stands out to me is that the opportunity cost of not studying in medical school is huge . I felt , the need to, to try to study whenever I can even like when exercising, I try to listen, you know, try to kind of do something medically oriented because of that people generally who go to medical school, you know, adapt really well to their circumstances. And that comes at the neglect of their wellbeing and physical health and mental health and the very qualities that our patients expect us to model,  just are not paid attention to. And I think that the system,  Yes, there are wellness efforts and so on, but I think that really the medical education system does not make it easier for us to prioritize ourselves. I don’t know if. There is a glimpse of truth in your experience, especially you, Joyce, that you’ve gone through school. Yeah. Joyce Wahba: [00:09:08] I mean, I would definitely agree with that. Like I think wellness very much needs to be like a systemic thing. Like that’s kind of built into the structure of what the school has to offer. Not just kind of like one-off wellness lectures. Cause those don’t really do much. It’s more of like a cultural change overall. Alex Belzer: [00:09:24] I feel like I was trying really, really hard. I don’t know how much I can speak about this, but I was really, really hard to do wellness stuff and they’re Dave Etler: [00:09:32] well, wait a minute, wait a minute. Wait a minute. I just want to point out that if you do say something wrong, you will have to die. I mean, Alex Belzer: [00:09:38] it’s a sacrifice we’re willing to make. Okay, good. Yeah. I was, I was trying really, really hard to like. Emphasize wellness if that makes sense. Joyce Wahba: [00:09:46] Wellness passport not make you more Paulius Mui: [00:09:47] well. Oh, that is AJ Chowdhury: [00:09:48] peak Alex Belzer: [00:09:49] wellness. No, I booked a flight, taken a trip and gone through customs to get to the land of wellness. Paulius Mui: [00:09:56] Absolutely. Dave Etler: [00:09:59] Yeah , these are efforts that are clearly still developing. I could, I think we can. Yes. AJ Chowdhury: [00:10:06] And they are open to student feedback. I sit on the committee. That’s actually revising wellness passports for next year’s M1s. That Dave Etler: [00:10:12] is,  no, I’m confusing it with something else. Nevermind. , AJ Chowdhury: [00:10:14] there’s a student liaison committee. Yes. Alex Belzer: [00:10:17] Talk Paulius Mui: [00:10:17] between Dave Etler: [00:10:17] the Paulius Mui: [00:10:17] two. Yeah.  If I can just add, so it sounds like you guys can, , empathize with what’s happening,  over at other places too. And so, so that’s one of three things. So then I think the second thing that I think about is that there’s also a culture of individualism and medicine and.  Obviously people will study sometimes together and, you know, there’s some, , team-based exercises, but overall, you know, I felt even though I had friends and classmates and so on that we got along with there, there’s definitely a sense of you, , competing, , ultimately against other people, even at whether it’s a silent competition or something. You know, there’s just, there’s that process of ranking. And like our school was ,  pass/ , fail  for the first two years, but  people keep track of where you stand and then you have to go through the match process to get into the residency as like the ultimate competition, you know, limited spots. And you, you need to be able to get into places. Whereas the real world medicine is really all about working in teams and having the emotional intelligence to collaborate. And, , that’s really ultimately how good patient care is delivered. And so, you know, you have to be able to work well with pharmacists nurses, audiologists, like all of the people out there in the health team. So Dave Etler: [00:11:39] the, so the game,  is basically an additional opportunity to learn while you’re enjoying the company of other people. Instead of like just hitting the books, Paulius Mui: [00:11:48] basically. Exactly. So really like if you just play the game, I don’t think you’re going to get very far in medical school. This is more medics, Joyce Wahba: [00:11:56] right? Their version. Dave Etler: [00:11:57] I mean, you know, version two, the DLC,  you know, Joyce Wahba: [00:12:03] expansion packs, infectious disease, the  start getting really specific Alex Belzer: [00:12:08] version. Oh, Honestly, what would a game be these days without more payments, right. Sports, Paulius Mui: [00:12:17] credit card. Yeah. And, and actually this it’s an interesting point and you can . Certainly take it, you know, when we’re going to talk about the details of the game. Yeah. So you can certainly take it and make it a lot, you know, like specialty specific, but truly, if you are creative enough, you can connect a lot of things to. To the foundations of medicine. I think that’s the other piece, the third part, I think that is kind of different about the medical training compared to the practice of medicine that, you know, I’ve had just under a year of experience, but yeah. To me, there’s that one difference of, , medical school. It really drills into you certainty and knowing the one correct answer. I mean, our often our self identity is wrapped in our academic standing and, you know, How we live is defined by the answer you choose. And that determines what specialty you go into. And the real world is a lot more messy. I mean, there is not any answer in the back of the book for most patients. Like, yes, there are definitely things that you shouldn’t do, but for the most part, even something as routine as like treating hypertension, you have so many different ways to approach it for a particular patient. And it’s really. An art of how you do this. And I think that this is what this game is really best at doing and showing how, like, most people say, like, where are the answers to the cards? Like, where do I look up these connections, how one card connects to the other, and that’s the whole point. Like you need to get out of that mentality because like that. It’s far from how the real world is. And I think the more we get comfortable with discomfort, this is where we grow, and this is how innovations happen in medicine and so on. I think that’s pretty Joyce Wahba: [00:14:09] parallel to fake it till you make it. It’s just like, yeah, this connects totally smiles and nods. Dave Etler: [00:14:16] When you began your residency journey the residency portion of your journey,  in the past year.  You had this theory about how these connections work. I mean, you pretty much knew that that was true, but where are you at some point? Were you ever like, okay, thank God. Now that I’m doing this for. Living, it actually turns out to be true. Paulius Mui: [00:14:36] Yeah. It’s amazing. It really is amazing. I still can’t believe it that this, this is so rewarding to have gone through med school and now I’ll be doing it in real life.  And Oh yeah. And I mean, I went to school late. Like I,  you know, in my twenties I kind of explored other things and , I got to know myself really well. And then I was pretty certain that medicine was for me, but just, , Being out in the real world and experiencing, and having that privilege to, to just have patients really listen to what you say because their health is in your hands. I think that’s really cool. Dave Etler: [00:15:08] You know, I’ve had, you know, I don’t want to brag, but I have had a few really good product ideas in the past. Paulius Mui: [00:15:17] Oh, no, I think I’ve heard some, Dave Etler: [00:15:21] for instance, I probably talked about them on the show. I did have an idea for a wearable airbag for motorcyclists, which is actually a thing it’s like an Joyce Wahba: [00:15:29] avalanche bag. Yeah. They have like these backpacks Dave Etler: [00:15:32] yes, exactly. My other, really, really good idea that I never. I’m waving around a screwdriver, why… My other, other really, really good idea was the ejection seat for motorcyclists, which for some reason, like if you get, if you find it in, in trouble, you know, you would eject you from the motorcycle, get you out of harm’s way. For some reason when I mentioned this to people. Nobody liked that. AJ Chowdhury: [00:15:57] Well, does it come with an extra optional purchase of a parachute so that you land safely? Dave Etler: [00:16:03] Yeah. Well, one of the, yeah, that was a great idea. I mean, I supposed, it was better than, you know, smashing into something I’m patenting that right after Alex Belzer: [00:16:10] this. Okay.  Give everybody a jet pack all the time. Yeah. Same thing. AJ Chowdhury: [00:16:16] Pretty much the same thing. Or we could Alex Belzer: [00:16:19] genetically push evolution so that everybody can fly. Okay. Dave Etler: [00:16:22] That’s a little more complicated than than making a card game  , or even making a, an ejection seat. Somebody did point out to me   the bridge overpass problem with my ejection seat. So percentage that’s when I abandoned. That’s when I abandoned the idea, what Alex Belzer: [00:16:38] percentage of roads are actually caused by, or our roads are covered by an overpass. I dunno, like less than Dave Etler: [00:16:44] 0.5%. That’s a good point. Yeah. That was a good point. I should have brought that up while your AJ Chowdhury: [00:16:49] product could drive a lot of business towards Joyce. Alex Belzer: [00:16:52] That’s true. Joyce Wahba: [00:16:54] Always looking for new patients.   Dave Etler: [00:17:14] I’m proud of you. Paulius.  I’m proud that you were able to, to come up with this and bring it to  some sort of fruition. So let’s try this out.  First of all, I’m going to awkwardly.  Run around and rearrange cameras so you guys can fill while I do this . Paulius Mui: [00:17:29] So how are you guys feeling?  Tell me what your experience has been so far. Have you like looked at the box or the instructions or any, or, you know, nothing I’ve seen the outside of the box. I think the box is big vibes, really Alex Belzer: [00:17:44] very pastel. That’s that’s all I got. I really read two wait three sides of the box. That’s about it. They’re six, five, five. I’m at five. I haven’t seen the bottom. Is there anything on the bottom? There is no, let’s go. Can you go see the, it looks like a nutrition label. It Paulius Mui: [00:18:03] does. I like AJ Chowdhury: [00:18:03] it. Paulius Mui: [00:18:03] Is this good for your health? Paulius you know, I can’t make any substantial claims, but I Joyce Wahba: [00:18:09] also, how badly am I going to be embarrassed by this? If I haven’t done any clinical care since like October and haven’t taken step two you since like, before that Paulius Mui: [00:18:18] this is okay. We’ve played with non-medical people. And,  I think it’s pretty interesting. I think, I think this is more about a different way to think and a way to teach each other. And just like in real life, you can look stuff up. And I think the, you know, the whole idea is to just generate a conversation that otherwise wouldn’t happen. And, , I think as long as it’s. Somewhat, you know, it’s like,  was it, it was saying, you know, like, , does, is this supposed to help you learn medicine better? I mean, I think it’s just going back to one of those things where it’s just an excuse for you to not feel pressured, to just always grind. And this is just like giving yourself the permission to hang out. And if you learn something along the way great. But if you just end up like hanging out with people and you know, talking about some medical things, I think that is. Okay. Just like what you’re doing with the podcast. I think you’re taking, you know, you’re setting an hour aside to do something that is not just, you know, scrolling through a computer and clicking on answer choices. I think so that’s part of it. Wait, Alex Belzer: [00:19:23] so you’re saying that we don’t have to memorize that the Philadelphia chromosome translocation is nine and 22. You’re saying that we can just look that up Paulius Mui: [00:19:32] cause they asked. Yeah. So it’s part of the system. That’s part of the system. Yeah, there were patients give us AJ Chowdhury: [00:19:40] five multiple choice answers for their diagnosis. By the way, we had our first physical SPs, the three M1s in the room last week. And we were, we were definitely getting softballs like I have a history of reactive airway disease. Hah. Dave Etler: [00:20:01] Yeah. And you do your best.  All right. So I have awkwardly set up the camera. We’ve got this top-down view of, the table. So,  what do we do? How do we start? What’s going on? Polly’s give us the, give us all Paulius Mui: [00:20:12] right. Okay. So, well, , Open up the Dave Etler: [00:20:14] box. Oh, yep. It’s important to, Paulius Mui: [00:20:17] and everyone in the room is going to play. Right. So I cannot play cause I Dave Etler: [00:20:21] need to run things over here. I realized I wanted to, Oh Paulius Mui: [00:20:24] my gosh. Okay. All right. Well, we’ll do another round later for you. Dave Etler: [00:20:26] If I can see on my monitor, maybe I can Paulius Mui: [00:20:29] see it. This is maybe what you could do is you could turn the box over and just,  spill the cards on the table and then, , shuffle them up.  We can just exactly mix them up like that, but there were different colors, the cards. And so that’s also on the top of the box. And so the way that the game is set up is that it has. 280 cards that we selected very meticulously to represent the foundations of medical knowledge. And so they’re roughly grouped into five categories.  And  , if you look at the box,  it goes from the peach to purple. , going outside in. And so the cards that have,  and you can flip one or two over just to get a sense of like what’s on there, but exactly. So let’s say vascular valvular heart disease. Right? So, so that’s , blue card. So that’s a diagnosis card. So what if we, if we look at the each cards there signs and symptoms, the yellow ones are the. Tests the workup, essentially, that exactly that you would order like an ultrasound and then the green ones are the results of different tests that would come back to you. So what does that one say? Hyper or hypochloremia. Right. So if you order a BMP, you know, you would  see what the chloride levels are. Then the, you already showed, , blue card, which is a diagnosis card, and then the purple cards are the treatment cards. So that’s. Metronidozole exactly. So like, for example, what do you guys, when you see metronidozole what do you think of anything random comes to mind? There’s a Z in that word. Okay. Alex Belzer: [00:22:02] Hazel, some kind of a proton pump inhibitor. AJ Chowdhury: [00:22:06] We have not learned that yet. Paulius Mui: [00:22:10] That’s really interesting. Actually, that’s one of those instances where like omeprazole is a PPI, but,  metronidozole is actually not it’s an anti- I think parasitic technically, , because it used to for like anaerobic,  or I guess antibacterial, you know, use for,  anaerobic,  infections, like.  Bacterial vaginosis, for example. , but anyway, so, so you have these cards and the beauty, I think of this game, you know, patting myself on the back is that,  these are building blocks of medical knowledge, right? And you can discover learning just by playing. And it’s very modular. So it’s almost like those Lego toy pieces that you can,  essentially,  , follow an instruction manual to build something very specific or, you know, once you’ve like have a bunch of Lego bricks, you can kind of create your own thing  and you can do what you want with it. And so same here, like we have these cards and we’ve created a number of ways that. You can follow our instructions and play whether you want to make it a competitive or a collaborative experience. If you have 15 minutes to play versus you have an hour to play. And I really encourage you to take a look through the instructions on our website at some point, just to get an idea of how you can play, but every time we’ve showed this game to somebody they’ve. Adapted it and created their own rules to play. Like they want to like, even somebody, one of the, , attendings at another school actually said that they would pick out the cards that are related to the patients on their service, and then use those cards to kind of, take the game based approach to learning about their patients and generating discussion, because you are going to be vulnerable when you try to explain things and you’re still learning. But at the same time for people, for educators, it’s a really good opportunity to identify what you don’t know in real time  and that’s a space for,  teaching you exactly where you’re at. You know, cause sometimes with the lecture hall there might, you might be, you know, giving the, the information only to segment of the people. That’s the right information at that time. But a lot of people might be, you know, you might be overshooting or undershooting sometimes. Any questions about those basic ideas? Alex Belzer: [00:24:25] Sounds like I’m going to do a lot of finding out what I don’t Paulius Mui: [00:24:27] know. That’s exactly right. Yeah. And I think about it. Yeah, no, I that’s exactly it. I think that’s a very sharp,  perception. And, and I don’t know if you’ve had that feeling too. Like, I mean, we kind of joked about this, but when, like you do, you know, like I said of UWorld questions, I don’t know if you, you guys have not gotten into it yet. Right? The, uh, ones, but it’s like a, you know, Q bank, , like you would do Kaplan for MCAT or something like that. , and you know, you get up, like you do like a set of 20 or 40 questions at a time, and then you get feedback of like, how many did you get right wrong? And it’s like very demoralizing sometimes to get more than half incorrect or whatever. Right. But if you think about it, like that is really good because you did not waste your time. You actually like struggled and you realized that this is how much you did not know. And ultimately that’s for the better, because if you’re just cruising and, you know, missing only one or two questions, you kind of wasting your time, you know? Cause you’re already know that’s 90% or whatnot. That Joyce Wahba: [00:25:32] is such a positive way to look at blocks where you get 40%. That is definitely not what I was going through stuff when you did it. And you’re just like, dang it Paulius Mui: [00:25:42] exactly. It’s cause you learn 60%, right? Joyce Wahba: [00:25:46] It’s like, wow, such a learning opportunity. Alex Belzer: [00:25:49] Well Paulius Mui: [00:25:50] development. I mean, I just tend to, I think lean and over optimistic zone, but it’s. It’s carried me this far and that’s just who I am. I think that’s Dave Etler: [00:26:02] beautiful. All right, we’ll get into it. Let’s see. Paulius Mui: [00:26:03] Let’s do it. Okay. So you’ve, you’ve shuffled the cards. So why don’t each of you,  draw? , let’s say why don’t we do five cards. For example, guys are Dave Etler: [00:26:13] meticulously picking up. Paulius Mui: [00:26:15] Can we look at them?  Yeah. So why don’t you take a look and it’s okay for, I think maybe show me the card so that I can see if you’ve shuffled them fairly. Okay though, where it’s not like everyone has one color. Okay, perfect. So, , for this first, so the way you would play, right? Like if you’ve dealt these cards out, so,  Joyce, do you like, can I ask you to, for example, , when I go first, would you be okay with that? Okay. So what you all could do is, , make some space in the middle where you’re going to build your connections. And then some, some basic ideas of how the connections work. So for example,  also somebody just can, , pull out a random card and put it in the middle. Exactly. CSF. Okay. So do you guys know what that is? Cerebral spinal fluid. Exactly. Yep. And Dave Etler: [00:27:05] camaraderie, Paulius Mui: [00:27:07] you know that? I did know that. Yeah. Dave Etler: [00:27:11] Look, a lot of you dude works at Paulius Mui: [00:27:13] a medical school. He’s a medical educator. There’ll be some. The thing is that you’ll need to look up. Cause as M1s, you’ve just not been exposed to some of these abbreviations and so on. And so like “metropablanopzole” Dave Etler: [00:27:26] absolve or whatever. Paulius Mui: [00:27:32] So, okay. So let’s say,  and you know, depending on how competitive you want to get, like, we, we could give like a time limit per turn or whatnot, but. For now, , maybe we can just like try without too, too much intensity. So the way the connections basically work is that  you can put your card on either edge of, , another card. So the connections would work, , essentially, you know, top or bottom or side to side, but the diagonals don’t need to connect in a sense.  And if you have only the cards that are directly touching should have some sort of connection that you explain. So for example, if you have, you know, like three cards in a row, the first card and the third card don’t have to directly connect, like they can, but you don’t have to. So it’s really all about the immediate connections. This is that’s the basic principle. Does that make sense? Yep. Okay. All right. So Joyce, so why don’t you look at your cards and you know, why don’t we take like 30 seconds or so, and see what things you could connect to the card in the middle right now using your cards. And you can use Joyce Wahba: [00:28:39] one. These are going to be a gigantic stretch. Paulius Mui: [00:28:42] And, and that’s that’s okay. And that can be part of the conversation. Like if this is something that is maybe borderline not true or then the group can say, all right, like we’re not buying it or we need to double check and look it up and then you’ll just take those cards back and it’ll be someone else’s turn. Yo, Paulius, Joyce Wahba: [00:29:03] well, yes, if you weren’t here, I would be the one with the most medical knowledge, I could say whatever I want and they just be like, “uh-huh!” Paulius Mui: [00:29:08] I mean, technically, yes. Joyce Wahba: [00:29:12] I’m just kidding.  I’m going to play cirrhosis, Paulius Mui: [00:29:15] play as many cars as you feel comfortable with with that current hand. So you could, you know, if, if you, okay. So I actually, when I see this, I’m not really like nothing jumps out at me immediately, but. Well, let’s say, if you don’t want to play any other cards, then after you’ve set your cards down, then you get to explain what the connection is. And you can take as much time to do that. And you can like use your phone if you wanted to. I mean, these are the rules you could create amongst yourselves, but so like what teaching point would you share with somebody about CSF and cirrhosis? Dave Etler: [00:29:49] I’m going to translate that. What bullshit Joyce Wahba: [00:29:55] I don’t quite see the connection there. He would say something on rounds and they ask you a question and you just BS your way through it. And they’re just like, AJ Chowdhury: [00:30:06] why don’t you make a report about this to present tomorrow? Paulius Mui: [00:30:09] Go ahead. Joyce Wahba: [00:30:10] Um this is an absolute stretch, but CSF, the F stands for fluid. Cirrhosis. You have really bad, like alcoholic cirrhosis, and you get like some ascetes goin’, then that’s also a fluid, AKA, this is a really big stretch. I don’t have a lot. In my card, Paulius Mui: [00:30:29] you did it, Joyce, Dave Etler: [00:30:32] mildly, you did a Joyce Wahba: [00:30:33] great is like, eh, take it back Dave Etler: [00:30:37] to do that. My understanding is that,  this is a, a game of spurious connections, even, you know, sometimes we’re here to be freethinkers. Alex Belzer: [00:30:45] Right? Paulius Mui: [00:30:46] Exactly. I mean, I think, I think. This is a good connection to start with. I think it’s a little bit of a soft connection, but I think it’s a really interesting way to think. Cause I would not have put these down cause I just, I wasn’t thinking the way you did. So. But the way you explained it actually made me think that one thing that I, for example, and like, I’m not that far from you guys in training, but what I would try to teach on top of that if I was a more seasoned attending, I would say, okay. So when we think about ascieties and cirrhosis, You want to think about the sag that it’s like?  Serum albumin to ascieties gradient. And if it’s like greater than 1.1, you want to think that the ascieties is caused by portal hypertension. So that’s like one idea and I have to double check myself with what I told you is true, but the there’s this calculation that you can do based on the fluid to tell you where it’s coming from. And then, , you want to also potentially think about,  like with ascieties, you’re testing it for bacteria because you’re looking for something called spontaneous bacterial peritonitis. And if you have, like, I don’t know, Joyce, you remember, it’s like, if you have more than 250 neutrophils, then like you want to start antibiotics and you have like a higher, you know, and that’s the diagnosis for it. The same way that you test CSF for bacteria that,  indicates that you want to start antibiotics for example. That was beautiful. Genius. Yeah, that’s kind of the idea. And then like, if we, if I was playing with you guys, we try to pull up the sag ratio and see what we can remind each other about that. And that’s pretty much it. And so who’s setting to your left. We can have. Okay, Alex. So why don’t you try next? Do I draw a new card since I played one? , so you don’t have to, because the idea would be to try to get rid of your cards first. So if Alex can play all five of his, you know, then boom game over in a sense, right. But this is like the version. So this, this version is called flash rounds in a way that in a hospital you can kind of do flash rounds where you just like . Quickly talk about the patient and like, don’t go too much into the detail. Alex Belzer: [00:32:54] Okay. So I think I’m gonna play multiple cards. You got dizziness on CSF and we got anti-histamine on cirrhosis and. Dave Etler: [00:33:04] Going for it, ladies and gentlemen, I think I’m going to, like, I’m going to put this Alex Belzer: [00:33:06] exciting. Would’ve put magnesemia on cirrhosis as well. And I think, well actually, but say like, can I attach things to Paulius Mui: [00:33:15] cards that I yeah, so exactly you can. Yeah and Alex Belzer: [00:33:19] that’s all the cards in my hand that I know what they mean. So, so here we go. So CSF is related to dizziness. Cause if you have too much CSF, in your ventricles, then you can push on the vestibular nuclei and make some weird stuff, go on and get dizzy.  Cirrhosis is a liver issue. , and I’m guessing that in some way, the liver is related to the metabolism of magnesium. So if you have cirrhosis and you have decreased liver function and maybe you can get magnesemia  the anti-histamines,  I know that there is some processing of antihistamine drugs that is done by the liver, , which might be screwed up in cirrhosis. And then with cellulitis, I know that the wheel and flare reaction that’s associated with, , the type one hypersensitivity, , Is in the skin and if you have cellulitis, then you might have more skin destruction. When you have a histamine release in the type one hypersensitivity. So anti-histamines, I don’t know how to finish that thought, but there’s, there’s a, there’s Dave Etler: [00:34:26] a connection there. I promise. I just want to say that that was a lot of words. That sounded great. Thanks, Paulius Mui: [00:34:33] Dave. Anybody can feel free to fact check me. Alex Belzer: [00:34:41] You’ve done. Good. Thank you. I would’ve played this card too, but I don’t even know what this card means. Paulius Mui: [00:34:45] Yeah, it’s Joyce Wahba: [00:34:47] a ARB. So it’s like a hypertension medication. That’s exactly right. Okay. Cool. Paulius Mui: [00:34:53] Angiotensin receptor blocker. Yeah. Okay. So by the way, your connections were awesome. I think the only, like all of them were really creative and you did it in a way that I think like wasn’t the first thing that comes to mind. One thing that I would say we should double check is,  magnesium and cirrhosis. Like one thing that I think of, , I think magnesium might, I think it’s a kidney that it will be filtered through. , but I do think that. The cirrhosis and mag levels are you tend to have low mag in people with liver disease. And I think, I don’t know if it’s just due to poor nutrition or other, like as just an associated thing. That’s what I think of, but the way I would double check it is just, you know, either Google or PubMed, magnesium and cirrhosis and see what comes up. And it actually has been a really interesting way for me to read a lot of pub med articles. Like just get to explore the Dave Etler: [00:35:49] connections. You know, , I will jump in with my knowledge and say that,  magnesium deficiency is commonly associated. As you said, with,  liver diseases and may result from low nutrient uptake. Like you suggested things like greater urinary secretion,  low serum, albumin, concentration, hormone inactivation. So yeah, Alex Belzer: [00:36:06] it seems like it Dave,  the Dave Etler: [00:36:08] cuff. Yeah, I had all that knowledge in my not Paulius Mui: [00:36:12] holding his phone up. He is pub med. So is AJ next? Yeah, I am. Alex Belzer: [00:36:21] All AJ Chowdhury: [00:36:21] right, so asthma and anti-histamine. There you go. Joyce Wahba: [00:36:26] Beautiful. I got that one. You have asthma, or you Paulius Mui: [00:36:28] understand that Dave Etler: [00:36:31] in this deck and AJ Chowdhury: [00:36:33] Magnesemia and arrhythmia, those are the connections that I can make. So with asthma, you can have allergy induced asthma, which you can treat with anti-histamines and arrhythmias. I know nothing about the heart, but I know that electrolytes can mess with the rhythm of the heart. So that’s my connection. There. Paulius Mui: [00:36:56] That’s that’s amazing. So good. So like, if you, for example, if Dave was, , an award winning, , faculty attendings specializing in asthma, you know, he would prompt you to probably say something along the lines of like, What specific antihistamine would you use and what would be the dosing like to just push your knowledge to the next level, if this was like a, you know, a teaching session. , so that’s one way to kind of explore and deepen and challenge yourself, you know? Yeah. This Dave Etler: [00:37:26] is pretty cool. Magnesium deficiency does, increase irregular heartbeats. Paulius Mui: [00:37:31] So yeah. Yeah. So actually that, that is a really cool connection because.  With torsades, which is this rhythm it’s if you look up torsades, it’s like twisting of the points from French. It is when you’re, , just, you’re pretty much close to dying, but the way to treat that is that you give a lot of magnesium  And interestingly magnesium, I don’t know,  Joyce, if this rings a bell, , how it acts as a calcium channel blocker. And,  that’s why it kind of blocks the, the rhythm that’s of the torsades and actually, you know, stabilizes the heart just filed that away Dave Etler: [00:38:10] for four, , three months from now when she’s day one on her, her roof.  Have you Paulius Mui: [00:38:32] guys Alex Belzer: [00:38:32] seen the videos where people will. Like, you know, there’s hyperlinks and Wikipedia pages. And so people will try to like, yeah, speed run from like Ben Shapiro’s Wikipedia page to like Sonic the hedgehog just by like going through and like clicking stuff,  that’s embedded in the Wikipedia page. Cause like there’s this virtual network of Wikipedia pages and they’re all connected somehow. , this is exactly what that reminds me of except with medical knowledge and these nifty little cute cards. Paulius Mui: [00:39:04] Awesome. All right.   Nolan, right? Is that yeah. Nolan Redetzke: [00:39:07] So I’m going to go with ACS, which I had to look up, but acute coronary syndrome,  Hey, there you go.  And that could be,  causing an arrhythmia.  But also off of that, , cortisol could be a triggering. Triggering that, but then off of cortisol, we have which is the excess cortisol,  , causing that. Paulius Mui: [00:39:30] So, yeah. Nice that’s work. Yeah. I mean, you’re getting the hang of it. And so that’s the idea is that. You, you know, explore what you don’t know together. And you’re somewhat vulnerable because like, I mean, it’s, you know, like you guys somewhat know each other. I don’t know if you’ve hung out before, but yeah, but like that’s. You know, it takes a lot of courage, I think, to do that because we, you know, often in like lectures, you just sit and listen, and then if you’re answering anything, a lot of it is just like on your computer and you click away, like, yeah, you might have some like,  I think we call them PBLs where you have to like Work together  through like multiple choice questions or whatnot. But this is, I think just really pushing you to that next level of, , exploring what being vulnerable and learning. I was actually Alex Belzer: [00:40:18] curious about the cortisol can connect a precipitate. Like if you had just had like cortisol rush, can that precipitate,  acute coronary Paulius Mui: [00:40:25] syndrome? I don’t know if it would precipitate it.  I often think that if you’re having a, so ACS, acute coronary syndrome can, you could have, , Multiple things that go under it, but something like a STEMI, right? You have an ST elevation MI and if what I would connect cortisol to is that you’re, you know, you’re stressing your body and your natural response is going to release some cortisol levels. And so it’s more of a response to that. That makes sense. I would think so. , but, and I mean, you could also think about that. Why are you having MI and is it related to, , like myocarditis for example, and,  you would treat myocarditis. Actually, I don’t remember if you would give steroids, but you could kind of like, kind of go down that path. And this is a good opportunity. Like, like, like I maybe should be knowing this, but, , like I admit, I don’t remember. And so I would go ahead and PubMed it or look it up and see what I can learn or maybe they’ve already looking things up. So, Dave Etler: [00:41:21] I’m not, I’ve exhausted my data cap during today’s show. Well, this is, this is great. I kind of enjoyed watching these guys go through it. And, talk about the connections. Love the idea. before we end the show, though, I wanted to, I would be remiss if I didn’t put you on the spot a little bit. Wait, can we AJ Chowdhury: [00:41:41] take a second on the box at the bottom? It says distributed by low yield productions, LLC. That is amazing. Dave Etler: [00:41:52] Good one. Paulius Mui: [00:41:54] Appreciate you noticing that. Yeah, I mean, yeah, we Alex Belzer: [00:42:02] all get it though. We all get it. Dave Etler: [00:42:05] Beautiful.  Yeah. So anyway, I’d be remiss if I didn’t put you on the spot to ask you how your first year went in the middle of a pandemic polys. , Paulius Mui: [00:42:15] well, I think overall it went really well. Obviously. I I’m still here. I’m smiling. , I learned a lot, , you know, I, so I’m in a family medicine program and it’s a lovely place it’s located at the entrance of a national park.  Yeah, it’s all those things. Yeah. They really make it easier to, I think, tolerate residency, but I I’m surrounded by. Great co-residents which I think make all the difference. And the pandemic has definitely changed how, , the things that normally happen. They didn’t for us There’s that. Social dynamic that really suffered, I think for everybody. But like in our program, we have end of block resident parties. Whereas someone just get, you know, we get together and go to a park, get food, or do some activity together. So those are on hold. And because of that, we don’t get to see each other’s families and significant others. And so on. I think the patient interactions are certainly different. Like, you know, and family med it, we see like acute urgent cases and we see chronic disease, you know, patients with chronic illnesses and manage those. And with the, with COVID a lot of the people with acute complaints,  like those numbers have decreased. So I think that really impacted directly what. What kind of, , chief complaints I was getting experience with and a lot of the people like we have a cold clinic section, so you, some of the patients are like,  triaged for you to only be taken care of respiratory issues. And so, you know, like that’s not how normally things are. You just kind of adapt and work with that. I think,  it was also, you know, like at the beginning everybody’s wearing masks and you like don’t know what the other people look like. It was really kind of interesting. Dave Etler: [00:44:05] Gotten really good at recognizing people by their eyeballs only. Joyce Wahba: [00:44:08] It’s gonna be a shock to the system to see the rest of their face, who are you! Paulius Mui: [00:44:14] Okay. And I mean, they’re also, you know, A component of like taking care of COVID patients. And like, this is very much like I’m in the middle of this thing that is global. , and,  actually like it’s, it’s your first that you’re–I remember, you know, reading, hearing about it and then. Now I have patients with COVID on my list and I’m rounding on them and I’m trying to like be safe and like always wondering like, like, did I like wash my hands enough to like, you know, like, am I at risk or whatnot, but certainly, I don’t know. You know, this is my experience. I think overall it’s been really, really great. And,  like I’ve gotten,  The vaccines and feel a lot more comfortable now, you know, and so on, but still, like, I don’t think we’re we’re done yet when it comes to letting our guard down. Yeah.  Dave Etler: [00:45:06] Joyce, here is an M4 going into emergency medicine, your family medicine. Resonant different specialty, but any advice for Joyce,  as she looks forward to starting her new job in July. Paulius Mui: [00:45:18] Congratulations. Where will you be? Joyce Harbor. UCLA. Oh, so awesome. Wow. I mean, I think it’s a, it’s a tough question. Like to broadly, you know, give advice. I think,  I think that things that have gotten you this far, you’re just going to continue to do, and like, that’s like. You know, , I think you still like the learning curve I imagined was going to be like insurmountable, but it really isn’t too bad. I think everybody has gone through this process who’s become a doctor and people relate to that experience of you being a new physician. I think, try to, I don’t know if you like the journal or reflect, but like, I still remember when I placed my first order ever as a physician. And like, it wasn’t like a Turkey sandwich. It was like a CBC. It was like a three year old and they were sick, but like not really like toxic. And I was like, I don’t know if I should get this, like, this will hurt them. Like, you know, on peds we usually try to just like, be more conservative and, and actually started out my first rotation in the ed. And that was really, really cool. And like, you’re going to have all these experiences, like I remember. There was a patient who I don’t even remember. It was like they were dizzy maybe and  I did my like neuro assessment and it was kind of normal, but then I had them walk and something was off. Like their gate was strange and I was like, okay, we probably need to like, get an MRI and my attending, , I was like, yeah, just do it. And I’m like, aren’t you going to go in like, double check what I told you. And I was like, wait really? And then, and then, yeah. And you’re like fitting in this MRI. I’m like, Oh my gosh. It’s like 2000 or something dollars. I’m like this one click is going to change. Like what happens to this person? And then now, you know, like you’re just ordering CTS and everything left and right. And so, like, I just think that this is such an exciting part of your growth that like, appreciate it. Enjoy it. Take like, like care for yourself. Like, don’t forget your priorities. Like I know that’s my, like, I think. The same advice that anybody like going through med school, too, like enjoy the process and, and, you know, like if it, if you don’t have to do residency the way that everybody else does residency, I think just find what works for you and take care of yourself. Like along the process. Dave Etler: [00:47:39] That sounds like fantastic advice. , well, I mean, so Paulius , getting back to the game, where can people find out Paulius Mui: [00:47:45] more about table rounds?  Well, you could check out our website, usually have all of our information there. It’s, it’s play table rounds.com and, , hopefully, you know, you’ll see your classmates playing it, and if you don’t see them, tell them about them. We’re doing some research with this game to just see if it can be part of a curricula in different places. Yeah. So feel free to explore and I’m available for contact. You can share my email if people want to email me, my email is Paulius@bu.edu and I’m happy to answer any questions. I really appreciate you guys having me on and being you know, courageous to try the game and. Yeah. Thanks. Good idea. For the game. Joyce Wahba: [00:48:27] I think it would be kind of funny or fun to have like joker cards. This could be just like a little tiny starter pack on the side where it’s just like random words that people have to connect. Like. Donut or something like that where it’s just like, okay, I have a Metformin. Okay. Diabetes, some like random, like everyday objects or something like that, that you just have to like throw in Dave Etler: [00:48:48] there. Nice. There you go. Love it. Paulius Mui: [00:48:52] We’ll have to call it that Joyce’s dresses edition. Dave Etler: [00:48:59] Well, thank you so much for being with us today on the Short Coat Podcast, it’s been a lot of fun. And that’s our show. Joyce AJ, Alex, Nolan. Thank you for being on the show with me today. AJ Chowdhury: [00:49:07] Thanks for having us. Thanks for being so I don’t know. Alex Belzer: [00:49:10] Insert good adjective here. Okay. Dave Etler: [00:49:12] I will take it. And what kind of jerk would I be if I didn’t? Thank you, Short Coats, for making us part of your week. If you’re new and you like what you heard today, subscribe to our show. Wherever fine podcasts are available.  Our editors are AJ Chowdhury and Eric Boeshart, and Alex Belzer is our marketing coordinator. The show is 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. Fox and Catmosphere. I’m Dave, Etler saying don’t let the bastards get you down. Talk to you in one week 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. Music provided by Argofox.  License: bit.ly/CCAttributionDOCTOR VOX – Heatstroke: youtu.be/j1n1zlxzyRE Catmosphere – Candy-Coloured Sky: youtu.be/AZjYZ8Kjgs8 ;Hexalyte – Wandering Hours: youtu.be/FOAo2zsYnvA;

A new group of co-hosts, all M1s, discuss what it’s been like to start medical school (in a pandemic). TL;DR We discuss what our new co-hosts, all M1s, learned about themselves and med school this year.Did they prepare or study before they started school in the fall?And very important: what flatulence schedule would they prefer? Steph Rodriguez, Zain Mehdi, Martin Goree, and Carl Skoog are approaching the end of that stressful first year of medical school.  Dave seized the opportunity to talk about the things many incoming students might want to know about starting medical school in the coming year.  We talk about whether to prepare before school starts, what sacrifices they feel they made to study medicine, what they’ve struggle with and what was easier than expected, and whether in the midst of a lot more online learning than they were used to, did they find their people among their classmates.    Dave likes getting to know people, so he also posed some Would You Rather questions in the hopes of revealing things about his new co-hosts. 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! 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. Music provided by Argofox.  License: bit.ly/CCAttributionDOCTOR VOX – Heatstroke: youtu.be/j1n1zlxzyRE Catmosphere – Candy-Coloured Sky: youtu.be/AZjYZ8Kjgs8 ;Hexalyte – Wandering Hours: youtu.be/FOAo2zsYnvA; What an AI thinks we said 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 today in the studio and live streaming on our Facebook group, the short code student lounge, it’s all first year med students, Steph Rodriguez joins us in the form of ones and zeros here in the studio. It’s Zane Medi. They do that right. Uh, Martin Gorey is here What’s going on in the man whose last name should absolutely be a verb. It’s Carl Skoog. Uh, guys, if Carl’s last name was a verb or a descriptive noun and Carl, you don’t get to answer this because that’s not how this works. If Carl’s last name was a verb or whatever, what would it mean? Carl Skoog: [00:01:12] It’s kind of like a snail. That’s like scooping along on the ground, you know, it’s like a little slimy, but it’s like it’s Dave Etler: [00:01:19] yeah, Zain Mehdi: [00:01:20] yeah. And you have the answer quick. Yeah, Martin Goree: [00:01:23] I thought about this. I Stephanie Rodriguez: [00:01:29] was thinking more of like a scoop, like ice cream now, like he’s scooping ladies away and scooping ice cream and all that Dave Etler: [00:01:36] scooping ladies away. Is that what you’re busy scooping them, ladies away. Those ladies, they got schooled. Did you get, did did school cause you to get made fun of did that not really Martin Goree: [00:01:52] made fun of, but mispronounced like more than you would imagine. Dave Etler: [00:01:55] What kind of name is scoop? I’d Swedish. I knew, I think Martin Goree: [00:01:59] it, I think it has some sort of, like, I think it’s a noun actually like means something about the forest or something like that. Oh, don’t quote me because I’m not Dave Etler: [00:02:07] a hundred percent sure. But I’ve said this on the show before. Do you know what Etler means in Turkish? I don’t remember now. Steph looked like she was about to guess. Do you, like an animal Stephanie Rodriguez: [00:02:17] is a, like a, like a biking. Dave Etler: [00:02:21] That was another one. Antler. Thank you. No, it means meats in Turkish. If you look up Etler on Google and look at image search, you’ll see a lot of pictures of cuts of meat. Interesting. Zain Mehdi: [00:02:33] It’s very different. Martin Goree: [00:02:35] And have you had a nice Etler? Dave Etler: [00:02:39] Oh wow. All Etler is delicious. Zain Mehdi: [00:02:42] It is. It looks just like any meat. It’s just like meat. Dave Etler: [00:02:44] I think it’s just meats, like , uh, the general category. No, Stephanie Rodriguez: [00:02:51] it looks good. I’m looking at these pictures right now and they’re like fat, meaty. Well, Dave Etler: [00:02:56] that’s all true. Stephanie Rodriguez: [00:03:04] I’m going to tell her shop to go get us some Etler. Dave Etler: [00:03:07] Yes. I’m so glad. We’ve got a bunch of em, ones today who are also new podcasters as your first year , uh, rushes to a close. I thought we should take some time to talk about that. Let’s give the listeners a sense of what it was like to , um, Oh , uh, yeah, because you know, what’s , uh, Courtney, thank you. Um, because I forgot that I have control over cameras. And so Stephanie has been the only person , uh, is there we go. Stephanie Rodriguez: [00:03:33] They only see my face. They’re only seeing Dave Etler: [00:03:35] your face for a long time. I hope you didn’t pick your nose. Stephanie Rodriguez: [00:03:38] I started like dancing and everything. Martin Goree: [00:03:41] Wheat. Dave Etler: [00:03:44] Thank you, Courtney, for , uh, calling the out. Is that the Stephanie Rodriguez: [00:03:46] one live Dave Etler: [00:03:46] person? No, there’s a few people now. My mom not joined in yet. What’s your mom’s name is your mom’s name? Uh, David Kelly or Garrett. Etler well Carl Skoog: [00:04:00] like a burner Facebook account. Yeah. Dave Etler: [00:04:02] Uh, anyway , uh, I would like to give the listeners a sense of what it was like for you to enter medical school, what you didn’t know , um, what you did know. Barry, what you didn’t know what you know now , um, which should be relevant and useful for once , uh, on the podcast. But also want to get to know you better since it’s your first time here and , uh, for several of you, my actual first time meeting you. So let’s start. Where did you go to undergrad? What did you study? Um, Oh, David Kelly says lies. I am her mother. Stephanie Rodriguez: [00:04:31] I’m obviously not dad. Fans not know what to do with technology. I would have to set it up for her. Dave Etler: [00:04:37] Uh, where did you go to undergrad and what did you say we’ll start with , uh, we’ll start with you Carl. Sure. Martin Goree: [00:04:42] So I went to university of Iowa for undergrad. So I am in Iowa city in, at this point, I guess you could say. Okay. But I studied biomedical science Dave Etler: [00:04:51] and graduated in 2020. All right. Uh, uh, Martin. All right, Carl Skoog: [00:04:54] well, I’m from Iowa city originally. I moved to St. Louis. I went to wash U for undergrad. I graduated in 2019. Um, but I’ve returned to the Dave Etler: [00:05:00] nest. Okay. Uh, Zane, Zain Mehdi: [00:05:02] um, I went to cor Cornell university, upstate New York for undergrad and studied double major in bio and English. And then I graduated last year in 20, 20 everyone’s favorite year Dave Etler: [00:05:16] and stuff. Stephanie Rodriguez: [00:05:17] Um, I am from the suburbs near Chicago. And so I went to Loyola, Chicago. I did biochemistry psychology. Um, it’s really cool that you did English major is saying, because then you can like, look at my essays since they are horrible and I don’t know what to do with them. So Dave Etler: [00:05:34] good to know. Well, we can also help you with that in the writing and humanities program. That’s Zain Mehdi: [00:05:38] know, I’ve heard Kate is very helpful with that kind of stuff. She is. Dave Etler: [00:05:41] She is amazing. That’s what we’re here for. That’s why we were made step. So if you want to, if you want to go to some rando. I mean to get critique on your writing, excuse me, you know, I can’t stop you, but Stephanie Rodriguez: [00:05:57] actually after , um, when I was writing my personal statement, I like sent it to so many people that by the end of it, I was like, Oh, this person sounds interesting, but it is not me. Yeah. That’s what I sent out when I got admitted. So whatever it Dave Etler: [00:06:10] was all lies at that point, Zain Mehdi: [00:06:13] writing all that stuff for med school was a lot of work. Yeah, for sure. But I think, I, I definitely feel like I had a little bit easier being, having an English degree because I knew I didn’t have to proofread like every 15 minutes. Like every time I re-read it, because I was just been writing for so much, like for four years straight, just kind of writing a bunch of Dave Etler: [00:06:32] stuff. So hopefully, you Zain Mehdi: [00:06:33] know, a little bit about that slight advantage. I think hopefully, otherwise I wasted a lot of money. Well, the real, Dave Etler: [00:06:38] I mean, the real trick is knowing what people want to hear from you, I guess. Yeah. That’s more Zain Mehdi: [00:06:42] important obviously. Dave Etler: [00:06:44] Well , uh, and you guys who took a year year , um, after graduating undergrad why did you do that? Carl Skoog: [00:06:49] I was an idiot , uh, my first two years of college , um, my grades weren’t great. I was having a lot of fun. Uh, it was kind of buckled down. Um, you know, I might’ve gotten into a med school who’s to say, I definitely wouldn’t have been, you know, in an especially safe spot by any stretch of the imagination. Uh, so really I feel like until my junior year of college, I was not really in any place where that was something that could like, you know, immediately be considered. Um, and at that point it’s getting a little late. I was Dave Etler: [00:07:12] also an idiot in college, so I guess Carl Skoog: [00:07:15] I think it’s a valuable experience in its own way, you know? Dave Etler: [00:07:17] Sure. But , uh, there are cheaper ways to socialize. Yeah, there absolutely are. Uh, Stephanie Rodriguez: [00:07:21] he’s hitting you with the truth right there. Dave Etler: [00:07:23] Hey man. That’s my truth. You know what I’m saying? Um, what about you? Uh, uh, Carl, I think you also actually went straight in, you went straight in Oh, Steph. Oh, it Stephanie Rodriguez: [00:07:31] was me. Yeah. Um, I took two years. Well, okay. Cause I made a different type of mistake. I worked full time while I was in college. And so I worked at the airport as like a gate agent. I was that person that was like , um, the airplane is ready for boarding, please come through and everything like that. And I also worked at like the hospital and at the pharmacy. And so I did a lot of stuff just because I liked working more than I did , um, going to school and yeah, that’s a mistake. Yeah. No, and it wasn’t, you know, I made a lot of money. I met a lot of people like at the airport, met like a ton of celebrities. That was fun. Dave Etler: [00:08:05] So I don’t think that’s a mistake at all. I think that’s a. No, I think there’s this. I think there’s a certain mindset that you got to , uh, it’s somehow a problem if you don’t, get into it early , um, because of opportunity costs and all this kind of stuff, you know, like you’re, you’re losing out on income and you know, you’re going to be old when you’re done and all that kind of stuff, which you’re still going to be old, you know, at some point you might as well, and it doesn’t matter that you’re done with med school or not. So I don’t know. Stephanie Rodriguez: [00:08:28] I think, yeah, no, that is true. I know, I know some people do think about that. Who knows? Yeah, I think it, it got brought up a lot during my interviews, for sure. I say like I got in just because of my extracurricular activities, not because of like my GPA or my MCAT was fine, but like my GPA was like, I also had a lot of fun, you know, my spare time, I was like more in, so I wanted to have fun during my twenties. And so that’s why. Dave Etler: [00:08:52] Uh, crystal says, OMG, I did the same job at the airport during school and while studying for the MCAT. So there you go right now. Stephanie Rodriguez: [00:08:59] Ooh, it is fun guys. It is, you get free flights and everything. Zain Mehdi: [00:09:05] That’s Dave Etler: [00:09:05] where it matters. That’s cute. Stephanie Rodriguez: [00:09:08] That’s what got you. Dave Etler: [00:09:09] But you weren’t on you. Weren’t working. You didn’t work on planes. You weren’t like a steward. No, no, Stephanie Rodriguez: [00:09:14] no. I had done it. Those, those flight attendants. Let me tell you about those flight attendants. They’re very mean I spill the Dave Etler: [00:09:23] tea on the flight attendants. Stephanie Rodriguez: [00:09:25] Very mean they, they act like they own the place and I’m like, I’m just trying to make an announcement. And then because you know, those planes, it costs them like a lot of money every second that they’re like late. And so I’m just trying to get people into the plane, make the announcement and then by, you know , um, so it’s a lot of work, a lot of responsibility. Dave Etler: [00:09:45] Where are you , uh, worried about starting med school in a pandemic year? Oh, sure. I mean, of course you were worried about starting med school. Cause you’re not crazy. Zain Mehdi: [00:09:55] I would say, I feel like the biggest thing was like not being taught, like see people and like, that was like a huge factor for me. Cause I was like looking at like a few different places and one of them was in the West coast, one of the most East coast and then there’s Iowa right in the middle and both ends, like the country were hit like really bad by like the pandemic early on. So like everything was closed down. Like there’s like nothing going to be in person. And I was like, this is going to suck for, for like our first semester, first year of med school. Like not going to be, to do anything in person, no like anatomy lab in person and that kind of stuff. And I was like, this doesn’t sound good. Um, but then thankfully here we were able to do stuff in person, which was a blessing, especially with like. How, like how few interactions I had throughout the quarantine with people besides my family, it was definitely like , uh, nice to be able to see people in person and be able to do stuff in person. But again, there’s still like its own complications because not everyone can be together at once. It was kind of like just small, like pieces of social interaction that you could have. Um, and even like, not being able to talk to like professors and like people like administration, faculty, like in-person is different than it would have been otherwise. So definitely a challenge to think about when starting off. But I think Carver handled it pretty well with everything. Dave Etler: [00:11:08] Sure. I was going to ask you like, yeah. Zain Mehdi: [00:11:09] I mean, I have, cause I know some people like at other med schools who didn’t have anything in person until like November and that was, I was like, wow, that really sucks. Stephanie Rodriguez: [00:11:20] How do you inform friendships Zain Mehdi: [00:11:21] then either you had like friends beforehand or like you’re just desperate for any kind of like zoom, social interaction. How else do you try and like engage with Martin Goree: [00:11:30] people it’s been hard enough even having like some in-person activities to meet people. Because I would say that I probably there’s 150 people in our class. Uh, I’d say I probably know 50 people, like pretty well. And then there’s another 50 people that I’ve just maybe never seen before. And that’s because they have the option, you know, stay home and do zoom if they want or come in for some stuff. But I don’t know. I really wish I’d met more people in my, in our class by now. Oh, for sure. Stephanie Rodriguez: [00:11:53] Yeah, just, I think it depends how lenient , um, some of the students are, some are more like, Oh, in-person stuff and others are more like I’m going to stay home because of the pandemic. I think it’s just depends on the attitude of everything. Carl Skoog: [00:12:04] If you were smack downs between people about that than I actually would have predicted, to be honest with you given like how polarizing the topic is. Right. What do you mean in terms of like people feeling like, you know, strongly either that we should be doing more in-person stuff or none at all. Um, and you know, in reality, the college has kind of just kind of played it down the middle for the most part. Anyway , um, Dave Etler: [00:12:23] we were, they were working pretty hard to like to walk a line. Um, and it was, it was for the most part, I think , um, it wasn’t a hundred percent. Uh, virtual. Was it because you did small group stuff? Zain Mehdi: [00:12:35] Oh yeah. We had a fair bit. Yeah. In the beginning that was in person, which was nice. Like there was, we had like, all our small groups were in person. We had anatomy lab in person. And so like, there’s like a fair bit of interaction, again, not like nearly as much as it would be without the pandemic, but like a lot more than the other plate. Like other places that I know of in other med schools that like I have friends that go to is very different in that regard. So yeah. I know Stephanie Rodriguez: [00:12:58] some places didn’t have like an anatomy lab. I mean, they didn’t have like a in-person anatomy Zain Mehdi: [00:13:03] for our third exam. We had to like do it virtually, which was horrible. And I cannot, I cannot imagine doing the entirety of anatomy lab, like virtually it was, it was like not a fun experience. So being able to do an Adam 11 person was really, really, yeah. Dave Etler: [00:13:17] Um, did you prepare in any way before you matriculated. Stephanie Rodriguez: [00:13:20] I felt like I needed to prepare, but I’m so happy. I didn’t, I’m so happy. I did it cause there’s no way you can prepare for like med school. I think just taking like the , um, classes and undergrad, like taking that biochem anatomy that really helped me , um, my first semester , uh, taking those classes just so it was much smoother and , um, easier to like go ahead and have some more free time to go ahead and make friends or be a part of activities as well. I don’t know about you guys. Dave Etler: [00:13:45] Well, this might be relevant for somebody like you, who this question might be relevant for somebody like you, who took some time away from your science studies. Um, so what do you think Martin? Carl Skoog: [00:13:55] Yeah, you know, it’s a good question. Um, I think med school teaches you everything you need to know. Right? That’s like the single biggest takeaway. There’s no need to like do mini med school during college, before med school. Um, obviously there are circumstances where it’ll make the transition easier going into classes during med school. Um, but I don’t know. I mean, like, I feel like anatomy was a bit of a foreign concept to me at first. I hadn’t had any exposure to that previously. Um, and I’m going to guess maybe like a third to half of the class had something like that, at least in some respect. Um, so that took a little while to get like, you know, my feet wet in it, but , um, I think as you kind of progress further and further, those differences tend to even out a lot. Dave Etler: [00:14:33] Yeah. I don’t know. That’s that’s our job is right. Carl Skoog: [00:14:36] Um, and I don’t know, I guess kind of what I’ve found personally is a lot of people who scribed in particular, like in an emergency room or something that were exposed to like a lot of different things before med school, the first two months kind of seemed like gods, you know, they had like a really broad knowledge base compared to other people. And then I think that’s kind of. I, I don’t know. I’d be willing to a wager that there’s not much of a difference now at this point. Yeah, no, I totally Martin Goree: [00:14:58] agree. I think most people are on a level playing field by this. Zain Mehdi: [00:15:01] Yeah. Now it’s gotten better, but yeah. Cause I, again, being like one of my majors being like something completely unrelated to medicine as it stands currently, like academically, why wise, but then like my other, like my bio major was focused so much on like molecular pathways. Like that’s like what I studied and that kind of stuff, which is like, which we covered in like the first, like two weeks of, of foundations. Like, okay, well that’s my entire degree there. That’s all I know. And so everything that was pretty foreign. And so Dave Etler: [00:15:30] you’re like, I could have done Martin Goree: [00:15:31] this in two weeks. Zain Mehdi: [00:15:32] Come on. It’s like I spent 40 waste of money and we learned it all in the first like month. Um, But, yeah. And so, cause I know I took like one anatomy class, which is like a comparative anatomy. So it wasn’t even just about like human anatomy. I was like about like turtles and like a bunch of random animals and like just awful, like apparently flies is a big thing. Cause the entirety of embryology was focused on fly embryology. I don’t know. Dave Etler: [00:15:55] It was a of pretty much the same when they’re Zain Mehdi: [00:15:57] embryo, I guess so, but like it was a mandatory class for every bio major. So I must’ve been important just in general, but um, really did not help much with anatomy lab, but like I know a few people who like had there’s one person who’s like did like a masters in anatomy. I’m like, okay, well, you know, a lot more than I do and I will come to you for advice. Stephanie Rodriguez: [00:16:14] Is it, those people that like came to like each , um, lab group and like started teaching us Zain Mehdi: [00:16:19] during the no, no, no, no, just another student. Yeah. Just another student just like had, had taken Academy masters and like anatomy or in the human anatomy. I was like, well, she knows everything already. And I’m like, Hey, you don’t know any of these things. Um, and then like, like Martin said that people had experienced, like after taking a year or two off to like work in like the hospital and like CBL, they’re like, Oh yeah, let’s do this, this, this, this I’m like, I don’t know what any of these things are. I felt so lost in the beginning, but I think you’re Dave Etler: [00:16:47] supposed to feel lost in the beginning. Oh yeah, yeah. Yeah. Stephanie Rodriguez: [00:16:50] People from different backgrounds. And so that’s a nice thing. Like everyone’s teaching each other, their own thing. Everybody has a weakness and a strength. And so it’s great that we’re all able to come together and learn from Dave Etler: [00:16:59] each other. So even in, I was going to ask that cause even, cause one of the things that, you know, I think we in student affairs we’re concerned about , um, is. You know, that we were sort of worried about a loss of the potential lack of opportunities to find your people and to do social learning , um, uh, and all that kind of stuff. Uh, it sounds like there were opportunities though, so, so that’s good, Martin Goree: [00:17:20] um, Stephanie Rodriguez: [00:17:20] to Dave Etler: [00:17:20] like meet each other to meet each other, but also to learn with each other. Yeah. I know you live in, in Firo, one of the medical facilities and there’s also a KK, so maybe you had a, I don’t know, some sort of advantage in that regard to somebody who lives, you know, maybe in their own apartment or Stephanie Rodriguez: [00:17:38] yeah. You know, that’s a big thing. That’s the whole reason why, especially because of COVID, but , uh, it made me decide to go ahead and live in a fraternity and a medical fraternity. Um, Uh, I say medical fraternity. Cause whenever I tell my friends, Oh, I live in a frat. They’re like, are you the only girl? They’re like, what’s going on? I’m like, know, Oh, it’s co-ed guys. I swear. It’s coed. And one of my friends came along and she saw only guys. And she’s like, didn’t you say this was co-ed? And I said, I said, so where there are girls here, they are coming out. They are just in their rooms or something. Um, but yeah, no, it was great. Yeah. I got to meet a lot of people as a result and then also upper class men as well to just give advice about exams when I would tell them like, Oh, I’m freaking out about this exam. They’d be like, yeah, that exam was super hard. I almost failed. And I was like, that is not the attitude I need right now. I need positivity. But , um, no, it’s great living with a bunch of other people during the pandemic. Um, just so you can make those friendships and it’s important to have a support group while you’re in med school. That is so important to have a support group. I can’t stress that enough. You need somebody, you can like tell your worries too. That is so important. Dave Etler: [00:18:38] Well, speaking of support, I get pitches , uh, almost every day from people who want to come on the podcast, which is nice. Um, but I got one the other day that I just wasn’t sure about. It was the author of a book about how to raise it was how to raise your child to be a physician. And I mean, that’s what it seemed like from the title title. I’m not going to say, say the title because maybe we’ll have this person on the show. I’m not really Zain Mehdi: [00:19:04] explained themselves Dave Etler: [00:19:05] through, except you’re like, I really want them to be like, what the hell. Um, yeah. All right. I’m just going to say it cause they’re not coming on the show. Um, , uh, I was looking at the Amazon description and it’s like, whether your child is a toddler, a teen or in college will help you figure out how to re I’m. Like, why are you doing that? No, you can’t. Who’s doing this. Did you guys, I like as a student affairs professional as a student affairs professional. All right. I’m going to tell you the truth. Martin Goree: [00:19:33] I don’t want to hear from your parents. Dave Etler: [00:19:35] You’re too old for that. I worry, you know, like when student, when parents con I’ve had a couple of parents contact me over the years and every time I’m like, Stephanie Rodriguez: [00:19:44] what are they contacting you about? Dave Etler: [00:19:46] Ah, there was a couple of times I got contacted , uh, during the, the fall semester from parents asking about vaccination. Like when is my chalk and your vaccination? I don’t know why they’re calling me probably because my, like, I don’t have anything to do with that. Um, I mean, my name is like among the first and the contact page on our website, so I’m pretty sure that’s why. Um, but like, I’m like, you guys are adults, you guys were adults before you even came into medical school. I don’t wanna hear you. I just think , uh, maybe parents shouldn’t be involved at this point. I don’t know. Stephanie Rodriguez: [00:20:15] Completely agree. Completely agree, but I bring this up because Dave Etler: [00:20:19] yeah, but I bring this up because , um, families are a source of support. Did you guys, did you guys feel supported by your families or did they just not have any idea what is going on? Zain Mehdi: [00:20:29] No, I, I definitely feel like it’s super important to have like, at least, I think for me, at least it’s been very important to have like my family support because , um, like my brother, he was like, he’s like the. He went through the whole like med school, like process first. And so it was like learning, like experience, like, see like, okay, this is what I’m getting into. Like being able to understand that like actually like, see if this is if it actually is for me or Dave Etler: [00:20:51] yeah. Yeah. You had an important , uh, I don’t know if advantage is the right word, but you had a nice window into it. Definitely an advantage. Zain Mehdi: [00:20:56] I didn’t, I would have been a very lost otherwise about like how to do certain things. Cause it’s like both my parents, they do research and like, that’s like, it’s, it’s different for sure from like medicine and like going through med school and becoming a physician. And so , um, like they try to offer advice on that, like, Oh yeah. Research. Like, if you’re interested in this, I can tell you about this. But like, that’s not even the majority of what, like being a physician is about research is like only if you’re interested in kind of thing. Um, so their advice was just kind of like, not as helpful as it could have been. Uh, but still like very important to me, just like kind of the support, like they’re trying to help like that super, I mean, just like effort is like all that. You need and like, just that kind of like, okay, if you need anything, let me know that kind of stuff. It works super well. Where’d your brother go to school? He went to Drexel in Philadelphia for med school. Okay. I mean, we’re from Pennsylvania, just having him as a resource was super helpful and still is like, sometimes, like I remember last semester for one of our CBLs I had a doing learning issue on, on EKG, which is , uh, feet there. Cause like there’s like a bunch of leads. It was like, it was so I was like, it was like Sunday night and I was like, Oh my God, I am, I have no idea what I’m doing. And so like, I called them up and. How he helped me a lot because he’s an internal medicine and going to go into interventional cardiology. So like that’s his feet. So like yeah. If yeah. Having that as a resource. Stephanie Rodriguez: [00:22:18] your sister also want to be , uh, go into Zain Mehdi: [00:22:19] medicine. Yeah. So she’s a, she’s already in like a BSDL program where, so she like, doesn’t, she’s like, she just started her freshman year of college, but like, she doesn’t need to like apply to med schools cause she’s already in a program it’s kind of like you apply to like, it’s like a dual degree kind of thing. And so she’s already set to go with that. Dave Etler: [00:22:37] There is a tendency to talk about being a medical student and physician in terms of sacrifices , um, like your, your, the sacrifices that you make to become a physician or a med or even a med student. Um, do you guys feel like you’ve made sacrifices. Carl Skoog: [00:22:52] That’s an interesting question. I don’t know. I guess, like, I don’t think there’s any right way to approach this necessarily. Like, I think it can just be like a job, you can treat it as like a job that you did, like a little bit of extra schooling for , um, obviously like certain time commitments, whatever, you know, can I push the boundaries lab? Dave Etler: [00:23:07] I guess there are things that technical, you do sacrifice, right? Like some people would say , um, Oh, I don’t know you because you know, you could go into another field and make more money for less outlay. Um, so I guess that’s kind of a sacrifice. Stephanie Rodriguez: [00:23:21] I dunno. I have like , um, engineering friends, cause I have majority of my friends back home are like engineers. And so here they are, I’m done with school , um, and their jobs making money and they’re like planning, vacations. All I are just like spilling money. Like, like it’s nothing, you know, and I’m over here like, Oh, I would love to join in maybe next time. But I have this test that I have to like study for. So I do feel that there is that sacrifice, but it’s nice knowing that , um, at the end I will get there. At one point, I will be kind of like them and I’ll be in my dream job. And so I think it’s so important to work in something that you’re not like constantly, like, why am I here at one? Is it going to be over this shift? So I think that’s so important about life because life is already, so can be sometimes boring. And so to spice it up, it’s nice to have a job that you love in my opinion. Well, we’ll Dave Etler: [00:24:11] check in toward the end of your third year. Martin Goree: [00:24:16] Like when you’re like, why am I here? Stephanie Rodriguez: [00:24:19] What Martin Goree: [00:24:20] is this over? I don’t want to be a family medicine doctor. Dave Etler: [00:24:22] I hate Martin Goree: [00:24:23] ophthalmology. I don’t Stephanie Rodriguez: [00:24:25] actually like ophthalmology. Dave Etler: [00:24:27] I don’t want to put words in your mouth, but you know , um, Martin Goree: [00:24:29] I think in that same vein of sacrifice, there’s like a nice sense of comradery. That’s comforting knowing that like all the other people in our class are going through the same thing and giving up the same things like , uh, you know, spending extra time with friends and. Doing fun weekend, things like that. There is a nice sense of comfort. Now. Carl Skoog: [00:24:45] I Stephanie Rodriguez: [00:24:45] think that’s what makes med school like bearable, just because of like all of us, like we know what we’re, what the stresses that we have, we have common stresses. And so being able to go on the weekends, knowing that we have a test on Friday or something like that, and not just caring about that and just living in the moment. I don’t know. It’s really nice. It’s important to make those friendships during school because you’re going to need those Martin Goree: [00:25:05] for sure. Dave Etler: [00:25:22] what didn’t you know about med school before you started? Carl Skoog: [00:25:25] It’s a little bit more busy work than I would have expected to be completely honest with you. Like, I pictured myself as just kind of being like, you know, a bit of a shut-in who like, you know, studies like 12 hours a day. And, you know, I think like that level of workload and commitment maybe like kind of picks up a little bit and coming years, but at least during your first year, you know, it’s not like I’m living off of like frozen pizza and , uh, You know, not doing anything bad by grinding for an exam four weeks off in the future. Exactly. Yeah, yeah. Yeah. So I don’t know. I mean, I guess it’s like a little more similar to college than I would have predicted actually. Okay. Dave Etler: [00:25:58] I didn’t expect that , uh, anybody agree or disagree. Martin Goree: [00:26:01] I agree on the busy work. I mean, it’s not necessarily a hindrance, but there is a lot of it and you find Dave Etler: [00:26:06] ways to, well, let’s talk about what do you mean by busy work? I’m not Zain Mehdi: [00:26:09] clear Stephanie Rodriguez: [00:26:10] if you think there’s going to be more or Carl Skoog: [00:26:12] less. I thought there would be less. I thought it would be primarily entirely exam driven with some clinical encounters. Um, as opposed to like, write this one page assignment Stephanie Rodriguez: [00:26:22] about. Yeah, we have a lot of assignments due on Monday there. I liked just like , um, the clinical notes and like the reflections and activity that we’re supposed to be learning about , um, on the side. So yeah, there is a lot of that and I don’t, I don’t, I don’t know the reasoning behind that. There is, I forgot the reasoning they gave and a Carl Skoog: [00:26:40] lot of it’s just like mandated, you know, Dave Etler: [00:26:42] but isn’t the reasoning, isn’t the reasoning for stuff like that. you are in the process of becoming something. Okay. And this is, this is kind of a big deal. I mean, you don’t see, maybe you don’t see it while you’re inside, but you are in the process of becoming something and it’s worth understanding what you’re becoming and how that’s changing you. Um, Martin Goree: [00:26:59] And Dave Etler: [00:26:59] the extent to which you are. And in that understanding, I think really helps guide. It could help guide you to , um, you know, to, to be more fully aware of, you know, your own humanity and your own biases , um, and your own understanding of human nature and all that kind of stuff, which is actually kind of important. I mean, yes, you’re, you know, scores are important. Um, grades are important, but , uh, uh, doc, after who isn’t fully air, at least as fully as possible cognizant of , um, human nature and doesn’t, and hasn’t put in any work to understand how they’re going to affect people and the kind of people. I mean, if there’s one thing we’ve learned in 2020 , um, You know, people matter, and it’s not just about science, but, you know? Yeah. So I don’t know exactly what you were assigned. So I am making, I’m making , uh, assumptions. Zain Mehdi: [00:27:53] We had a similar discussion during the humanities elective on Tuesday with Kate and yeah. And Kate, by the Dave Etler: [00:27:59] way is much better at articulating these things than I am. Zain Mehdi: [00:28:02] Cause we were just discussing, seemed like writing and its place in medicine. And like obviously someone who like has like, cares about that and like writes like that’s something that I do. I was like, okay. Yeah, I totally agree. Because it’s like reflective of like you’re reflecting on yourself and your own experiences. And that gives you your own perspectives to think about later on. But it also like reading about other people’s reflections and other people’s experiences, especially if it’s like a patient can help you in the future, understand that kind of population better. And um, but like I, again, I still get it. Like there’s a lot of work that seems like it’s not. Important compared to like all the science stuff that we need to learn. And like, it seems much more like a priority for us, like focus on that because that’s what, like, essentially that’s what matters, like first, like just take care of taking care for the patient’s health. Like that’s like the primary goal, but , um, it’s just like, I feel like it’s still important to like, think about those things. Occasionally. Maybe there’s a little bit too much of it right now, just because there’s just a bunch of different things that we have to do. But occasionally I feel like it’s, it’s a good way to just. Think back and like, think about what’s going on and understanding things better , um, in a way that you might not have thought about before. Cause you just sell like immersed in the material. Um, but yeah, that’s kind of like how our discussion went on Tuesday about the Carl Skoog: [00:29:19] topic too. Yeah, no, I absolutely don’t want anyone to think that I was like arguing that, you know, med school should Dave Etler: [00:29:24] be somewhere it’s a little late for that. Yeah. Martin Goree: [00:29:27] Just cut that from the record. Dave Etler: [00:29:30] Totally. Carl Skoog: [00:29:31] I don’t know. I mean, well, the fact that there are like, you know, a number of like smaller assignments that, you know, exist on kind of like a periodic basis that need to be turned in. That’s something, I guess I wasn’t fully like expecting not that it’s bad by any means and just, you Stephanie Rodriguez: [00:29:43] know, I’d rather, it’d be like a discussion than it being us like writing something, but maybe that’s because I don’t like writing, writing, Dave Etler: [00:29:51] writing is tough. Uh, I, you know, I can, I can see that. Um, you know, I, I mean, personally I’m like, I like this format better. Like just people sitting down and talking. About, yeah. About these things should Zain Mehdi: [00:30:01] be mandated that every med student at one point goes to the shortcut. Stephanie Rodriguez: [00:30:05] Yes. People come out of their shell. I told a friend actually to come on when I was like trying to recruit , um, the last minute spa and my friend was like, Oh, I don’t know how I feel about being recorded and everything like that. And I was like, and this person always carries cash on her. And I was like, maybe you’re looking protective custody or something like that. Cause like always has cash on her. She doesn’t like to be recorded. She doesn’t like pictures to be posted. And I’m like, Hmm. Dave Etler: [00:30:31] I think you’re onto something. This person is definitely is definitely in the mob. Martin Goree: [00:30:38] I told Stephanie Rodriguez: [00:30:38] her, I was like, if you’re in the mob, I will accept you. That’s Zain Mehdi: [00:30:42] okay. Yeah, I’m okay with HIPAA you’re covered. I don’t Martin Goree: [00:30:47] think that’s covered, but Zain Mehdi: [00:30:49] definitely not. If you’re a threat to others. Dave Etler: [00:30:52] What was the easiest part of med school so far? Martin Goree: [00:30:56] Huh? Hm, Dave Etler: [00:30:58] wow. I really expected there to be Zain Mehdi: [00:31:00] something for me personally, I really liked just like the simulated, like patient stuff that we do. I feel it gets very Dave Etler: [00:31:09] well Zain Mehdi: [00:31:09] reviewed. Yeah. It’s just, I feel like I really didn’t. George is like talking to like, if I sure it’s like a fake patient by talking to a patient about like, what’s going on and wait, wait, wait, we don’t call them fake patients, simulated patients. Sorry. But , um, I just, I, I thought that was a lot of fun. Like, especially this week we had like our own, like one-on-one where we kind of did like a full thing with everything, with an SP where we did like the full HPI, like past medical history, family history, everything as well as doing a physical exam based on like a potential differential we had on mind. And I thought that was super a lot of fun and like, not easy for sure. But like, it’s definitely just, that was a nice way to just like. Feel more like a physician, you know, before we’re actually physicians. And so I really liked that part , um, and thought that was a good time. And I think we’ve been prepared, like we’ve been getting prepared slowly to get to that level and it’s been getting better and better, which with each encounter that way I Martin Goree: [00:31:59] would agree. I think the curriculum does a nice job building upon itself. Like looking back at the first couple of weeks and that school will be like, this is how you talk to someone. This is how you can have a conversation. And then, you know, they slowly out on different components of the fiscal exam, like parts of the interview. And then by the end of the first semester, I felt like super confident in my abilities to meet with patients. And I wouldn’t say it was easy, but like, it was definitely not as difficult as I expected it to be ahead of time. Yeah. So yeah, Dave Etler: [00:32:24] that looks good. And they do a great Carl Skoog: [00:32:25] job of making , um, I think like assignments of that nature, like really approachable. Um, you know, I don’t think anyone that I’ve talked to anyways really felt like there was just kind of some like overbearing evaluator who was just like breathing down their necks, ready to like knock them off for, you know, whatever they could do wrong. It’s it’s very much like an encouraging building process. Zain Mehdi: [00:32:42] Yeah. I think that’s a super important part of it. Like being able to like make mistakes and no one care that you made a mistake, it’s just kind of like, okay, you made this mistake, this is a better way to do it. Potentially try to figure it out this way. And I think that’s super helpful. Cause then, cause we all eventually will take care of patients in a slightly different way and being able to like figure that out ourselves I think is super helpful. Dave Etler: [00:33:01] Um, okay. Well what have you struggled with Zain Mehdi: [00:33:03] time management? Yeah, Carl Skoog: [00:33:06] the stuff’s hard boring answers, but it’s kind of true, Martin Goree: [00:33:10] especially. Oh no, go ahead. I was just every week is so different. Yeah, it’s really, I mean you can’t learning time management is kind of an ongoing process. Like we never have the same schedule every week. So it’s, you really have to adapt. Zain Mehdi: [00:33:21] I was going to say one thing. I was like, okay. Cause like one week we have absolutely nothing going on, like testing wise and the next week we have a test and like, there’s a bunch of stuff that like, it’s so different each week that like, it like messes up, like whatever schedule I have for one week, because I have to figure out how to do it differently the next week. Martin Goree: [00:33:37] I don’t know about you guys also, but Stephanie, but I don’t usually plan too far ahead because of that. Like, you can’t really plan look more than four or five days ahead, which is fine. But Zain Mehdi: [00:33:47] no, I see that very often people are like, Oh yeah, well we have this tomorrow or in two days I’m like, Oh really? I haven’t looked past today. And like, I feel like that’s a very, and yeah, I don’t know. It’s just this just how it is. Cause there’s just so much to focus on at one time that like, you can only take it like day by day in some cases. Is Stephanie Rodriguez: [00:34:05] this why you can’t like give me a set date on when we’re going rock climbing. Zain Mehdi: [00:34:11] I don’t know how anything works. And, and I’m just like trying to figure out things as much as I can. And it’s, it’s just not, I’m not good at it. I made it this far, so true. Fair enough. But if you want to go on Monday down to go, you’re going on Monday. I have no idea. Maybe, maybe not we’ll week. So I don’t know. Stephanie Rodriguez: [00:34:33] Oh, I don’t know. Test weeks are Swedes are interesting. It’s more about winging it and everything like that. I don’t know. I was going to go with Zane rock climbing this week, and then I remembered I had my COVID my second dose COVID vaccine scheduled later in the day. That’s what I mean, like you take it day by day. I was like, Oh, you know what? Maybe it’s not a good idea to go right after I get the second dose. And so he Dave Etler: [00:34:55] almost had him though. You almost got him to go rock climbing on Monday. Zain Mehdi: [00:34:59] I went twice this week. Just like, it just didn’t work out with like Steph schedule, other people that had went with. Cause it was like a fairly large group of kids here. Who like, Dave Etler: [00:35:09] are you talking about like actual climbing of actual rocks or at the, Zain Mehdi: [00:35:13] yeah, at the rec center? Um, cause I don’t know how to do like lead climbing yet. That’s not, that’s like the next step. Um, but right now it was just kind of the top rope and bouldering on like the wall that they have at HTR, T H C Martin Goree: [00:35:24] H Dave Etler: [00:35:25] CR CRP X Carl Skoog: [00:35:27] four letters Zain Mehdi: [00:35:28] and roll. I dunno because there’s another, there’s like a tennis rec center that’s near where I live and that’s the one that I think about, but no, it’s CWIC um, Dave Etler: [00:35:34] And campus recreation and wellness center. I already Zain Mehdi: [00:35:37] forgot it. Right. Um, yeah, but I, yeah, twice this week, because there’s like a large group of kids who like rock climbing and so it’s been a good time, good way to meet, like, hang out with people that you might otherwise not like see often. Good. It’s nice to know that. Yeah. Stephanie Rodriguez: [00:35:51] People are really are Dorsey here. Yeah. That’s what I learned when I moved to Iowa really outdoors. Dave Etler: [00:35:56] Um, who or what has helped you this year in any Martin Goree: [00:35:59] fashion? Dr. Swales? Zain Mehdi: [00:36:02] Yeah, like Dr. Swales person, just Martin Goree: [00:36:06] like he brings is Zain Mehdi: [00:36:06] really positive. It’s just like, it’s like, he validates like what we’re feeling, but also is like, try to get us more excited to do what we’re doing and it really, it helps for sure. Stephanie Rodriguez: [00:36:17] Yes. He has an Instagram, which is like the cutest with his little histology stuff going on. If you guys should follow him. Carl Skoog: [00:36:25] Yeah. Martin Goree: [00:36:28] This Dave Etler: [00:36:28] is second account. Oh, I didn’t, I didn’t know about that. So the Zain Mehdi: [00:36:31] second Stephanie Rodriguez: [00:36:32] credit as followers, Martin Goree: [00:36:33] it’s like 30,000 followers. That’s incredible. We Dave Etler: [00:36:35] are you serious? Oh yeah. It’s Zain Mehdi: [00:36:37] kind of a common thought you follow it? Stephanie Rodriguez: [00:36:40] No, no I do, but I don’t look at the followers. I just looked at his like images and everything was, Martin Goree: [00:36:45] you know Dave Etler: [00:36:45] what that’s, that’s refreshing Steph doesn’t care about your followers. I don’t care about Stephanie Rodriguez: [00:36:50] that. Thank you. I also have an Instagram and there’s zero posts. So maybe that’s why I’m actually like the social media chair for like a number of Dave Etler: [00:37:05] she’s an influencer. Zain Mehdi: [00:37:07] Really? Yeah. Do you, so you met it at the bowl where Instagram. Stephanie Rodriguez: [00:37:11] I control the bulwark, Instagram. I control the women, surgeons of Iowa, whatever Instagram. I also control, like sometimes the SNMA one. I just jump into a ton, Zain Mehdi: [00:37:23] you know? Dave Etler: [00:37:24] Okay. Well now I know now I know who isn’t liking my posts on our Instagram. Oh, the short coat. I just, you know, Martin Goree: [00:37:36] I don’t know that Carl Skoog: [00:37:41] popularity here, David. Oh, you’re right. I spoke was the only listener we’d still be doing this. Zain Mehdi: [00:37:47] I’m there. Dave Etler: [00:37:48] Uh, Carl Skoog: [00:37:48] shout out to that guy, by the way. I only remember the one name. Yeah. Stephanie Rodriguez: [00:37:51] I just gave you like, Dave Etler: [00:37:54] like likes or for chumps. I need a share or a comment or a save, please. That’s how the algorithm works. Stephanie Rodriguez: [00:38:02] And I felt like when people are like, it’s so cute emoji, I see that all the Dave Etler: [00:38:08] time. We’re like the lowest, the lowest interaction, I think saves, saves are the highest, the most valuable interaction. Cause it says, Oh, at least leave a comment Martin Goree: [00:38:20] or something, leave a Stephanie Rodriguez: [00:38:21] comment. Yeah. I think they should get rid of likes and just leave comments. It would open up discussions for people. The Dave Etler: [00:38:27] likes of the only interactions I get. So apparently Zain Mehdi: [00:38:31] I can’t see likes anymore Dave Etler: [00:38:32] in my Instagram. Yeah. you have to click through, or maybe you have to be a creator or a business account to see them. I think that’s what it is. They did deemphasize them. Cause I can’t see it anymore. And I think the reason they, they said the reason they deemphasized them was because , um, they weren’t as important. Um, no, that’s fair, but the whole goal of instant we can go on for the whole goal of Instagram. As I understand it is to keep people on Instagram. Okay. That’s Alice. So all of those other things are like. Strong signals that you’re on Instagram. You’re staying on Instagram . Let’s I w I’ve enjoyed getting to know you in this fashion. Let’s uh, go through a few. Would you rather, , um, maybe we can know you a little bit more. Um, would you rather murder a squirrel or murder a clown? That’s important question murder, a squirrel or murder a clown. Martin Goree: [00:39:30] Is it an evil clown? Clown? I feel like most Dave Etler: [00:39:34] people either like clowns or don’t like clowns and they don’t really, I mean, if it’s, if it’s, I mean, obviously if it’s the clown, that’s like the worst clown, right. But clowns are pretty bad for some people. I probably Zain Mehdi: [00:39:49] killed a squirrel. I don’t know. I feel like I don’t, I don’t have a problem with clowns. And if he makes me a balloon animal all the better, Stephanie Rodriguez: [00:39:57] yeah. He brings happiness. I’m Carl Skoog: [00:39:58] more afraid of clowns than the squirrel. So I’m going to avoid antagonizing a clown and I will also go the squirrel route for the larger lown listenership out there. This is Martin Gorrie. I’m on your side. Okay. Let’s just establish that. Dave Etler: [00:40:16] People doing their gap years as clowns, someone has to, it’s gotta be one listener, dude. I would love, love, love to hear about that Carl Skoog: [00:40:23] listener. MarkerWhat percentage of the population do you think is in like the clown profession, less Zain Mehdi: [00:40:28] than London per second, one dying, Carl Skoog: [00:40:31] like kind of common. Do you think it’s more than 1%? Go with like 15, 15 I bet if you put a poll in our class group me right now asking how many people were clowns, you’d get like 24 Zain Mehdi: [00:40:48] versus like an actual clown, like in like white base. That’s Carl Skoog: [00:40:51] what I’m saying. We’re out, we’re on the same page here. Kind Martin Goree: [00:40:54] of interesting. We’re all pro clown. Carl Skoog: [00:40:57] I’m not good with estimations. Dave Etler: [00:40:58] did you express a , uh, an opinion on this stuff? I Stephanie Rodriguez: [00:41:01] wouldn’t, I would kill the squirrel because I don’t know. I have a lot of trees next to my building. And these squirrels sometimes will follow me to the door. I’m kind of Zain Mehdi: [00:41:10] afraid of them. Martin Goree: [00:41:12] Dave said, murder, not kill your murder. Do you, Dave Etler: [00:41:16] do you try, do you accidentally leave a trail of nuts as you walk around, you might, you might want to check. You might want to check your pockets for holes. Maybe the nuts are falling out of your pockets and the squirrels are, are just, you know, they’re just doing their squirrel thing. Stephanie Rodriguez: [00:41:33] Well, that my building also leaves the door open. And so they can like easily go into the kitchen downstairs and grab some Dave Etler: [00:41:40] food. They’re really skeeved out by squirrels. So Zain Mehdi: [00:41:42] I bet I was squares a little bit more bold. And as well as that I’ve seen, like, they don’t like, if there’s a human around them, they’re not running away instantly, which is different from where I’m from, where if the squirrel comes in like 10 feet radius, they run away. Yeah. Dave Etler: [00:41:54] Um, would you rather. Lick a scalpel recently used for cadaver dissection or drop your phone in a portable toilet near the stadium after halftime and retrieve it Zain Mehdi: [00:42:07] without a doubt. I’ll look that scalpel, I’m not dropping my phone in a port-a-potty next to it. Music festival, Carl Skoog: [00:42:14] God gave us antibiotics for a reason. You know, Zain Mehdi: [00:42:16] I’ll take the scalpel, the scalpel, like all of that preservative. I’m sure it’s probably going to be a little bit less problematic than all the whatever is in that port-a-potty Stephanie Rodriguez: [00:42:25] Well, you can like lick the scalpel. You don’t have to like spit it out immediately and you can just spit it out. Yeah, Dave Etler: [00:42:31] you could, you could technically reach into a port-a-potty with a gloved hand, grab your phone and then somehow Zain Mehdi: [00:42:36] phone is not getting it every single, like no crevice that phone’s gone and you have to fish it out. Yeah. So that’s Dave Etler: [00:42:46] the part, that’s the worst part. So you just abandoned the phone just because it’s not worth worthless. I spent a thousand dollars on that phone, but I am licking Zain Mehdi: [00:42:53] that scalpel without a doubt. I have a waterproof Martin Goree: [00:42:55] case. I Dave Etler: [00:42:56] think I’d still like , uh, Steph , uh, you seem to have a visceral reaction to this question. Stephanie Rodriguez: [00:43:02] I’m thinking of the scalpel and the porta-potty and everything like that. Martin Goree: [00:43:05] Uh, Stephanie Rodriguez: [00:43:05] I’m scared because like, what if somebody does pick up your cell phone from the port-a-potty and like steal all your information? I have like my cards on my style and I do Zain Mehdi: [00:43:14] like the Apple. First of all, who’s who’s fishing that out for you sounds Dave Etler: [00:43:19] strangely like you’re off the grid friend right now, two in the Martin Goree: [00:43:23] same room Zain Mehdi: [00:43:24] before they’re so concerned that even a phone that’s fallen into a port-a-potty is a greater concern of their like personal identity that someone might stretch. Dave Etler: [00:43:35] Well, fears are fears are often , um, irrational. So that’s fine. Would you rather get plastic surgery that made you look as beautiful as the most beautiful person in the world or become a doctor in the specialty of your dreams? I mean, everybody in this room is already as beautiful as the most beautiful person in the world. So I guess this was, and step two, Zain Mehdi: [00:43:54] I was going to say the, exactly, like we’re already at contract to becoming whatever physician we want to be, hopefully, but Dave Etler: [00:44:01] your dream, your journey, like all Stephanie Rodriguez: [00:44:04] saying, you want to go into neurosurgery. So Zain Mehdi: [00:44:08] it is harder, but I feel like it’s like, it’s plausible. It’s not, it’s not plausible that plastic surgery will end well all the time. So if I make it work exactly right, then Dave Etler: [00:44:19] it would work. I mean that’s, I mean, it’s, it’s not, there’s no chance that this plastic surgery wouldn’t work. That’s why I’m leaning more. Zain Mehdi: [00:44:26] Yeah. Yeah. Stephanie Rodriguez: [00:44:26] But don’t, you have to go ahead and like, let’s say, if you get like , uh, like breast surgery that once every 10 years you have to go ahead and replace it. So would you want to go through that hassle every time Martin Goree: [00:44:40] I’m talking about the Dave Etler: [00:44:40] female, I guess we know something about staff. They’re Stephanie Rodriguez: [00:44:47] my friends, we talked about this just because there’s a friend of ours that wants to be a plastic surgeon. So we like talking about like, Zain Mehdi: [00:44:53] yeah, I saw a few of the like discussions for breast implant stuff, because last semester I was in my ECE, which is our early clinical exposure exposures. If for those listening , um, was in the plastic clinic. And so I, we like, it’s gnarly for sure. Down the line. They’re not fooling around. Yeah. But the whole thing is it’s going to be perfect. That’s that’s, that’s the thing. So. In this scenario. Dave Etler: [00:45:16] So project you’re supposed Carl Skoog: [00:45:20] to, I don’t know, I’ve hesitated long enough that I guess I have to suck it up and answer the plastic surgery. One, to be completely honest, I would want the plastic surgery. If I was approaching this from Lincoln altruistic angle, I should have known that within like a millisecond and I Dave Etler: [00:45:35] definitely didn’t. Okay. All right. So you’re to you’re getting plastic surgery. It looks super hot. Oh yeah. But you’ll still be a doctor you just went. Yeah. Right? Yeah. All right, dude, did you a way in there? Yeah. I’ll take the Martin Goree: [00:45:47] plastic surgery. Stephanie Rodriguez: [00:45:50] I’m so surprised about Zain Mehdi: [00:45:51] this. Are you going to pick the dream dream specialty? Is that your answer? I Stephanie Rodriguez: [00:45:57] don’t know. I think like if you, if you look super. Did you say, like you would look perfect after this plastic surgery, Dave Etler: [00:46:04] beautiful person in the world. It was beautiful person whose opinion in the world’s opinion, the entire entire world got together, Stephanie Rodriguez: [00:46:13] thinks the same and Zain Mehdi: [00:46:14] I’m sure that’ll help get your dream like specialty. Exactly. That’s what I was thinking. And the hottest person in the room. Oh yeah. Okay. All right. So it, the full purpose. Proficiency is out the window. Nope. If you’re, if you’re hot enough and she can get away with anything, Stephanie Rodriguez: [00:46:29] I think there’s like a research study about that. Like people Zain Mehdi: [00:46:32] call it it’s like halo effect or something. It’s Carl Skoog: [00:46:35] actually my summer research project coming up. Yeah. I am taking a sample size of 10,000 supermodels and then 10,000 people who look like me. Stephanie Rodriguez: [00:46:45] I would believe that. So is that true? I’m looking at Martin Goree: [00:46:49] every word of it. Zain Mehdi: [00:46:51] Whenever they saw that to review for SRF. They’re like, this is the one Martin Goree: [00:46:57] to see the comments. Dave Etler: [00:46:58] All right. Would you rather wake up in nursing school, dentist school, physical therapy school or pharmacy school got a four way thing here. Nursing dentist, PT or farm. Zain Mehdi: [00:47:12] I’d probably go PT. I feel like that’s okay. That’s the thing I think of most interesting of the bunch to me. Dave Etler: [00:47:20] I don’t know. There are no wrong answers, huh? Okay. Carl Skoog: [00:47:22] I was like, I don’t think I mentioned this at the beginning when I was supposed to, I did a chem major and then was actually looking at jobs for Pfizer, out of college for antibiotics synthesis. So you missed your chance? I think. Exactly. Yep. Uh, you would not want a vaccine made by me Dave Etler: [00:47:37] right now, Carl Skoog: [00:47:39] but I’ll go with the cop out and go with pharmacy for that Dave Etler: [00:47:42] reason. All right. Fair enough. I think I’d go with dentistry dentistry. It’s a Carl Skoog: [00:47:47] procedure holistic field and Dave Etler: [00:47:49] I Martin Goree: [00:47:49] like that, so. Okay. Stephanie Rodriguez: [00:47:51] Uh, physical therapy or dentist, I don’t know, maybe physical therapy. I would love to have, I wouldn’t be one of those buff people and get an Instagram and show people how to do squats because I can’t do squats Carl Skoog: [00:48:00] correctly Dave Etler: [00:48:02] to Steph and Instagram yet she has zero Martin Goree: [00:48:08] posts. Stephanie Rodriguez: [00:48:08] I have zero posts. I’m not big about social media. Stephanie Rodriguez: [00:48:13] So that’s why. except if you have been on Snapchat, your stories are amazing. Stories are wild, so they should not be seen by a Zain Mehdi: [00:48:23] professional. Like I’m always , uh, complaining about stuff. I do art or do art. Yeah. That’s the two Dave Etler: [00:48:30] options I am on Snapchat. So I will immediately be adding you Zain Mehdi: [00:48:35] stories. Carl Skoog: [00:48:36] Impeccable. Do you think it’s feasible to be an Instagram influencer? That’s never posted Martin Goree: [00:48:42] to Carl Skoog: [00:48:43] be up at night. That’s Martin Goree: [00:48:44] actually my SRF project possible. Dave Etler: [00:48:50] Alright. What’d you write there have aphasia. Uh, and if you don’t know what that is inability to understand or express using language have and knows me and knows me and nausea, loss of ability to smell or have prosopagnosia the inability to recognize familiar faces. Carl Skoog: [00:49:07] Can you smell the person and recognize them? Oh Dave Etler: [00:49:10] God, Whoa. Ooh. I don’t know. You don’t like it. If that was, I don’t want to know as the, as the smelly person in this scenario, I don’t want to know if that’s how you recognize me. just so you Martin Goree: [00:49:23] know. Yeah. Stephanie Rodriguez: [00:49:24] That’s yeah. I agree with that Dave Etler: [00:49:26] even though that’s entirely plausible. Zain Mehdi: [00:49:30] I feel like I, I don’t know, cause I really liked my sense of smell. I dunno. I like like good smelling things. It’s like something like, I, I dunno, I Dave Etler: [00:49:39] haven’t, well, people have really, I mean, especially in 2020, they’ve really discovered how important the sense of smell is. Zain Mehdi: [00:49:45] But also like a Fe, like, I don’t know, the other two options also suck incredibly too. Um, but I feel like you can, easiest to live without a sense of smell. I feel like compared to the other two options, like unable to recognize people’s faces, I feel like would be problematic and unable to communicate very problematic. So Dave Etler: [00:50:05] probably professionally and interpersonally survive without taste, even though you might be kind of miserable. Yeah. Zain Mehdi: [00:50:12] It gets the least. Probably like the least bad. Dave Etler: [00:50:16] Fair enough. Stephanie Rodriguez: [00:50:17] If we say which one we’re okay with losing or which one we would want, Dave Etler: [00:50:20] which one would you rather aren’t they both wait Zain Mehdi: [00:50:28] it’s which loss of function? Loss of, yeah. Which loss of function. And would you want? Dave Etler: [00:50:33] No. Would you rather have, I mean, you don’t want any of these things, but you have to pick. Zain Mehdi: [00:50:40] Okay. So what’s your answer stuff is like, Well, Stephanie Rodriguez: [00:50:45] I’m just thinking about like, I can’t smell. So like, I don’t care about losing that. Um, Zain Mehdi: [00:50:50] you Dave Etler: [00:50:50] can’t hang on. You can’t smell, you can’t smell. You have enough nose, Mia and nausea. I have an Stephanie Rodriguez: [00:50:56] Osmium undiagnosed. Zain Mehdi: [00:50:59] How Dave Etler: [00:50:59] did you say you don’t know how this came about? You’re just a, not a smeller. Stephanie Rodriguez: [00:51:03] I just can’t smell, you know, candles. They look pretty. I like the light, but I just can’t smell anything. I’m just like, Dave Etler: [00:51:09] okay. What about food? What about tasting food? No, Stephanie Rodriguez: [00:51:13] that’s why I love to like taste it because I can smell it. Dave Etler: [00:51:17] Taste and smell. Go together. Stephanie Rodriguez: [00:51:18] Yeah. Yeah. They kind of do go together, but yeah, I can’t smell Zain Mehdi: [00:51:22] them. You can’t smell like anything or is it just like not, well, it’s Stephanie Rodriguez: [00:51:26] not, well, Dave Etler: [00:51:29] it’s like, you’ve got a permanent cold basically. Stephanie Rodriguez: [00:51:31] Yeah. Look, I have a permanent coal. That’s what it is. That’s what my life is like. Hey, that sucks. Yeah. Yeah. Being able to recognize faces. I think that’d be cool. You know, you get to meet a new person every time. You’re like, Hey, what’s up? How are you doing? I already do that. Not Dave Etler: [00:51:50] at all awkward spoken, like, we’ve all another thing we’ve sort of gotten used to in 2020 is we’ve all kind of got face blindness because we’re all wearing masks. I’ve actually gotten pretty good at recognizing people with it. Well, I’m so Zain Mehdi: [00:52:03] bad at it to this day. It’s like somebody has spent like literally like hours with, and like I see them walking around like Donald, that person. Martin Goree: [00:52:11] I have a hard hat. Dave Etler: [00:52:15] Yeah. Those are the worst I have always, I think I’ve always because I don’t have great vision. I think I’ve always sort of relied upon my ability to recognize shapes and walks , um, in identifying people at a distance anyway. All right. For the same annual salary, would you rather. Be a TV doctor or be a real doctor. Zain Mehdi: [00:52:33] Oh, real bad. I, I just, I don’t like TV doctor. I feel like it’s not. Dave Etler: [00:52:39] I know, but the point is like, you are the TV, do you don’t have to like, Oh, okay. You are the TV doctor. personally, I would rather be a TV doctor, first of all, let’s go on to school. Uh, and all you got to remember is your lines. Zain Mehdi: [00:52:52] You’re good. I feel like I’d be a fraud. I don’t know. A lot of the times the ones that I’ve seen, I’m not an expert expert on this field of TV doctors, but from what I’ve seen, some things aren’t not right. A lot of the time. And so because of that, I’m like, I feel like this is just like a friend. Stephanie Rodriguez: [00:53:13] I feel like all these TV doctors are going to call out saying, now they’re going to add saying like, I am valid. Um, I have a purpose. Carl Skoog: [00:53:20] Yeah, doctor, Dave Etler: [00:53:21] we just have an ongoing beef. We, for sure. We for sure have a lot of listeners and followers who are TV doctors. So Stephanie Rodriguez: [00:53:29] tag Dr. Phil, I want to see this. It’s like Carl Skoog: [00:53:31] the other 15% of the population you got clowns and you’ve gotten to be doctors. And then the other 70%, it’s just like everything else. I guess Dave Etler: [00:53:40] you should be. I feel like you should be a census census. Absolutely. Really got your finger on the pulse of America. So Carl Skoog: [00:53:47] at 96% of the populations under the age of five, that’s a Dave Etler: [00:53:50] fun fact. Hey bull, where community, just like one of my photos on Instagram, Stephanie Rodriguez: [00:53:54] I wonder who that was. Carl Skoog: [00:53:58] All right. Assuming you would still Dave Etler: [00:54:01] emit. The same volume of gas, would you rather fart all your farts on for the year on December 31st? What Zain Mehdi: [00:54:09] a win and the year Dave Etler: [00:54:10] or fart once per day, the moment you see somebody attractive. Zain Mehdi: [00:54:15] Well, definitely the first time. Stephanie Rodriguez: [00:54:19] Well, why would you choose a second? One Martin Goree: [00:54:21] sounds Zain Mehdi: [00:54:22] painful. It does a little pain. Stephanie Rodriguez: [00:54:25] I feel like when you though, when you fight with somebody, you do become closer with them. Zain Mehdi: [00:54:30] They just think you’re weird. Hell, because you’re fucking, you don’t know them. Dave Etler: [00:54:35] Yeah. There’s a, I think what Steph is talking about is when you like move in with somebody or you become their boyfriend or girlfriend, then you know, it’s okay to fight with people and they’ve been, then you become closer. I don’t think that fighting with somebody that you’ve only recently met automatically. Zain Mehdi: [00:54:54] if someone comes up to you, don’t fight. They’re like, Oh wow. You don’t think I’m attractive. You’re not partying. You’ll be offended by. Stephanie Rodriguez: [00:55:04] So at what point is it okay to fart with somebody until you move in with them? Like, I mean, as relationship wise, like at what point are you okay with it? And don’t tell me, no, you don’t fart because I hate it when people tell me that I hate that Dave Etler: [00:55:16] third time. I would say third time. Uh, you’ve spent the night. Martin Goree: [00:55:18] Okay. It’s been a long time since I’ve had to worry about this. Thank God. Zain Mehdi: [00:55:23] I feel like it depends on each, like, if like the vibe that you like you have with another person, just kind of depends on that. Right. Just kind of chill together. Dave Etler: [00:55:32] Yeah. A controversial thought. Maybe you should just, you know, let your farts out. Why is it that on the show? I always talk about farts. I gotta, Zain Mehdi: [00:55:42] I have Dave Etler: [00:55:43] to examine my life. Um, uh, maybe if you’re just letting it all out on a day-to-day basis whenever, and you find somebody who likes you that you’re like, you’re like, Oh, well this is definitely the person. This is definitely the one. Cause they don’t mind that I am. A gaseous individual. Martin Goree: [00:56:01] I’m still just really intrigued by like all at once for the entire year. Zain Mehdi: [00:56:04] Yeah. Yeah. Dave Etler: [00:56:05] How long is that going on all day? Yeah. All day. Somebody look up Stephanie, you might be in the best position to look this up. How much people fart in a year? Somebody is somebody is definitely looked into this in a volume. How much, what volume of gas does the average human produce? Stephanie Rodriguez: [00:56:26] Okay. Well they say the average person for it’s 14 times every day, and there are 365 days in a year. Right. Or sort Carl Skoog: [00:56:37] of like 5,000. Martin Goree: [00:56:39] And what’s the average volume per farm. Dave Etler: [00:56:41] What is the Stephanie Rodriguez: [00:56:49] then normal flat volume is. 476 to 1,491 milliliters per 24 hours. Wow. Carl Skoog: [00:57:00] That’s oddly specific. Zain Mehdi: [00:57:02] You talked about like the rest of the staff Martin Goree: [00:57:05] was this FEV one where you breathe into the contract part easy one volume. Carl Skoog: [00:57:20] If you’ve got like IBD, it goes up exponentially. Dave Etler: [00:57:23] Uh, well that’s, I mean, you know, you don’t, we don’t have to do the calculation. I think we can pretty much go with the idea that it’s, that’s, that’s a large volume. Um, but yeah, you’d have to let it out on one day. So I think you’d be pretty much partying continuous. Like it would just be one long, like you would lose weight. Like he did Carl Skoog: [00:57:44] lose a lot, would fly that one day or Zain Mehdi: [00:57:47] just so full of gas at your. And when you release it, like you’re you way more because the gas was keeping you up. Oh, Carl Skoog: [00:57:54] medical consequences to being filled with that much. Dave Etler: [00:57:56] Oh, for sure. Nope, not a one. Okay. It’s all good. I’ll go with that one. Yeah. Well , uh, that’s our show. Uh, Martin Steph, Carl Zane. Thanks for being here. Thanks for being here. Thanks for being on the show with me today. Thank you, Dave. Zain Mehdi: [00:58:13] Thank you for that podcast. Stephanie Rodriguez: [00:58:15] When do I log off? Do I Martin Goree: [00:58:16] just Dave Etler: [00:58:23] things to do. When do I get out of here Stephanie Rodriguez: [00:58:25] management right there? Dave Etler: [00:58:28] Google would I be, if I didn’t thank you shortcuts 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 available. Our editors are AIG Chowdhury and Eric Bozart and Alex Belzer is our marketing coordinator that shows me possible by a generous donation by Carver college attendance and student government and ongoing support from the writing and humanities program chairs provided by your communities. Our music is by Dr. Box and captain sphere. I’m Dave, Etler saying don’t let the bastards get you down. Talk to you in one week.

Noooooooooooooooooooooooooooo! TL;DR Should Victoria also get a law degree to facilitate a career in health policy?Shea sends feedback on our recent discussion of options for unmatched MD SeniorsWe practice answering patient questions with a straight face by visiting Yahoo! Answers for what might be the last time! The Big News in medical education is that a valuable resource for practicing patient interactions and understanding their concerns is shutting down. That’s right, Yahoo! has decided to shut down it’s beloved, if deeply sad, site that allows people like Dave to post their urgent health-related questions. Will they flock to Quora? Who knows, but for now M4s Sophia Williams-Perez and Marisa Evers, M3 Annie Rempel, and M2 Eric Boeshart celebrate its impact on medical school podcasts with some new questions and revisit some old favs. Listener Victoria writes in wondering whether an MD/JD degree is right for a health-policy focused career. We can help, and we start by noting that no-one has signed up for this dual degree option at our school in several years. And listener Shea fact checks (with love!) our recent discussion of options for unmatched senior MDs. 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 Dave Etler:  [00:00:00]Welcome back to the short coat podcast, production of the university of Iowa Carver college of medicine. I’m Dave Etler. With me today in the studio to talk about something very, very, very, very, very, very serious is  Annie REM Pell. Hi informer receivers is back. What up, what up and would you look at that? It’s Eric Bozart. Hey guys. And finally it’s Sophia Williams Perez or Sophie Williams Perez our time making up her mind. We’ll go with Sophie today. Okay, Sophie, I’m glad to have you all here today. On this solemn occasion you’ve probably heard. At this point, listeners, it’s all over the news, but yeah, who answers you’re shutting down in may. So thank you for being here. You guys, to help me process what is probably the most horrible news of 2021 so far? I’m totally sure. I mean, you know, We had the insurrection Annie Rempel: right off the bat. Dave Etler: I think this is worse Sophia Williams-Perez: personally, arguably similar scales. Dave Etler: I’m especially glad to see you Sophia. Sophie, this is your third appearance on the show. Is that right? I’m so I’m just very happy to have you back. You guys too, I don’t want to exclude you guys, but Sophia Williams-Perez: particularly Sophie. Yeah. Dave Etler: As president of the SeaComm student body this past year, I will forgive you. You’ve been it’s all a facade. I don’t mean to put, I told him behind emails. Yeah, I totally made it put you on the spot. What’s it like to lead a bunch of medical studies? I, Sophia Williams-Perez: the phrase that comes to mind is herding cats. I’m not surprised. I’m just kidding, but it’s been fun. Normally at like any given year, I would have anticipated certain things to happen, but obviously with what has ensued with the pandemic last year. Yeah. You were all Dave Etler: like last year, you’re all like, yeah. I’m student body, president Annie Rempel: charity auction. Yeah. Holiday fees. None of it. Instead you’ll be doing these things. Lots of emails, apologizing, buddy. Her emails are very graceful. Well crafted. Sophia Williams-Perez: I appreciate it. I read them only 87 times, and then I still noticed a typo. Okay. That is Dave Etler: humbling. Worst mass emailing is the worst. Every once in a while, I have to send out a mass email to the entire university announcing something that we’re doing, like, you know, our conference. Yay. And invariably, I screw it up. I’m sweating for you. I will screw it. I will screw up regular emails as well. So Eric Boeshart: that doesn’t. It happened to just like that happens to me on a daily basis. Like, it doesn’t matter who that’s gone to. I’m like, God, I have to ask my fiance. Like, can you read over this for me? Annie Rempel: Yeah. Dave Etler: Kate and I are always showing each other our emails to verify that they’re not ridiculous. I mean, it doesn’t matter. We all screw them up. Yeah. So, well, good job. The past year keeping up, keeping up your smiling mask while you dealt with it. With all that. We’ve got some listener feedback from Shea wrote into the shortcuts@gmail.com about our last episode in which we discussed the possible alternate paths for students who are unfortunate, if not to match. And she says, or he is Shay. I’m not sure. I think it’s either. Or they say, thanks for bringing to attention. The alternative options that med students can take. If they don’t match. I completely agree that people should have other avenues and that knowing there are backup options could be a relief for med students going through the awful process of not matching. I heard Holly’s dissent about the lack of training and her concern for family members who could potentially be treated by these quote associate MDs. Does she know ARN PS practice independently? Is she aware of what training they have pointed question? Of course, psych being my specialty, how they should know that it’s really, it’s actually really competitive and there aren’t a lot of unfilled spots. In fact, there are only three unfilled positions in the whole country, and those were at a new program. that was actually not NRMP eligible for the match so effectively there were zero unfilled spots. Just my fact checking for the day. Thanks for bringing this topic to light. You are so welcome, Shea. Thank you. Thank you for sending your feedback. I appreciate that. Any quick comments about Marisa Evers: that? I don’t think that not matching should be an option. Yeah. That’s my Annie Rempel: 2 cents. Eric Boeshart: It doesn’t kind of Dave Etler: crazy. Yeah. I mean, , like I said, in the last show, the whole discussion was about me, you know, sort of feeling terrible. You know, for people who had to go through, you know, like match and then soap and then have it not work out, and then you have to do it again next year. And you know, all the problems associate go back to,  episode three 61 last week show, and you can listen to my soap box, my ideas, my ideas, I’m putting quotes around the word ideas. But yeah So, thanks for sending your thanks for sending your feedback. I really do appreciate it. Here’s a listener question from Victoria. Victoria says, first, I want to thank you for your continued efforts to provide inspiration information and guidance to pre-med and current medical students. Thank you for highlighting our intro  . I have been a listener for the last few years and look forward to a new episode every week. Thank you. Secondly, I am wondering if any, CCOM students are in the MD/JD combined degree program. If so, what made you decide to pursue this program? What has been your experience so far? Would you recommend it to a person who wants to pursue medicine, but has a passion for health policymaking too? What are your plans? Post-graduation how will you use these degrees? So many questions that we can’t answer because it’s been years since we’ve had an MD/JD student Victoria, I checked and I don’t even know. We don’t even remember how long it’s been. We have this option, but nobody’s taken us up on it. But co-host AGA Chowdhury looked into it for us and he had some thoughts. I didn’t know. What, what do you [00:06:00] guys think is, is MD/JD a health policy? Making, I mean, Marisa Evers: the only we were talking about this before, the only person we know who is MD/JD is Dr. Thompson, and she did JD and then came into med school and it seemed like, , A roundabout way to get to where she wanted to be, but you can do health policy without having to do the JD. It’s just, I guess, a personal preference of how long do you want your schooling to Sophia Williams-Perez: take? Yeah. Right. And like what your health policy Avenue wants to be Dave Etler: health policy. It’s a big, yeah, Sophia Williams-Perez: it depends on like what your ultimate goal is with health policy. Like if you wanted to be more and maybe legislation, you know, like formally in legislation, whether that’s state, federal national, whatever it is. The JD might help because then you have some of that background information, you’ve taken the classes, you know, the nuances about like how things occur on those given levels. But if it’s more like a local or do you want it to be in like organized medicine or things like that, I would think an MPH could get you to where you want to go, because there’s the AMA and there’s other places like that that facilitate plenty of physicians that just have an MD or. Have masters of some sorts rather than JDS that I know of. Yeah. Eric Boeshart: It seems kind of crazy too. Cause like a, if you choose to go down that route, you don’t really, you would have to eventually probably pick one or the other. It would seem like, I feel like it’d be hard to be a practicing lawyer and. Practicing physician. Like it just seems, I don’t know, kind . Of racks my brain a little bit. Dave Etler: AJ Chowdhury looked into it for us. And he says, yeah, it’s a very small program that requires you to fill out a very specific niche. There’s not much overlap between the two and assuming the MD is first in your priorities, you don’t need a JD for many of the legal and policy tasks an MD can do. Like being an expert witness or consulting in biotech for pharma. Hospital administrator may be, but you’d probably be better served with an MBA. He of course had problems with the financial issues of being a JD and an MD. He says it’s the worst financial choice because you’re adding on three more years of debt and opportunity costs. As you lose three years of top end physician income. Law’s going to make you less money. So if that’s important to you and it’s a good idea to do things like get involved in advocacy or policy  in his estimation before choosing to apply to a dual degree. Just because it’s so financially,  , and time intensive with not a lot of payoff, unless you have really good reasons and really understand , why you’re doing this. So Eric Boeshart: if can I ask a question real quick? Yeah. Did, so when ADA was looking at that, did, did he say that. People who would. Pursue an M D J D that , they would potentially more likely be going. Like they could do like expert, witness type stuff. I’m thinking, I’m just thinking, because , I’m a Minnesota native. And so I’m obviously following the Derek coven trial right now. And they’re talking about all that testimony, like from, you know, it sounds like pulmonary care experts and things like that. I’m just trying to figure out, like I was thinking in the car ride over today. Like , . How does a person get to that point as a physician? Like, does someone have to approach me to ask me to, Hey, you, will you testify in court? Yeah. Obviously you have to be, Dave Etler: it’s a good question. He didn’t, he didn’t he didn’t tell me that. I didn’t think of asking that. But I would imagine that. Yeah. Do you guys know anything? Do you, have you guys heard anything about this? I would just imagine that, you know, your, your publications  , would play into that. , my guess is it’s something that you, I don’t know if you just decide to  become an expert witness or it just sort of happens to you. Like, so I have no idea. I had Marisa Evers: a professor in college who was a psychologist and they were a forensic psychologist. So like, they, they were like specific for like an expert witness and stuff, but it was just something, I was like, they threw publications and then kind of got involved in it, just like it kept going. And they just like, yeah. Get hired as an expert witness in a lot Sophia Williams-Perez: of things. Yeah. I Annie Rempel: think same goes for forensic pathologist and they just have it. I mean, just, they have an MD and are very routinely called to be expert witnesses for cases they’ve done autopsies for Dave Etler: so clearly more likely to be an expert witness if you’re a forensic, whatever. Yeah. Right. That makes sense. Forensic Annie Rempel: lawyer I mean, you Dave Etler: know, you laugh with however you want at whatever you want. That’s what we’re all about. And the show you do you it sounds like we’re leaning towards masters of public health for health policy though, as a easier slash more what’s the word I’m looking for? Easier, more accessible, more accessible, more universally efficient and efficient. Yeah. But JD, you know, if you want to do MTJ, JD, your, your options are somewhat more focused. Specialized. Yeah. So but good luck. I’d like to hear more about that. I confess I don’t know much about it, so I hope we helped. It’d be interesting to hear every show. Okay. Well, Eric Boeshart: are we going to there? Yeah. Oh, I was just gonna say, I’d be interested to hear plans, like what that person plans, like, what, how they view that J D being used. Dave Etler: Yeah. Well, yeah, I’d like to, I’d like to know more about what can we do. It’s not like I couldn’t have invited her on the show and ever asked a question. In honor, of our old friend, Yahoo answers the saddest place on the internet. Let’s give you some exposure to the ideas and concerns of your potential future patients. Today, I have selected some favorites that we’ve had on the show in the past, and I’ve picked a couple of new ones. So let’s see what you guys can make of these questions. Maybe give some advice, maybe we’ll learn something. I think it will be you people who teach something, but, and not these people, but yeah, we’ll, we’ll, we’ll figure it out. So let’s start with our first one. We have this old favorite from somebody with concerns about [00:12:00] hygiene.   . So my armpits Annie Rempel: smell at first, it was my left and it smelled like melted butter and was always itchy. Dave Etler: Now it’s just my right armpit that smells Annie Rempel: like melted butter and is always itchy. What’s going on? Dave Etler: Are you putting melted butter in Annie Rempel: that’s the first question I think Marisa Evers: about also if your boo smells like melted butter, Dave Etler: Yeah, my armpits smell like cinnamon rolls. When the Annie Rempel: movie theater popcorn, there’s Dave Etler: an undercurrent for me. There’s an undercurrent of sort of a urinary smell to a movie theater popcorn. I don’t know. I don’t know if that’s, Annie Rempel: where are you going? It’s not enough to make me not Dave Etler: eat. Annie Rempel: So they take the popcorn, Sophia Williams-Perez: you know, like behind the wall and then they come back out and hand it to you. Dave Etler: come on. Haven’t you ever been like, you know, you just pick it and you’re like, Well, it’s Annie Rempel: not bad. Sophia Williams-Perez: I’m trying to think of, you know, the 8.8 million last times I peed. I can’t, I can’t draw. Dave Etler: Did you know that? No matter how large a mammal you are, it always takes one minute to peak. So you can be an elephant and you will still pee one minute. I find that hard to believe. It’s true science. I believe it was say no time Annie Rempel: myself. I Dave Etler: have. It’s pretty cool. About a minute. It’s pretty close. Eric Boeshart: You just have a chalkboard in your bathroom. Just kind of like Sophia Williams-Perez: last minute, minute and a second. Yeah, I Dave Etler: go in, there’s like a chess clock in the back of the toilet. I just hit it. I count Eric. I can count a secret. Okay. Yeah. I Annie Rempel: wonder if elephants get BPH benign prostatic hyperplasia. Dave Etler: Is that like a big prostate? Yeah. Yeah. There you go. Yeah. Getting good at this. Annie Rempel: I feel like that might spread out the minute. What Dave Etler: are the symptoms of curiosity? 50 year olds, 50 year old, Annie Rempel: man here. You’re asking for a friend asking for a friend. What Dave Etler: are the symptoms of blah, blah, blah, blah, blah. That big, big process, Marisa Evers: hesitancy frequency hesitancY. It can mean that you’re going more often because you’re struggling to empty your bladder when you do Dave Etler: go. I’m a firm believer in always being prepared for anything. So I was happy to discuss this one a while. If you wouldn’t a partner are stuck in Annie Rempel: the desert with no water, any fluids or nutrition. And your partner is deathly constipated, like about to die. You are a male, would it be the correct course of action to pee in their butthole? If you had no other Dave Etler: devices to collect the fluid and scored it in this Annie Rempel: manner, why are you going to knock them out? Right. They’re dying Marisa Evers: apparently in the desert and your, and your solution is to give them an animal with your yard. Annie Rempel: I’d go find a cactus. Uh You know, aloe Vera type Yeah, but they said Marisa Evers: no options, no options available. The only liquid you have is their urine, but their solution is to pee in someone else’s butt Dave Etler: hole that Annie, I mean, that’s, it’s a good solution. I think the problem is that you don’t, you don’t have a,  device that you can use to put it where it needs to go. Other than right. Other than drinking, the cactus keeps and then peeing in at somebody. But Annie Rempel: we are in a bad situation. I think, I think you’re Sophia Williams-Perez: really tied our hands with this question. Dave Etler: I wonder if that was part of it. Yeah, yeah. Yeah. Eric Boeshart: So, I mean, the big question is, is there any nutrition, I guess first, first things first, is there a nutritional value in your Dave Etler: state? What does that have to do with it? You’re putting it in their butthole. Annie Rempel: The issue is the constipation plus lack of. Water and any other Sophia Williams-Perez: material, Marisa Evers: probably constipated, because you’re not, you’ve already taken all of the liquid you possibly can right Sophia Williams-Perez: out of you. Right. And like how long have they been in the desert? So like how long have they, are they truly constipated or have they just not been eating and they have nothing to pass, but you still can pass things. Marisa Evers: Some Annie Rempel: like Sophia Williams-Perez: what’s our mucus contact. Annie Rempel: Yeah, Marisa Evers: I never stopped discuss. Annie Rempel: Okay, wait, can we just confirm these are these I’ve been asked to answer. Yes. Dave Etler: People have these questions. People have these questions and they go to Yahoo answers. They, well, they now they can’t go to Yahoo answers. Wiki Marisa Evers: answers will be the new Yahoo Dave Etler: answer Cora or something. Yeah. I did I confess, I did look at Quora just to meet, just to reassure myself. I feel a little better, but the, the, the questions are a little bit more, I don’t know. Anyway. Point is I’m I’m. Yes. I’m personally having a difficult time, figuring out a reason to pee in somebody bought a whole medically. I don’t want to rule out other reasons. Annie Rempel: I, yeah. I don’t think it would accomplish what you had and then you lose that fluid and then, you know, Sophia Williams-Perez: goodbye. Yeah. What if you had to drain the urine later, if you get dehydrated, Dave Etler: if they’re constipated. Okay. So deathly constipated. That’s also kales. Marisa Evers: I forgot what the depth, so there’s obstipation happening. Yes. They’re not passing gas as well. They have a bowel obstruction, Annie Rempel: so Marisa Evers: is going to fines from the Sophia Williams-Perez: cactus and just do an X lab. Look at that. Annie Rempel: What’s the next lab [00:18:00] Sophia Williams-Perez: and exploratory laparotomy kind of from that Annie Rempel: sounds, Dave Etler: that sounds Marisa Evers: okay. Very sterile in the desk. I’m not going to, Dave Etler: I’m not going to advocate for this, but the next person I read about, who’s done an X lap with a cactus spine in the desert. I’m going to be damn impressed. That’s right up there with the guy who did surgery on himself in the Arctic. You know what I’m saying? Yeah. Or in the Antarctic anyway. Okay. It’s a great question. Thank you. Yeah. Who answers? Let’s look at the next one. You know not a small number of our Yahoo answers discussions over the years. We’re about pranks by alleged friends. So here’s a new example. My friend played a prank on me and put Windex and my Marisa Evers: Gatorade in my stomach kind of hurts. Should I make myself out? Make a couple of times. Dave Etler: Or what, why do, why do our friends do this to us? You know, my friend is always, my friends are always putting Windex in my, Hmm. Is this a message? This is a message. Your friend is trying to tell Annie Rempel: you. They’re Marisa Evers: just trying to give you ethylene glycol poisoning. Or Sophia Williams-Perez: maybe they saw a big fat Greek wedding. I was thinking that, what have you ever seen that? It’s like, they put Windex on everything if you’re, if you’re sick, but Windex on it, if it’s something sturdy, put Windex on it, right? Yeah. Marisa Evers: Our toxicologists would say, please don’t do that. Dave Etler: Yeah. Let’s, let’s, let’s be clear for our listeners to not, we don’t advocate. I mean, we don’t have a kid, a lot of things that we’re talking about. We don’t certainly don’t advocate. Cactus spine X labs, and we don’t advocate pudding, Windex. We don’t advocate friends, especially putting Windex in there. I mean, if you want to do it yourself I still don’t recommend it. But  friends, shouldn’t Windex each other. That’d be the new tide pod. This Annie Rempel: is ground zero. Dave Etler: Terrible idea. Yeah, you should make yourself vomit probably or, Oh, how about call poison control center? Yeah, definitely call poison control. That’s step one. I think probably step two is yeah, probably make yourself vomit. That’s fine. Right. Well, Annie Rempel: where they drink? Like, did they take a sip? And they’re like, Oh, this tastes gross. Like how much did they consume? I’d want to know that. Marisa Evers: I mean, you probably. Give them some IV fluids anyways, like you don’t want to Dave Etler: vomit. Okay. So you don’t want to my understanding of, , vomiting after consuming something poison you. Don’t definitely don’t want to vomit. If it’s corrosive, then you’ve got another issue. Yeah. Your esophagus already had enough problems on the way down. You don’t need to make it worse on the way up. Yeah. So I’ve always, I feel like that’s, when they say don’t induce vomiting, you think? Yeah. Sophia Williams-Perez: What’s the active ingredient in Windex. So definitely the self language. I know Marisa Evers: that I was on a toxicology rotation. I talked about the toxic alcohols. Dave Etler: So definitely glycol. That’s not the stuff in Antifa. Annie Rempel: It is. Marisa Evers: Yeah, it is. Yeah. So like Windex has. Different things within it. And like ethylene glycol is one of them. I’m pretty sure. Yeah. And then, so like that can cause you to have some like metabolic abnormalities so you can get an acidosis that can happen. And that’s like, there’s an acronym called mud piles and it talks about like an eye on gap, metabolic acidosis. Dave Etler: Okay. I thought we were, that we were getting back to the cactus anus. Windex. And you can have some mud piles, Marisa Evers: actually just a spa that we’re sending them to. Annie Rempel: Very bizarre. Dave Etler: Okay. Well, see, we did learn something. I did learn something today. Appreciate that. All right. Here’s another one. We can discuss there’s another oldie about the spread of. Insect borne diseases, a fly hit the inside of my lip earlier. Can I get a disease or something? Put was feet away and may have gone on it. I wiped my lip right after with my shirt, please help I’m freaking out. I remember liking this one mostly because of the voice and it says poop was feet away. I mean, this can happen to any of us really. It’s really not. A weird question in the sense that, , it’s not like, , butter pits or . Friends feeding us, Windex. This is a real thing that can happen. And then you might be concerned about, what would you say to a patient who expressed this concern? And it was like, doc poop was feet away from this fly. In my mouth. I’m Annie Rempel: so sorry. This happened first and foremost. Dave Etler: Show your compassion. I like it. Annie Rempel: Can you tell me more? Dave Etler: I can’t speed away. Come on. I’ve told you, I’ve told you everything you need to know poop was feet away. It was right there. Annie Rempel: I mean, the amount of like fecal matter, that’s being transferred on a little feet of a fly is probably pretty darn small, but you know, monitor your symptoms. I’d say stay hydrated, you know, like Dave Etler: under your symptoms. That’s what I always say to my watching race. That’s what I always used to say to my children when they’re like, I have a stomach ache and I’m like, well, let’s, we’ll, we’ll Keep an eye on it. See what happens. I could be a doctor. I really could. All right. Let’s see. This one, you guys are ambitious. So this previously aired question might hit a nerve for you in a couple of different ways. Annie Rempel: Years old, never been to college. Will I get a job, putting people to sleep for surgery and get paid for it from next month? I never done it before. I will ring hospitals in my city tomorrow. They will let me put people to sleep in theater, calling hospitals, she’s doing the right thing. She’s asking the question. She’s calling Dave Etler: hospitals tomorrow. Annie Rempel: To ask if it was all fields that call, Dave Etler: I love this [00:24:00] idea because it like, okay, so Annie Rempel: this question, clearly this person, Dave Etler: this question occurred to this person moments ago. Right. And they were like, I could put people to sleep. Yeah. Anybody can do that. Annie Rempel: I’m going to call hospitals tomorrow. I Sophia Williams-Perez: want to know how she’s going to do it was just like slug them. She knows that it’s usually done via medication and she just takes Marisa Evers: her rag. Annie Rempel: How hard could it be? You’re just good people Dave Etler: sleep Annie Rempel: anyway. Yeah. sounds like a, would be serial killer Eric Boeshart: or those people that gets away like in person, I think a doctor. Annie Rempel: I just need practice. Dave Etler: That’s an interesting theory. Like this person is a serial killer who is looking for an outlet for his or her destructive urges doctor. Oh my God. I mean, yeah, it’s, that’s actually really good. I mean, you know, like you could be a psychopath. I dunno if that’s the proper term for a serial killer, but let’s just say it as you can be a psychopath. And channel , your bad desires into something good. And that’s what this person is doing. Eric Boeshart: It’s like, they’re asking permission. Like, can I try? Yeah. Marisa Evers: The worst they can say is no, Annie Rempel: don’t move on to the next hospital. Dave Etler: Do you know hospitals in my city, one of them is going to . Surely, you know, you miss a hundred percent of the shots you don’t take. It’s like dating. Annie Rempel: Oh Dave Etler: man. Oh my gosh.  Actually, I’m going to put this on my list of questions that patients should ask before surgery. When was the last time you hired somebody off the street to put me to sleep because they called you one day and you were like, Oh shit. Yeah. We’re our anesthesiologist is late today and we have somebody that needs to be put to sleep right now. Actually, here’s another question just occurred to me. Are they applying for euthanasia? Do they think like, like, like pets, you. Annie Rempel: You still Marisa Evers: have to go to like some sort of schooling for that. Annie Rempel: Just putting them Dave Etler: to Annie Rempel: sleep, Dave Etler: going off to a nice Annie Rempel: rest. The long nap, Dave Etler: the long, long dirt nap, Marisa Evers: the farm Sophia Williams-Perez: always made that joke about Annie Rempel: Jasmine. Did you lose a pet now? She’s living. She’s good. Why is your mom on the Dave Etler: carpet? She’s the oldest kitty cat. I assumed it was cat 18. I assumed she was a cat. She has a cat. I don’t know what I’m asking. I don’t know what I’m going to do when my cat gets old. I’ve only been she’s she’s only probably we think a couple of years old. So it’s a little, it’s a little early, but we do love her. It was really early. Annie Rempel: We’re not even thinking about it. I know. Dave Etler: I know. Marisa Evers: Well, most of our cats, whenever they were getting to that time would just run away and they’re like, Oh, it’s time. Goodbye. Is Dave Etler: that what you call that backdoor? You had indoor outdoor cat, cheaper Marisa Evers: MCAT so that they like were allowed to like come and go as they pleased. But like, they always stayed on our property, but then our cat turned 22 and she just Dave Etler: disappeared. Okay. Yeah. Cats do that when they’re sick, they sometimes go and hide. Yeah. Yeah, my cat’s an indoor cat strictly because I won’t let my pretty precious. Kitty out of my sight. I don’t know Sophia Williams-Perez: ours was just too fat. We couldn’t let her outside. Otherwise she’d get eaten Annie Rempel: on anywhere for her life. Dave Etler: Our cat was a stray was Australia that was picked up and, and, and and neutered and, you know, th the shelter and all that kind of stuff. So she lived a life on the, on the main streets. And she probably had kittens at some point According to the vet. So, you know, she led a hard life, I think. Yeah. I also think she might’ve been abused by somebody  she acts weirdly in certain situations, like when I hold a broom. So I’m a little concerned about that, but she’s got a happy life now. But yeah, I don’t want her getting out of the house. I feel like she’ll just run across Rochester and you know, the end, the end. She’s my baby. Marisa Evers: Timothy just likes to hang out with the squirrels. His name is Timothy Timothy, Dave Etler: Timothy Marisa Evers: He just likes to like, look at the squirrels. So we left him outside. He’s also mentally challenged. So we kind of just let him do whatever he wants. Dave Etler: I do wonder a little bit about Fishwick that the formal Eric Boeshart: diagnosis mentally challenged. He got attacked Marisa Evers: when he was a kitten and our, so our cat had kittens and Timothy was one of them. And our dog was very selfish of attention and attack the kittens and ticket. These organs were outside, like, yeah, I found Timothy when he was like that and we rushed him to a hospital and then he had some brain injuries because of it. So he is mentally challenged, Dave Etler: crapped my Marisa Evers: pants. It was very sad, but he’s doing very well. He’s very lucky, but he does strange things. Because of it where like, when he’s happy, he chews on his tongue and like, he can’t drink water. Normally he steps in his bowl and throws it in his face. It’s really cute. We let him do whatever he wants, because I think he’s our dad. Dave Etler: She’s my baby. I don’t know what to Annie Rempel: do now. How do we recover? I don’t know what this was Marisa Evers: like 15 years Annie Rempel: ago. He’s fine. Dave Etler: Okay. Annie Rempel: Once was a tangent of all tangents. Marisa Evers: Remember we started with a fly peak. Annie Rempel: We got to, Dave Etler: I’m going to move on to the next question. No no. All right. So there is a lot of insecurity on. Yeah, who answers and I [00:30:00] hope that doesn’t transfer over to whatever options we have in the future. But this is, you know, this is exemplified by this person’s recent concerns that I actually think you can all relate to. And I don’t mean that you’re ugly. Oh, I gave it away. Come on. Is it possible bad sleep? Make me ugly. I’m 16. Unfortunately for a long while I was getting maybe five hours of sleep on school nights. It did not affect my height. I’m pretty sure. And lately I’ve been able to get more sleep mainly through naps, but I feel like, look Annie Rempel: ugly. Could that be due to the sleep? Oh my God. Dave Etler: Lack of sleep. Make it ugly. It can make me act ugly. Yes. Marisa Evers: So there has been research that has shown that whatever side you sleep on, it will become more puffy in your face. So that’s actually kind of why they suggest that you like sleep on your back because it can affect where you get wrinkles on your face and like the. Special cemetery. And that will actually affect how Dave Etler: are you talking about when you’re a kid? No, it Marisa Evers: can happen now. No,    I know I am a science speaker and it really upsets me cause I’m like, Oh, I’m always going to be asymmetric. Annie Rempel: I don’t need to be ugly Dave Etler: face, sleep, sleep person. I don’t know how to put that really, but Eric Boeshart: we’re all just lopsided. Can you tell which side Dave Etler: can you guys tell which side I sleep on? Annie Rempel: You are correct. That was my preferred sleep side. Marisa Evers: This can also tell which side you sleep on because it stimulates growth of your hair. Cause my hairstylist did this last time. I got my hair cut. There’s longer or longer on the side because like the wrestling, when you move your head, it stimulates hair growth. I Dave Etler: am now going to sleep on my forehead. I have a problem. I have a pattern about this issue. Will that work for 50 year olds? God, I hope so. Marisa Evers: I secret doctors. Don’t Dave Etler: do this one strange trick. Annie Rempel: To Dave Etler: alleviate your baldness problems. Okay. I like it. See it every time we do this Annie Rempel: spit, Dave Etler: I learn things. This is why we do this. Annie Rempel: I’m an educator. Dave Etler: I’m an educator by bringing this to you. I am an educator. All right. Here’s an old favorite. I think. Probably every one of us in this room can understand sympathize with let’s take some tingling Annie Rempel: and pants. What is the most likely reason for this? That’s it? That’s my Marisa Evers: question. I heard tingling with a G or tinkling tingling, piddling the nurse. Dave Etler: I think this is something we can all relate to and Well, I’m a little surprised that this person doesn’t know what’s going on. I mean, you’ve all had it to Eric. You’ve had it. Annie Rempel: Yeah. Lateral cutaneous Sophia Williams-Perez: for moral nerve. Your pants are Marisa Evers: just a little too tight. Yeah. Or your impression of a nerve. Or you Annie Rempel: were pregnant, your pants are tingling like this. How long? Like, is it Sophia Williams-Perez: shorts or actual like long pants? Because if it’s shorts, then you would assume it’s just like, you know, only me up, but if it’s full pants, then it could be anywhere from ankle to Eric Boeshart: hips. I’m just thinking of like the simplest stroke. Localization stuff. Just where do you have sensation? Dave Etler: Whoa, Whoa, Whoa. You cannot just go past that. Marisa Evers: An anal wink, Annie Rempel: Wink. Yeah. Dave Etler: I mean, I, I, I think I understand what you’re on here. I didn’t realize this Marisa Evers: one. Yeah. So that’s like, if you have an injury, like a trauma response, that’s something that you’re going to look for. Or you can also kind of injury. Like if you had a spinal injury, they want to make sure that everything you’re having sensation and still having reflexes. That’s also why sometimes they’ll, they’ll say if you have a finger and they have a butt hole, you need to check to make sure that the sphincter’s intact. Dave Etler: But you can, why did they put it that way? Why do they put it that way, Marissa, by that way, if you have a finger and they have a butthole, like Marisa Evers: everyone should be having that checked, that’s not a real thing that actually happens, but it is pretty frequent where it’s like, that is part of like a primary and secondary survey. When you have a trauma response, you have to check if they have like their sphincter intact. We in the Annie Rempel: desert. Dave Etler: wow. See again, learning things. Annie Rempel: Okay. Eric Boeshart: Thinking you still Dave Etler: processing dead. Always. , I will process for hours after today. All right. Next. We’ve got another hygiene related question. It’s a big topic on Yahoo answers. Annie Rempel: What’s a good comeback Dave Etler: for when people say taking above is dirty. I shower, but I also like taking baths because I sit down it’s relaxing and I put lavender, Epsom salt and Rose oil to relax my muscles and make it smell good. In passing conversations, I’ve leaned on that I took above and someone will interrupt me and say, taking above is just fading in your own debt. I got embarrassed because I never thought about it like that, but technically that’s true. And everyone agreed. So I was really embarrassed and didn’t know how to respond. Is it really bad to take above? I mean, what can I say? Because I take a lot of buffers and I don’t want people to think Annie Rempel: on gross or something. [00:36:00] No, that’s awesome. I know Dave Etler: this person’s like, I just want to have a nice Epsom salt Rose oil bath. It sounds lovely to make myself happy. And do it every day. Annie Rempel: Yeah. Can she draw me up a bath? Marisa Evers: She just showers after she can just tell or shower or also what you do in the bathroom is your own business. Dave Etler: You gotta remember that Annie Rempel: for Sophia Williams-Perez: your friends. Dave Etler: Yeah, no, I I’ve not taken a bath since I was a child. I think probably that’s just not a thing, Eric. You take baths. Do you, do you like, do you like S you know, maybe set some candles up and like Rose oil and Epsom salts and put on a little meat Eric Boeshart: glass of wine. This is a cup of precession, my fiance. And I had like, Dave Etler: I, well, okay. I’ll bring it out. Bring it out there. Eric Boeshart: Well, it it’s, she’s, she’s a bath person and I’m a shower person. And you know, again, just like she, like early on, she was Annie Rempel: like Dave Etler: calling your fiance a dirty woman. Eric Boeshart: It’s one of those things of like, she, she tried to convert me, I guess, that not convert me, but you know, like, she’s like, Hey. Have you ever tried this? I’m like, honestly, I’m like, no, I prefer cha you know, get in, get out, get clean. But then again, I’m, I’m also the type of person that I’d take a long shower too. So like, I kind of get the benefit if you’re just trying to like, turn your brain off, just, just shut down. Yeah. Dave Etler: But like, I like me a long shower when I can get it. Yeah. It’s a little hard household of four people with, you know, two kids who also like to take long showers and, you know, 40 gallon, hot water tank, but that’s just, that’s just the logistics. All right.  your fiance convinced you to take a bath? Did you try? Eric Boeshart: Yeah, I have, yes, it has its benefits, but I’m also. Six four and don’t fit in most bathrooms. Annie Rempel: So it’s challenging. Eric Boeshart: There’s logistics there that Dave Etler: it’s long time since I’ve seen you. I forgot that you were, that you were tall. Tall Annie Rempel: boy. Okay. Wait, my question is though, so Erica, your house It’s your bath, tub and shower one like do, do you, do you step into that? I feel do you clean it? Do you clean it Eric Boeshart: again, Annie Rempel: Val? Every Dave Etler: shower you do? No, no, Annie Rempel: no. Dave Etler: You’re not saying clean it after every shower. No, Annie Rempel: no, I’m just curious. Like, I, I feel like if you had like two bathrooms or like a bath tub specifically, and then a shower that you walk into specifically, it feels like those are like separate, but I know a lot of bathtubs have a shower over it and you can kind of choose. And I feel like that’s like, I don’t care about my own body dirt. I feel. I would be more weirded out by like, if this is Sophia Williams-Perez: like, yeah, like right now, my drain has a little ring up ratio, Mar sessions. Marisa Evers: Why Annie Rempel: haven’t you cleaned that shit? Just like the last couple of days yet? Dave Etler: We do not judge. Marisa Evers: You’ve noticed it. Annie Rempel: Sending emails. Okay. So many emails. Here’s the Marisa Evers: thing. I had friends in college who were males who never cleaned their bathroom and they had mushrooms neurotic Annie Rempel: about it. I’m having a, an anal wink moment here. Marisa Evers: They just have, they, I guess they didn’t know how the curtain works. I dunno, but the water would just splash out of their shower. Yeah. Onto Annie Rempel: the Dave Etler: ground, outside their house. Marisa Evers: Onto their bathroom floor and mold grew and then mushrooms sprouted from that mold. And they just Dave Etler: never dealt with it. Some commitment to not washing your cleaning at some point. Annie Rempel: But these were your friends. Eric Boeshart: I’m not wanting to talk because. So it’s like a very familiar situation. So Marisa Evers: I’m amazed and appalled at the same time of the standards that especially college age boys will live in 18 to 21 year old boys deal with, Dave Etler: you know, some, some of us didn’t learn a lot about cleaning when we were children’s and we had, we had parents specifically moms back then we did a lot of it. Sophia Williams-Perez: We don’t have moms. Annie Rempel: Well, I want it to be, Dave Etler: I want it to be a, you know a feminist when I was discussing this. Hm. Marisa Evers: My mom is one of those neurotic people that will clean the bathrooms and shower every day. This Dave Etler: is reminding me that I should clean the bath. Yeah, me too. Annie Rempel: Sophie Dave Etler: feeling very strongly. Then when I go home tonight, though, there’ll be a little bathroom cleaning. Annie Rempel: I don’t want it, you know? Sophia Williams-Perez: Recommend a knife or scissors in the mushrooms Annie Rempel: are these edible Marisa Evers: that you can, you can eat them or that you can have a psychedelic trip or you can die Dave Etler: flame thrower. I would, I would rush Marisa Evers: in the house. Annie Rempel: I live in an apartment Dave Etler: complex.  them Marisa Evers: all share the same plumbing [00:42:00] anyways. And the mushrooms are probably in the next 30 Sophia Williams-Perez: minutes. Dave Etler: The thing about this is if Sophie’s apartment catches fire for no reason, for no particular reason, you’ve got one week. All right. Let’s mushrooms. All right. You know, every one of us, we, you know, we’ve already talked a little bit about poop. Every one of us poops, it’s another big deal on Yahoo answers. Let’s see what we can do for this person. What should I do help? I took a sodium phosphate enema because I was constipated and it said it should work within minutes up to an hour, but an hour went by and nothing. So I did another one. Then half hour went by and they’ve been constantly shutting since then. I read the bottle, which I should have done first. I know, but I Annie Rempel: didn’t. And it says can cause serious dehydration or kidney problems if taken more Dave Etler: than one proper dosage, is that what is going Annie Rempel: on or will I be okay please? Only serious answers. I’m Dave Etler: not sure we can comply with that last bit, but let’s see what we can do to help this person. One or two doses is this problem. Just Annie Rempel: increase Marisa Evers: your oral intake. And then if drink, drink, drink, drink a lot. And if you still are hydrated, go to the hospital. Dave Etler: Yeah. Sodium phos. Can you, so what’s, he’s talking about an anima. In this case, but I’ve, I’ve had the pre-surgery like drink. Is it the same shit? Coli Marisa Evers: is right. Don’t you get that pre surgery drain? Sophia Williams-Perez: I don’t know what the active ingredients are actually cold is like not bowel prep. It’s bowel regimen. It’d be like, just to keep stool, soft bowel movements. So Cola wouldn’t be like the stuff Dave Etler: that you would take if you were having like intestinal surgery is what I’m talking about or like a colonoscopy you’ve got to get rid of it. Yeah. Yeah. The go lightly is what they use her, which is not which, which is like the worst name for a product ever, because it is not true. You do not go like Annie Rempel: heavily Dave Etler: for a long time. It’s another respective from a 50 year old. Yeah. Yeah. Increase your intake of water. Marisa Evers: So GoLYTELY is sodium sulfate, sodium chloride, sodium bicarb, and potassium chloride. So Dave Etler: potassium, Marisa Evers: sodium, France without Sophia Williams-Perez: fleets. What am I? Oh, perhaps it’s just showing me. I should probably brush up before Annie Rempel: intern year. Oops. Dave Etler: What are you going to do again? Oh, Marisa Evers: I’m blanking. The first thing that comes up is fleet and it goes to, Oh Sophia Williams-Perez: yeah, you’re going to, so I knew the cactus spine. Excellent. That’s Dave Etler: right. Should have known. Sorry, what were you saying? Marisa Evers: The first thing that shows up is for the fleets is it just says gentle glide, Dave Etler: gentle glide. Is that a feature of Marisa Evers: fleets that there are still glide tip designs for maximum comfort Annie Rempel: soft it’s flexible. Dave Etler: It’s fair. Gliding. That sounds nice. I’m Annie Rempel: glad right on brother. Dave Etler: I’d rather it be that than other words, Annie Rempel: rigid, Dave Etler: slamming special slamming tip, Annie Rempel: rigid wide gauge tip, but yes, over you’re right. It is study impossible. That’s under Dave Etler: that. That’s in another section of Amazon. Oh my God. How long have we been doing this? Sophia Williams-Perez: dangerous. Dave Etler: Oh my God. All right. I’ve got one more. Over the years, we’ve, as I’ve said, we’ve actually learned a few things from our discussions on Yahoo at questions. But sometimes I learn things from the answers to start. Here’s the question. Let’s see if you know. The possible diagnosis for this person who is very concerned. I’m going to get me a better. Okay. Here we go. I have white Annie Rempel: dots around the gland of my penis. What is this? It’s a very good Dave Etler: question. You’ve got white dots, multiple thoughts. Annie Rempel: Do they Sophia Williams-Perez: ever do drops on Rose pedals? Annie Rempel: But Sophia Williams-Perez: then I would say good pal to hurt. Annie Rempel: Oh, okay. Are these painful? We need to know. Are they painful Dave Etler: or not? No, that would have been, that would have been something I would’ve discussed. Yeah. Annie Rempel: I Sophia Williams-Perez: have painful white dots Annie Rempel: or. Yeah. Dave Etler: Okay. That’s not what the answer was. You could be penis, you could have penis deaths. I’m sure that’s a thing. What’d you call it?   Cockney. Annie Rempel: I’m taking that out. Dave Etler: Don’t mean to align our friends across the pond. brilliant. Yeah, the answer that was in the th those are all probably, I mean, you know, like I’m, who am I to judge? Differentials. I don’t, I’m not a doctor, but the one that I learned about in the answers was in my mind, earns the award for the most. What the  name of a condition? Pearly penile papules. Annie Rempel: Is that Sophia Williams-Perez: an accident like gnosis cause it just sounds like the Annie Rempel: description of Dave Etler: what they look like. Yeah. There’s a description. Pearly pearly penile papules, Y Annie Rempel: yeah. Sophia Williams-Perez: Yeah. Dave Etler:  Oh. Marisa Evers: Cause all of that, there’s like the six P’s when it comes to lichen planus. Right. Sophia Williams-Perez: Except for them it’s all purple purple in there. Annie Rempel: Yeah. Polygonal. You can have polygonal, papules. Dave Etler: Are they regular? Like we talking about like a regular polygon here. Annie Rempel: Are they papules? Are they plaques? Marisa Evers: Can it be both all I’m telling you Dave Etler: all I’m telling you, is that the name of this particular, that, of this particular descriptive bit of, I don’t know. What’s what’s the right word. Diagnosis. Diagnosis is not the right Annie Rempel: word, but But the name of this particular issue, Dave Etler: curly, penile, [00:48:00] papules. Why was the alliteration necessary in this case? Why, why it makes it worse? Also why Purley Annie Rempel: that’s, that’s a thing. That’s what I have an image in my head of a skin. Some other word available than purr. When you string those words together, it’s not, Marisa Evers: I don’t like it. Opalescent Sophia Williams-Perez: like if it’s white or something, Milky Like, you know, goes on that food border, but you see red. Strawberry tongue. Dave Etler: There is a strong tradition of food descriptors for conditions. Okay. Thank God they Sophia Williams-Perez: haven’t reached Kit-Kat yet. Dave Etler: If you have Kit-Kat penile, Annie Rempel: wrong Dave Etler: there. I, yeah, I just don’t like this particular string of words. They’re all fine on their own. I don’t know about papule papules. That’s kind of a yucky name. You guys are all used to this, but when I get exposed to these ideas, sometimes they blow my mind, like who I just want to know who was the person who thought, yeah, that’s how we’ll describe it in this gross way. That sounds like Annie Rempel: something a dermatologist would say those words. Maybe we’re just, we’re in it too Sophia Williams-Perez: deep. We’re numbed. Dave Etler: If you’ve got this problem, if you’ve got this problem or some other  do you go to the dermatologist or do you go to the urologist? They Marisa Evers: might just send you back and forth to be honest Annie Rempel: first, probably Sophia Williams-Perez: go to your physician primary care, but then where would they send you if they didn’t Marisa Evers: know how I know when I was in Durham, we had to see some genital concerns. Sophia Williams-Perez: So it could be either. Yeah, I suppose. Yeah. It depends on characteristic. Like, does it look infectious or does it just look like a skin thing, Dave Etler: you know, The these, this particular, which I’m not going to say again. The, the commenters thought it was a normal feature, you know, like a normal feature of. It was within normal limits. The PPP. Did they show Annie Rempel: up? They Marisa Evers: did not. I was going to say, I don’t think he would upload Dick pics too. I mean, you probably can. I don’t know. I’m pretty sure I don’t want it. Where am I going to get that? Dave Etler: And some things on Yahoo answers and in my quest it’s possible. I don’t know if they stay there, but yeah, it seemed to be that the commenters seem to think it was it. Within normal limits this issue, but again, they didn’t ask as many penetrate. They didn’t ask as many important questions. I caught myself Marisa Evers: word, Annie Rempel: Oh God, put that in the trading. No, let’s not mix Dave Etler: that in at all. Well, that’s our show. Sophia. Marissa, Eric, Annie, thank you so much for being on the show with me today. It’s been lovely. Annie Rempel: Thanks, Dave Etler: Dave. And what, what kind of pearly penile papule would I be if I didn’t. Thank you. Shortcuts for making us a part of your week. If you liked what you heard today. Subscribe to our show, wherever fine podcasts are available. Our editors are AGA Chowdhury and Eric Bozart and Alex Belzer is our marketing coordinator. The show is made possible by a generous donation by Carver college of medicine, student government, yay, and ongoing support from the writing in humanities program. Our music is by Dr. Roxanne captain sphere. I’m Dave Etler saying don’t let the bastards get you down and talk to you in one week.  `

You can have the best scores and grade, but personality counts TL;DR Affective presence is the lasting and stable impressions your interaction partners get from you.Your scores and grades only get you in the door.It’s your personality that makes you a medical student, and later, a doctor.  So make sure you’re giving off the right vibes!Listener Kalmen reminds us of a paths for some students who don’t match. Dave continues his ruminations about why a very few people don’t match into residency.  He thinks that some of those people (who weren’t the victims of luck or strategic errors) were burdened by a negative affective presence–the feelings that others have about interpersonal interactions with them. Which brings up (at least) two questions:  how do you know if people have a negative impression of your affective presence?  And even if you do notice, how do you fix it?  M4 Holly Conger, M3 Emma Barr, and M1s Albert Pedroza and Rick Gardner help him hash it out. And reacting to Dave’s other concerns about graduating students having additional paths if they don’t match, listener Kalmen writes in to theshortcoats@gmail.com to point out that some states do have such a path.  These states offer licensing for so-called associate or assistant physicians. Aside from the confusing name of this kind of practitioner, Dave is down with that because he just wants everyone to be happy.  But many–including Holly–aren’t so sure. 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!  And remember that we livestream every recording on our Facebook group, The Short Coat Student Lounge.  Join us and help us with our discussions! What an AI thinks we said 361 Your Affective Presence Could Sink You Dave Etler:  [00:00:00]Welcome back to the short coat podcast, a production of the university of Iowa Carver college of medicine . I’m Dave Etler. With me today in the studio. I have Emma Barr. Hello. Hi, Emma. And then , uh, I , uh, Oh, good Lord. I don’t know what just happened. Coming to us from the internet. We have Albert Pedroza.   Hello?  Yeah, it’s still an audio podcast. We have Nicole Heinz. Oh, yeah, the coal Hines. I’m I’m this is a good start. I’m kicking butt podcast and wise today. And we have Holly Conger. Hey there.  Yeah. So today we’re going to talk about a touchy subject, a subject that before the show, Nicole said she was a little nervous about Leland. What little nervous. You’re Holly Conger: a little nervous. Nicole. I’m a little nervous. Nicole Hines: I’m always a little Dave Etler: nervous though. It’s fun. Fine. It’s fine. We’re going to talk about personality. We’re going to be, you know, like is being smart, technically proficient, hardworking enough when it comes to a career in medicine,  or will I don’t, you know, like I don’t want to broaden it to personality. Cause I feel like that is like, okay.  Or will your personality kill your chances  at a career as a physician?  Now the answer is no, but I want to talk about, the kinds of personalities that make your life more difficult in achieving that goal. But first I do want to say, and this is something I’ve been wanting [00:02:00] to say for a while on the show. And I haven’t really known how,  but that is, there is some shit going down in America. And I wish I could help, but all I have is this podcast in my wildest dreams, you have the support, you need to lead a life of your choosing.  You deserve to be happy, healthy,  and successful in whatever ways you define those words. So if you need support because you experienced racism, discrimination, harassment, mental health crisis,  I want you to be able to get the help you need.  And so I’m going to put some links in the show notes from now onto some resources, but the bottom line is that for what it’s worth, I see you. I wish I could do more and maybe I can. In ways that I don’t understand yet or know about yet. But I see you and I’m glad you’re here. And other people are too. Thank you. Listener feedback from Coleman about assistant physicians or associate physicians. So common is working towards a nursing degree. With an eye on medical school someday, you heard us talking about students who didn’t match and know someone who wasn’t successful on her first try.   Fortunately, she was successful in her second tribe. So, but our discussion resonated with common because of that. I hope I’m pronouncing your name, right? He points out that the States of Missouri, Arkansas, Utah, and Kansas have started licensing a new form of provider called an AP. Or GRP. I’m not sure what GRP stands for. But H AP I think is a assistant physician. He says these are medical school graduates who take step two and get boarded to practice in a legal framework, virtually identical to physician assistants. Hm. It’s just something we’re more familiar with. He said he contacted the state rep and she was willing to attempt to pass it where he is. And several other, other States are working on this as well. And I’ll add verbatim what he said. I’d say medical schools and medical students who you lobby for these laws, as well as raise awareness that such programs exist because they seem to be the best kept secret in medical education almost every year, at least one and four commit suicide after failing to match. If we can soften the blow just a little, we can save careers. Save mental health and perhaps [00:04:00] even save some lives. So yeah, Arkansas, Kansas, Utah. And Missouri. And so I did a little research. We’ve talked about this on the show before. I did a little research, Arkansas these folks practice under the supervision of a physician. I think there is a a naming problem here. I think associate physician or assistant physician sounds too much like physician assistant. Yeah. I would suggest associate MD. How about that? Emma Barr: Do these people like go into that job, working like with the idea of doing it for a year and applying Dave Etler: again? Well,  this is what I’m thinking. I mean, maybe I think that’s possible. I think there should be a path going forward. From MD into a full fledged, independent physician you know, say after X years of call it associate MD hood or, you know, you could do your job hunt outside the match just like normal people do. When you think about that. I feel like if you Emma Barr: say you have to do X number of years before you become like a like board certified, that’s basically just yeah. Dave Etler: Essentially. Yeah. Yeah. Okay. Yeah. I’m down with that. And Emma Barr: you have to have regulations over, like, did you see this many kinds of patients and. That kind of stuff. Nicole Hines: So are you, are you recommending people apply, apply for it? Sorry. What was, what you just said where you say people apply for these while they’re also applying for the match or after they don’t match, then they look for these Dave Etler: positions. Yeah. Oh, I think probably the default should be matching. And I, and the reason I think this is because actually  the match success rate is actually pretty high. Most people at least  you know, like above 90% of people, I think it’s like 94% of people nationally find their match. And we do a little bit better than that. Actually, we do pretty well. So I think that’s how the default should be, but I also think I also feel that we should have a path forward. In some way, and this kind of struck me as like, well, if you provide that path, th WMC, for instance, disagrees with this whole idea they [00:06:00] cite patient safety and I know among physicians, it’s a controversial plan and maybe Holly has. Thoughts about that now that she’s almost a physician I’m willing to bet that Holly does have thoughts. I do. Yeah, go ahead. What are your thoughts? Holly Conger: I guess I’m confused as to what those purpose would be, because I know that there’s usually two groups of people who don’t match there’s those who were, you know, Great applicants going for a very competitive specialty that don’t match that can very easily soap into something else or do a prelim year and apply again or take a research year to go for that super competitive thing again. Or there’s people who weren’t going for anything competitive and for whatever reason that may be, whether they have a red flag on their effort interview terribly or whatever it is, don’t match, even in a non-competitive specialty. And I think those are the people that maybe this is aimed at. Cause I think it’s normal to try and soak. And so like they’re not match rate. I don’t know if that counts people who had the soap or not, or if it’s just straight up didn’t match ever after the soap or not. Dave Etler: Well, again I think this is an alternate path for people who, okay, so here’s the thing. If you have an MD and you can pass step exams and your only roadblock to getting hired for a residency position is well, and your only roadblock is getting hired to be a resident because the system trains several thousand people more than it can handle every year. I think that that’s what I’m aiming for. Holly Conger: Yeah, it was like, there are fewer applicants for the spot, so I don’t think Albert Pedroza: there’s a lot of spots that go and fill every single year. Dave Etler: But why is that? Is it because they do they give up? I mean, this is what I don’t understand. Like did those, those programs could fill their positions if they wanted to. Albert Pedroza: I think so, but I think the issue is with the whole matching process with the whole algorithm. And then I don’t think there’s anything set in place for the ones who don’t match besides the soap. So there’s soap and then. There’s nothing else after, so yes. And then those spots  go unfilled, Dave Etler: but again, why do they go unfilled?  You can match [00:08:00] outside soap after soap is complete. That is a thing that you can do, but people don’t, Nicole Hines: is it a lack of interest in that specific field? Like, even if you don’t match, but you’re given. Just the one field that you absolutely don’t want to go into. Dave Etler: Well, I mean, that’s possible. I don’t think Albert Pedroza: so because there’s a lot of specialties that go that have spots that are unfilled. It’s not just a few Holly Conger: like family medicine and internal medicine, psychiatry, I think are the ones that always have spots, but like, ER, the surgical subspecialties, like usually they have none. Dave Etler: Yeah. I mean, there are certain, there are certain that don’t have any problem filling their positions, but also there are certain, there are people who want to go into positions that just don’t have that they don’t make it in because the numbers aren’t there for them. And what I’m saying is that,  perhaps. Students are making choices about their specialty that are unrealistic, maybe. I think that’s possible, but I also think that you know, the other problem with soap is that the more times you go through it, I eat more than once. The less likely you are to match them next year. Emma Barr: Do you mean like each round Dave Etler: during the soap week? No. No, no. If you go through it next year, again, your chances drop by. Tens of percent. Yeah.  Cause it looks like a black Mark and I, I don’t like it. I just don’t like it. I think the whole system is weird. I mean, like we are,  on a personal level and after 18 years of doing this, like sometimes match looks like I don’t know, I’m used to the concept. But everybody else who looks at this as like what in the world, Holly Conger: it’s a very weird process for sure. Very anxiety provoking, even when it goes your way, even when it turns out while it’s super stressful, Dave Etler: weird. It’s just a weird situation. I mean, on the one hand, it’s nice because. You know, 95% of people get a position, but then there are those people who it’s kind of a mystery as to why they didn’t get a position. And they’re kind of screwed a little Emma Barr: bit. So were you saying that programs can see how many times an applicant goes through the soap? Dave Etler: I believe [00:10:00] that that is Emma Barr: well, they can tell that they’re reallocate and probably Dave Etler: yes, yes. Now. Okay. So there, I know there are a lot of edge cases. I know this is a weird idea. That I’ve had. But you know, I don’t feel like  it’s necessarily a safety issue as the WMC fears. Guess my question would be like, well, let me, let me finish your goal for that person. They’re going to go to residency. My, goal is either for them ultimately, as a career in the thing that they spent $300,000 doing and which they are competent to do based on the fact that they’re graduating from medical school. And they passed. The licensing exams. If that’s what the bar is for being safe enough to practice medicine, to being knowledgeable enough to practice medicine, they have achieved those things. The only thing they didn’t achieve was getting a job after med school and the stakes in that situation are so high to me that we, as a as an industry, I guess, as a system, I feel like we should be providing them with a backup plan. No, Holly sonar, Holly, Holly. Has never bought anything less than what I am saying, right. Holly Conger: To play devil’s advocate on the flip side, you know, if someone is not matching multiple times, you know, I would question why, you know, and I would question like, is that someone that I would want. To take care of my family. Like, is there something coming out and this whole process, that’s like a big red flag possibly, Dave Etler: but it’s also possible that it’s just bad luck. I mean, once you don’t match once that is enough to plummet your chances by a certain number of points. Right? Well, Holly Conger: I think it will, every time you have Albert Pedroza: to apply, but it also has to do with, for example, let’s say you have somebody who applies to 10 different places and they only ranked 10 places I mean, the chances of them not matching is higher than somebody who let’s say applies to 40 places. Dave Etler: Yes you can make it, you know, you can make mistakes. Yeah. In how you rank people, et cetera. And the mistake that you could make is, I mean, basically we tell people during the match, like you have to [00:12:00] rank enough spaces, enough programs to make sure that you match that is your goal. Soap is not a backup plan. And so we tell people that, and invariably  some people are specific enough in their wants and needs to have that be a problem for them. And so, yeah. I understand that.  I know that there are a lot of reasons why somebody might not match, but the reason I don’t like is the chance part of it. I just want people to be happy. I want people to be happy. Yeah. I know I want people to be, I want people after they’ve spent $300,000 and invested so much money and so much time and so much energy. I want people to have something. I have two Emma Barr: thoughts. So one of them you’re saying that like, once you take your step exams and you graduate from medical school, you’re like quality qualified doctor, but that’s not really true. Dave Etler: What I’m saying is that you’re qualified to be a resident. So you’re qualified. I mean, assuming that this idea gets enacted, you are qualified to be an associate MD. Right. Whatever you want to call it. And you are qualified to practice under the supervision of a resident, right. Of a physician who may not be part of a residency program, but who is nevertheless a physician. Emma Barr: Right. But then if you take that to employers, like that’s not associated with the residency program, they’re not used to, like, they may not be used to having that. So that would be a barrier too. Dave Etler: I mean, I’m not saying that. You know, you propose this, you make it and it fit in and happens overnight. . Holly Conger: I guess I would wonder, like, how do you get them licensed and how do you get them insured? Because you graduated from med school, but you didn’t go to residency and it creates this weird, you’re not board certified. You never trained, like, what are you, what can you Dave Etler: do? Yeah. Well, I think that’s the intent of these laws in these, you know, Four and perhaps growing number of States that,  are looking into this, that Holly Conger: comes with it, or just if you dropped a fourth year med student, which is basically what somebody who didn’t match is into a hospital and said, go. You know, they need residency to teach you how to do whatever it is. And so like, I definitely wouldn’t Dave Etler: work that Holly Conger: way, struggling to imagine a path where they can just like, be a pseudo position, [00:14:00] I guess. I just like don’t know what their role would be. Yeah. Well, Albert Pedroza: I think what Dave is saying is that you’d have sort of like an apprenticeship. Dave Etler: Yes, actually, that’s a better way of putting what I’ve said, Albert Pedroza: for example, like somebody who you don’t necessarily have to go to college to become an electrician, they have a program where you work under an electrician for two, four years. And then after that certain amount of time they basically say, okay, you were supposed to learn everything you needed to become an electrician. And I think that’s what Dave is saying, right? Dave, like under a physician. And then after a certain amount of years, you would be. Said too. It would be said that you’re competent to be a physician. Dave Etler: I think that’s it exactly what I’m saying and, and said ever so much better than what I said I know that people would have difficulties with the comparison between, you know, an electrician and a. And a doctor or something like that. I understand that. But conceptually that’s what residency is. Anyway, a residency is an apprenticeship model. It’s just not called that. And  the other problem with my idea is that residency is also very structured. You know, in a lot of ways, you know, there are things that you can do as a, as a second year that you’re not doing as an intern. And then there are the classes and things like that. So I know there’s a lot of details to work out. I just want people to be happy. I want people to leave here. I want everybody to leave here with prospects and not have to wait an entire year or more before achieving their life’s ambition. I think I just, I like it. Holly Conger: I agree. And I think that I mean there’s like weird consulting jobs and other things that you could do, but usually the best path is to go to residency. I guess I would just be concerned if you just like eat. All of the regulation of residency and all of the training requirements and careful planning to make sure you’re competent, you know, like that would be very scary to me. So like letting someone just like avoid that whole path and still hold the same title and responsibilities would frighten me. Dave Etler: Yeah. Again, I’m not arguing that there isn’t structure. I’m just arguing for. An additional path [00:16:00] that puts them on the road too. And maybe when I say achieving their dream, I’m, arguing to put them on a path that will allow them to approximate something of what they imagine their life would be like. Let’s, let’s be honest, nobody, In this world, most people don’t achieve their  life dreams, you know, like it’s just not a thing. You know, so I guess nobody has the right to achieve their dream, but if you work really hard and  you’re a good person and you, and you, embody the ideas and it just doesn’t work out for you. Especially after you’ve paid so much money and so much time and so much effort, it doesn’t seem right. Yeah. Okay. Enough. I have an, I have a whole nother, I’m going to give myself the last word because you all had come up with with very  reasonable objections to my plan, but I still like my plan. You’re making Holly Conger: me feel like a butt humbug over here, but like, I don’t Dave Etler: I love you, Holly. Let’s Emma Barr: see, actually listening. I have one more word. That’s what I have to do with that specific idea. I was listening to a podcast on how to give your elevator speech on like a project proposal or whatever. Yeah. So I feel like you just gave us your elevator speech and we’re giving you feedback and you’re not supposed to wait too long into your like planning period. Introducing the idea to other people. Cause then you get too attached to the idea, but you also don’t want to introduce it too early because then you might not have some thoughts I Dave Etler: have. And so what you’re saying is that perhaps have introduced this idea to appreciate that. That is excellent. It’s all been great feedback, like, okay. Like as I said, you all have said reasonable things to me about why this is. If not impossible, at least there are problems that need to be worked out right Holly Conger: now. Emma Barr: You can go work on it and then come back to us. Dave Etler: All right. All right. I will add this to what was I supposed to do last week? There was something I was supposed to fix last week. I can’t remember what it was. This Holly Conger: headphones. [00:18:00] Dave Etler: This is not good. Holly Conger: I know. It’s like licensing. Each state fester rules for how many times you can fail a board exam and still be licensed. And so sometimes I think that is what gets in the way of certain people. Because if you fail step one more than Y you lose a lot of States that you can even be a doctor in. If you fail it three times, it’s even more, you know, like there’s a lot of nuance in there, I think. Yeah. Dave Etler: Yes.  Affective Presence All right. Let’s shift gears for a minute, cause I want to talk about something else. That affects your career.  I want to talk about effective presence. Do you know what effective presence is? I did not know what effective presences until this week. Anybody, any, any ideas did you read? Nicole Hines: I read the article. Yeah, Holly Conger: I think you could explain it better. Dave Etler: All right. Effective presence is the consistent and stable feelings that an individual tends to leave in their interaction partners. This is an interpersonal trait because it is defined by the experiences of the interaction partners rather than by those of the focal person, which means that you can’t judge this on your own, or you might not be able to judge this on your own. I worry that some people enter medical school with personalities that will make it tough for them to get a residency position or to achieve everything they want to in their careers. And you know, so, one of my questions, you know, was effective presence of factor in the 2021 match. And you know, who knows? There’s no way for me to know whether that’s true or not, but I do know that, there was some decrease in certain categories of people applying to the match in, in their success. And maybe one of the problems that people are talking about is Students spent more time doing clerkships in their own institutions while institutions [00:20:00] were trying to protect their own because they couldn’t go away for match for a residency. They couldn’t go away for a way rotation. Good luck. All residency interviews, you couldn’t go away for a away rotations. And so they had to spend all their time in their home institutions and for some people. And, and so that meant that students had more opportunities to impress their home in institutions specialty decision-makers or the opposite or not. So even though some think that home institutions protected their own by ranking people, they knew more highly it’s possible that overexposure hurt some people who didn’t deserve that outcome. So that’s my thesis thoughts so far. So I’m looking at, you know, like Holly for some reason is, is I’m gonna, I’m going to on the live stream, I’m going to turn a Holly, I turn on grid grid view again, because Holly is the only one looking at me. And I feel like after the first topic today, Holly’s face basically is saying, Dave, Got Holly Conger: trying to say that with Dave Etler: my face. Well, now, now I’m reading into everything hot into every, into Holly’s every expression change. Nicole Hines: She using her eyebrows today. She’s Dave Etler: using her eyebrows very expressively. Emma Barr: Oh, I don’t want to receive that comment again. Holly Conger: Sorry, Emma. Emma Barr: I had so. When I was reading the, the popular ardor article, not the actual manuscript, it seemed like they focused on the negative aspect of effective. What is it called? Effective, effective, present, present. And there were saying like, you know, you can annoy people and things like that. But then when I looked at the manuscript or the study that you sent us, I didn’t read all of it. It was like 54 pages. But they, it seemed like they were talking more about, can be a positive thing or a negative Dave Etler: thing. And it absolutely can be, of course. You know, if you. And, and that’s the point, right? If you, if you walk into a room and people want to interact with you, you probably have, and they know you, you probably know I already have a [00:22:00] positive affective presence. But there are people, and I think we know people, we can probably each, you know, sort of think of people that we know in our lives, who on occasion you’re like, or maybe the instant, they walk into a room you’re like, Hmm. You know, like, I like you. I like you in all. Emma Barr: But I wish you weren’t here right now. Dave Etler: Where’s there other people in your life. You walk into a room and homeowner, no matter what you’re doing, you’re happy to see them. You’re happy for the interruption or whatever. Circumstance there was, Emma Barr: but I’m also wondering, are they also talking about, you know, those kinds of people that can walk into a room and like whatever their emotion is, like, it kind of spreads throughout the room. Like if they’re happy, everyone else can be happy. But if they’re like having a bad day and grumpy, then everybody else is kind of, I don’t know. I Nicole Hines: don’t think that’s what it really is because there was a line in there that said like, Some people could be like super depressed, but they’ll be the positive kind of effective presence. Okay. So Emma Barr: yeah, it’s more constant, like a constant negative or Dave Etler: stable feelings. Yeah. According to the definition they read consistent and stable feelings. Holly Conger: I’ve met people before that just like, I don’t know what it is, but they irritate me and I’ve also met people that I just like really enjoy being around. But those people, I don’t think are always the same for everyone, you know? So I might find somebody annoying, but you might think they’re great. You know? And so I was, was wondering like, how consistent is this across. Dave Etler: I did read something that said that maybe it was what maybe it was the popular article that I posted that, that said that research seems to say that those are, that those feelings are, are more or less stable across people too. So it’s so that the same person that you might feel positive about other people also feel positive about it, but of course that’s not a hundred percent true. I mean, I Holly Conger: think. Nicole Hines: With the people that come to mind for me, it, it definitely seems to be more of that stable feeling that just everybody around kind of gets that energy from them. Albert Pedroza: is effective presence, [00:24:00] essentially? Charisma is what, right? Holly Conger: Hmm. That’s what I was going to say. I was like, I think if you’re like a compelling person or like a good leader, like you’re, you know, you can woo people, but there were Dave Etler: people who. I guess. So, I mean, charisma, I feel like charisma has a, has a connotation for me that is more about public versus private, but maybe that’s, maybe that’s a false, like if you have charisma, you know, you’re, if you say somebody has charisma often you’re referring to there. Sort of like onstage personality kind of thing, but maybe that’s bullshit. I don’t know. I’m not going to say you’re, I’m not going to say you’re wrong. I don’t know. I think it might Nicole Hines: kind of be like social intelligence or like self-awareness type thing. Yeah, because the memories I have interacting with the people who come to mind, it’s like I would be talking with somebody and they would just. Out of nowhere up here and decide that they were hanging out with us and they wouldn’t get the signals that they weren’t really welcome. Holly Conger: They were so emotional, super relevant. Dave Etler: Yeah, exactly. That’s so I was thinking about like, Oh, say, so the problem, as I tried to point out before, the problem is you can’t tell or if you’re let me put it this way, unless you really think about it, it’s hard to tell. What your effect is on other people in this way. So you really have to pay attention, you know, you have to, you know, how do you know how you affect other people? I mean, you have to watch what people do when you talk to them for more than a couple of minutes. If they start doing other things, they start looking at their phone. If they start, you know, clicking their computer mouse or whatever, there’s one of two things that is going on. Either you interrupted them. And they have something that they really need to get done. Or they may be wishing that the conversation is over. The effect is the same, you know, either way. That’s a strong hint to go, Hey look, great talking to you. I gotta go. Nicole Hines: when I said I was, I was nervous at the beginning and something instantly came to mind. This is kind of where it lies. [00:26:00] And it’s that like, you can’t tell whether you have that positive or negative, but if you have like really bad anxiety or insecurity and you already constantly think, or self-critical in any situation that you’re in and you think, Oh, all these people hate me. They’re judging everything. I said, when in reality, They like you have such a good point. Dave Etler: What impact does that have? Yeah, Albert Pedroza: well, I would, I would actually disagree that you don’t, that you wouldn’t be able to know. What sort of presence you have, because let’s say you have people constantly telling you, Oh, you know, good job. Like these people like you, or like, we like you, we want you to come back around. Like, that’s essentially, you’re getting feedback from somebody they’re telling you, like, Hey, I enjoyed our, either our conversation, our whatever. And so I think people give feedback Dave Etler: don’t they. Yeah, we’re not talking about your mom, Nicole Hines: that validation doesn’t always come and it doesn’t always come at the right times. Emma Barr: Exactly. Like I’ve had two clinical experiences where I’m working with a team and I interpret silence or like no feedback as like I’m doing a bad job. Like I I’m automatically self critical. And then I find out, you know, A day, a few days later when I asked her feedback, they’re like, no, you’re doing great. Like, you know, this is awesome. All this like positive stuff. I’m like, why didn’t you tell me, like, I’ve been thinking I’m doing wrong the Dave Etler: whole time is why it’s really hard to know. Isn’t it. It’s, it’s hard to tell. I mean, you almost, you have to ask, which is why you ask, you know, this is why you ask Albert Pedroza: it’s a little bit weird, like, yeah. Cause Emma Barr: it’s like your personality, like Holly Conger: there’s only so much you can change. Dave Etler: Well, look, I mean, there are ways, there are people that you could ask, right? You could, you could pay for a coach if you want it to do. I mean, that’s an extreme, that’s extreme. Possibility. Right. What Emma Barr: do they like follow you around and ask the people Dave Etler: for you? No, but I mean, they could help [00:28:00] you figure it out.  They could help you, like for instance, say, you know, well, what do people do when you talk to them for more than minutes? Do they start clicking their computer mouse?    I mean, you could ask your mentors, but again, you know, I know what you’re going to say, which is that you know, they’re not always, probably willing to say, well, you know, you’re kind of annoying. Holly Conger: I kind of don’t like you, but I also can’t tell you how to fix it. I think that like emails or whether this is relevant for medical school, but I think this applies to every field, you know, like every field you get ahead of people like you, every field, it’s important to be able to, you know, work with people and get them to want to do what you say and all of that. But I wonder how it’s separate from just like those like social skills and emotional intelligence, you know, like, because. Part of like the biggest feedback people have given medicine is like read the route, you know, pay attention and know when to shut up. And when it’s okay to ask a question when you’re being annoying and then, you know, when the resident can teach you, you know, like just Dave Etler: pay attention.  This reminds me of helping my father fix things when I was a child. My father is a lovely man, but he would get very impatient when trying to fix things. And I can understand this because sometimes it doesn’t go well. And then you have a, like a ten-year-old. Like hanging around going what’s that? What’s this? Oh, can I help? Can I help? Can I help daddy? What are you doing? Daddy? And finally, my father is like, I’m like, okay, so this is part of the learning Holly Conger: for me. Emma Barr: So you’re saying that annoying people didn’t get yelled at us kids Albert Pedroza: basically. Holly Conger: Or I wonder if it’s bad, what is it? Bad essence. Bad. that effect, if that correlates to people with like low emotional intelligence or lower social skills. I wonder if it correlates, if it’s secretly kind of the same thing. Dave Etler: I suspect that that is true. Yeah. Albert Pedroza: Dave, did you ever get yelled at for not holding the light in the correct? Oh yeah, Dave Etler: yeah, yeah, absolutely. Holly Conger: Your [00:30:00] analogy is reminding me of like the classic med student in surgery over the med students. Like, what’s this, what are you doing? Why’d you do that? What do you do next? Can I hold this? Can I like get in here? You know, I can, they’re just like back. Emma Barr: And then they’re like, your one job is to suction. Why aren’t you sectioning production? Holly Conger: And you’re like, I don’t know. You yelled at me to get Nicole Hines: One of my interactions with a person that comes to mind and like the social awareness is this memory of being in a class, in a computer lab. And they chose to sit right next to me. And at one point they turn to their left, which is a sign them on and they sneeze. On my hand and they Holly Conger: don’t acknowledge it, Nicole Hines: sorry. Like they just sneezed on my hand and go back to their statistics. And I made sure by them again, I, I wasn’t. Confident enough to address it. I just went and washed my hands and came back and got my work done. I didn’t want to deal with that. I’d already had enough run this person. It was only spring semester of freshman year. Dave Etler: That’s the kind of thing though. I mean, recognize when you’ve made a mistake, right? Because we all make mistakes. I mean, I know like what was it just the other day? You know, I had yet another brilliant idea. I always joke that I’m so full of good ideas about how to improve medical education, but nobody ever thinks they’re good ideas, you know? So I was walked into somebody’s office. I think it was Matt Edwards. And I was like, Matt. Got a great idea. Let me tell you all about it. And. At some point, I can’t remember what he said, but he said something that to me was like I have things to do. And so at that moment I was like, Oh, I wonder how, how long I’ve been unwanted. So as I left, I cracked a joke about, I basically said, you know, I’m sorry I took up your time. Kind of thing and cracked a joke cause I left and he laughed and hopefully that diffuse [00:32:00] the situation. But the point is that, you know, it’s possible to make mistakes. That’s fine. Hopefully if you have the humility  to admit that you screwed up, that you sneezed on the hand of the person next to you. Emma Barr: Like if you, if you recognize how socially inappropriate you were, it’s not as bad. Dave Etler: Cause you’re gonna make them, you’re gonna make mistakes. I bet Albert Pedroza: to say that that person did that sneezed on your hand, didn’t even know what was like socially acceptable or not. If they’re just Emma Barr: were, they were trying to get back at you Nicole Hines: interaction with them. so right when I got to college, I went for band camp. And we hadn’t even activity. So I went on a walk with my, who is my best friend now, and this person decides that they’re coming on the walk with us too, except they’re on the phone talking to somebody. So they’re trailing like 10 feet behind us talking on the phone, telling them that they’re going on a walk with some people from the Dave Etler: wow. Nicole Hines: Oh, what’s going on. Like, we didn’t ask them to come. They’re saying they’re with us. And then once their call ends, our conversation just kind of dies and they try to join in and we’re just like, Dave Etler: we’re done walking. I feel Holly Conger: like I’m just like an anxious person. So I like kind of always watch how like people respond to me. And therefore if I pick up on signals that I’m annoying them, or this is not a good time. I quiet down very quickly. And some people, I guess, just like don’t. Yeah, but I think maybe that’s part of being like the teachable and like noticing thing, which being teachable is a big skill, but I didn’t realize it till I came to med school. You know, like being able to learn and Institute feedback is something that a lot of people can’t do which is probably part of this, because I’ve asked a question at the wrong time. I’ve been told that now is not the time by a resident, but then you just like learn the pattern [00:34:00] of Oh, Don’t do that again. Dave Etler: Yeah, I, yeah. I mean, absolutely. Again, you know, this, the cues sometimes are hard to read depending on the situation. And, and so, you know, I learned that dad under the sink means shut up. Yeah. You learned that whatever situation you’re in with that resident or in that situation, you know, Probably there are better times to, to ask questions or contribute your observations or whatever. But I, you know, like I want this to not be important, you know, like I want this to not be important, but my gut says that it’s important. You know, and I think probably 99% of people who get into medical school, you know, have already have some, some facility at this. But I think it’s possible that man, I don’t even like, I don’t know if 99% is the right I get. Yeah. Okay. What the hell? Let’s just a number of people who get into medical high number of people get into medical school already have this unlock. But that can’t be true for everybody. And so I just thought it would be. You know, good to talk about, you know, because the, the stakes are kind of high, right? I mean, I, I don’t know what the actual number is, but I suspect. That, you know, let’s say 99% of medical students eventually match. Okay. And it will, but it will cost you hundreds of thousands of dollars in education to achieve that. And there are no guarantees that, that even if you get to the point where you’re ready to match that you will match. And in fact, if you aren’t successful in the first trial, you have to wait. And you know, all the things that we talked about earlier in the show will happen. Would you even want to take the chance. I think if Albert Pedroza: you go a little bit further, you can think about the responsibility that a physician will have in the future. And I know that sometimes it’s a little bit. Easy to not think about it, but really essentially what you’re going to be doing later on is you’re going to have to take care of another human being and you have to be willing to work under a high pressure, high pressure situation. And you have to be okay [00:36:00] with, for example, if you do something wrong, getting corrected, if you do something that you weren’t supposed to do, getting corrected, receiving feedback, because it’s such a high stakes profession. Dave Etler: Yeah. And, and of course also that, you know, if you, even, if it matched, even if matching isn’t, you know, a problem for you, you’re still going to have to interact with people and be a part of their lives. And, and would you rather, you know, for instance, patients. Seek you out if they need your help or would you rather than be like, Oh, that sucked, I’m going to go. Or, you know, would your, would you like knowing that your professional colleagues at least tolerate working with you, you know, like, or are they, or instead of avoiding you, like, anyway, Emma Barr: another question I just thought of like, is how quickly does that affective presence come out? Like if you have like a, okay, so if you have a 15 minute appointment with a patient. Are they going to not like you instantly Holly Conger: see what I was thinking about is what, if you ever, 15 minutes residency interview. Yeah. That Emma Barr: too, or like over zoom too. Dave Etler: Yeah. Yeah. I think it, I think it comes fairly quickly, but you know, there is a, there, my guess is from my own sort of feeling about this, my guess is that there is a. Sort of a process of confirming, confirming that idea, like Emma Barr: the person interviewing you or the patient, shouldn’t be so quick to judge you. Right. I Dave Etler: don’t think anybody’s going to immediately shut down, but people form their ideas pretty quickly. Right. Actually Holly Conger: I think in residency interviews, that’s exactly what they’re trying to do. I think the main, their main purpose. Do I like this person, you know, like they don’t care anymore about scores or all the activities on your app or your personal statement, because they’ve all reviewed all that and decided they liked it enough to offer you an interview. So the interview is pretty much exclusively about, do I want to work with you? If I am on a night shift with you at 2:00 AM, are you the type of person I want to get to talk with? Or am I going to want to just like bang my head against the wall? Because you won’t shut up for like, I don’t like you and blah, blah, blah. And so, like, I think that’s [00:38:00] exactly the purpose of residency interviews. It’s just a little scary. Albert Pedroza: So let’s say, we’re saying that 15 minutes is not enough. I mean, what timeframe would be enough, you know, so, I mean, if somebody doesn’t get a good feeling about you within 20, 30 minutes, do you want them to spend a couple of days with you a couple of weeks? Dave Etler: No. Holly Conger: I mean, I think that’s kind of like the away rotation argument that gives you more chance. To meet more people for a longer period of time, for better or for worse, you know, like it could work Dave Etler: either way for you. Less is more if, if you have this problem Holly Conger: but like for instance, the interviews, I think whether they’re zoom or in person, they’re usually about 15 minutes. Some of the longer ones are like 30, but like, so they’ve clearly decided that that’s enough for them to decide if the interview changes, how they view you. Like, I think for some people it’s like, wow, I really like this person. I’m going to move them even higher up. Or sometimes it’s like, wow, I really did move down. Or sometimes you stay the Dave Etler: same, but w w you know, I guess the question is, what can you even do about this?  I mentioned like, you know, coaching, ask a mentor, all this kind of stuff. you know, I think You’ve got to figure out what it is that you’re good at and what it is that you need. Help with, I mean, one of the things that I know that I need help with is that I, I would imagine that sometimes my jokey, you know, personality is like, you know, shut up, Dave. Holly Conger: I’ve never really thought that Dave Etler: to be context here is important. Holly Conger: In other situations that’s Dave Etler: podcast, you’re trying to get I’m serious done. And there’s Dave Etler in the corner crack in his little jokes, you know, I can imagine. And the other thing that I do that I’m pretty sure is detrimental, but I don’t, I’m not sure that I can. Care is I’m a bit self-effacing and this can be a turnoff. I know. I’ve heard people on the show say, you know, that they were told that they were too self-effacing and that it was kind of a problem because, you know, it gives people the idea that you are in fact. And ineffectual bumbling [00:40:00] don’t know, puts that in their head for you. And the truth is that that a self-defensive, that is a self-defense mechanism. Hello. That’s a self-defense mechanism for, you know, like heading people off. So it’s best not to do too much of that. In my opinion, one author says one author and the proprietor of smalltalk science.com says that the best personalities are humble, caring and unselfish, positive enthusiastic goal-oriented and compassionate, playful, and flexible. I can buy Holly Conger: that’s a lot to live up to all just like likable characters. Dave Etler: Yeah. And I would add. And I think we’ve, I think Holly said this before in the show, I would add that some of those encompass the important skill of learning when to leave the room to stop talking, to receive in the background, you know, flexibility, for instance unselfish caring. Those are two things that I think link up with this skill of being like, you know what I’m going to shut up now. I think, Holly Conger: you know, being able to recognize you’re not the center of the universe is always important, you know, but like sometimes other things take priority over you and. I think one thing that Nicole pointed out that I’ve, or maybe it was Emma, I don’t remember. Like when you interpret silences that hate you is I really did that a lot as a med student too. And it wasn’t until I started being like the more advanced student on rotation, where I started to realize, like, you’ve just got a lot going on, like the closer you get to a resident and it’s not that you dislike the student or they’re doing bad, or you hate them. Sometimes you just like. Forget, you get distracted doing all your other stuff and the anxious student that projects like this be to add onto them, which happens a lot. But yeah. Yeah. Which I guess I say to try and save students from doing exactly what it sounds like we all do Dave Etler: part of the problem in that situation is that you’re expected to put yourself out there. Right. You’re told I’ve. And in fact, I’ve said on the show, you know, if you don’t talk, nobody’s going to know what you know. And so there’s a bit of a conflict there. I, I understand that. But again, read the room. Hmm. Nicole Hines: I’m still curious whether This affective presence is the same in person or virtually because with people with negative presence, I’ve always [00:42:00] felt just like zapped and drained. The moment they come around and it’s almost like an energy they bring to the room, but. Does that same energy come when they’re across the screen, because like we’ve used the term when they walk into the room, like when I sign into the room, do I bring that same feeling to people don’t know. Dave Etler: Yeah. That’s a good question. Emma Barr: I feel like it would be, have to be super strong if you’re just sitting. If they’re sitting there, like, I don’t know. I guess their Mike might not be off. Maybe they’re un-muted Holly Conger: why I wonder Nicole Hines: if at that point. If you already see this person in that way, then every little thing they do is annoying to you. So if you already see somebody from personal interactions like one-on-one or in public, then you see them virtually you’re going to overanalyze every little thing they do. And it’ll just be more, Dave Etler: yeah. It Holly Conger: feeds on. I think the only experience I have to try, and I guess it’s like the zoom interviews because I had to do a bunch of them with people I’ve never met before. And there was definitely ones where I connected really well with the interviewer and I felt like they were going super great. And I really liked the person, but know I definitely had some really awkward. Awful ones that I was like, looking at the clock, like how many minutes do I have, like, try and keep going with it. Nicole Hines: What if your interviewer has a negative effective presence? Well, how did they get to that Holly Conger: position? Dave Etler: Well, that’s a problem because you’re also trying to judge, I mean, the other part of residency interviews is you’re trying to judge them. Holly Conger: Like, it’s all about fit, which I’m hoping, like, no matter what your presence is, you’re supposed to find that people who like you and want you, like, that’s the whole point. So hopefully. You just find that, I don’t know Albert Pedroza: if this was true or not, but didn’t they say that. During some med school interviews, they would purposely try to have like a negative presence to see how you could alter that presence. I don’t know if that Holly Conger: was, so now we’re getting that at one school. Now we’re getting Dave Etler: into some science [00:44:00] bullshit right here. Holly Conger: When I interviewed at one med school, you know, four years ago or whatever it was now I was in the interview room and all of the lights shut off halfway through my interview and like, wouldn’t come back on. And I remember being like, is this attached to adversity? If that counts like unexpected stuff. Dave Etler: You know, one thing that I appreciate with awkward people is that, you know, I’ve, I’ve known some weird people in my time here and in my life. And I think the ones that I love the most are the ones who knew that they were weird. I remember one person even thanked me once for sincerely, for pointing out a full paw and seemed genuinely grateful for the feedback, which I found super endearing and made me love that person even more. So I think it’s possible to be awkward and. Have trouble reading the room, but also be somebody people want to be around. I genuinely liked being around this person, even though. I worried about them. Holly Conger: Maybe those are the people that I would worry about on like a quick interview, like them getting to know them to find them endearing. Yeah. Dave Etler: I think this is the key, like display sincerity, self-awareness humility. Those are the three things that I think could take the curse off. An otherwise problematic, effective. Presence. Holly Conger: Some of my favorite friends have what I call like a really strong sense of self, which I think is what you’re getting at, where they, they know that they’re a weirdo, but they’re, that’s who they are and they don’t make any apologies for it. And that’s who they are. And they still don’t want to irritate people, but this is just who they are. And so sometimes I really liked those Dave Etler: people too. Yeah, making the effort, I think is important too. You know, like, you know, it, it, to the extent that you are aware of a problem, if you do nothing to ameliorate that problem, and that’s obvious to the people who know you, maybe that’s kind of, that’s kind of an issue. I think one problem I have with this thought and that you’ve sort of touched on Holly, is that if I argue that you should focus on [00:46:00] the ideas and am I saying you aren’t great. Just the way you are. Is that a valid thing for me to say? I mean, I’m not saying that you suck, I’m saying that you have a choice that you can be unapologetically. Awesome. Just the way you are and understand the consequences of that choice or that there might be consequences for that choice. Or you can try to make changes that enable you to achieve something that you want to achieve. Both ideas are valid. Holly Conger: I feel like you can be unapologetically yourself and know that and know that that makes you really great in a lot of situations. But I think that also takes awareness in which situation maybe some of your personality traits are not great. Just like take some awareness, cause nobody’s going to be. Perfectly suited for every situation. Yeah. Dave Etler: I’m pretty sure that the reasons that I’ve stated about myself as being a problem or the reasons that I have never once been asked to help with resonant with a med school interviews, even though I have offered, because I think that they think I am going to sit there and crack jokes the whole time. And, and just be, not serious about it when, in fact, like I believe that I can go in there completely serious and then completely professional about it. I just don’t show them that side of me too often. I’m the, like the least professional Emma Barr: you should offer to do a mock interview. Dave Etler: That’s a good, that’s a good point. Holly Conger: Maybe it’s, they’re worried. You’re just too nice of a guy that a really horrible student can interview with you and you just like won’t write anything bad. That’s true. Dave Etler: I’ve kind of made it. No, I’ve kind of made a note that I love everybody. Emma Barr: You just said you wanted everybody to be happy. So Holly Conger: apparently David said dove, and maybe I’m the hock. Dave Etler: You and I should interview people together. Etler team. Yeah. For Emma Barr: anyone who’s listening. If the lights go out, it is a test Holly Conger: to make sure, to just pretend it’s not a big deal. Be nonchalant, adaptable. [00:48:00] How would it Nicole Hines: go over if you’re in one of those rooms with like the motion sensors and your lights go off and you just flood your heart a little bit and then pick up right where you are, what just happened, Holly Conger: whatever you gotta do. I don’t know. Dave Etler: There  is a special subgroup of personalities that I wanted to also address which is people who don’t suffer fools gladly students who don’t suffer fools gladly. This is a problem because fools are everywhere. They are. You know, among the residents there among the attendings there among, you know, every, every, you know, like those people are out there. And so I have some advice for those people who I have also loved. Never let them see you. Roll your eyes. Wait, can you Emma Barr: explain, go back a little bit. What do you mean by fools? Dave Etler: I E you don’t like what somebody is doing or. How they approach the world or how they think about the world. And so you’re a fool. And so basically if  I thought that Emma bar, we have to clarify camera here, if I thought the Emma bar, if I thought that you am a bar where a dumb ass, but you were like my resident or my attending or whatever, there are some people out there I have known who. Find it difficult to conceal, that sort of emotion, that sort of frustration or annoyance. So that’s what I, that’s what I say. Like you don’t suffer fools gladly. And if you can, if you let them see you roll your eyes, I said, all right, if you let them see you roll your eyes, then they’re going to know that you think that they’re foolish and that’s not good. Decide if you have to speak up. There are dangerous situations and ethical issues and things like that, HR problems, you know, things like that, that you, you know, might reasonably think that you [00:50:00] should speak up about. And again, you should know the consequences. If you do that, especially if the person is of a higher status.  So if that’s what you’re going to do, whoever you talk to about this, whether it’s that person or somebody that has control over that person or something, give your feedback with sensitivity and love or don’t give it at all. That’s my advice. Figure out how to say it so that people will deal with the situation in a constructive manner. Offer a solution with feedback, with offer a solution with the feedback. Or if you don’t know what that solution is, at least say that, like, I don’t know what to do about this. Maybe you have ideas. Hmm. So is the Albert Pedroza: person who rolled their eyes? The one that’s Dave Etler: clearly I’ve clearly confused, used a confusing term Holly Conger: for which I Albert Pedroza: it’s the one who’s rolling their eyes. The one who’s also giving the feedback. Yes. Okay, Dave Etler: I follow you. So I guess the point is like, if you see something that is truly a problem, dangerous situations, ethical issues, HR problems, things that are like serious situations that should be addressed, offer your feedback with love and sensitivity. While knowing that there could be consequences. And if you can’t live with those consequences, then you have to make a decision on whether to speak up or not. But the point is give your feedback. Sensitivity love step back, consider your job done, you know, and then wipe that wipe that look of contempt off your face because that’s, yeah, Emma Barr: sometimes I feel like it’s hard to tell whether it’s like just a personality thing or like what they said or did was actually like something concerning. So like when I’ve been in that situation, go to like a third party and be like, does this sound, you know, Yeah. Concerning to you. Dave Etler: I don’t know. I just wipe my nose on camera. Anyway. Those are my thoughts. Emma Barr: I’m trying to remember when you said the rolling. I think rolling ice thing. I think I’ve gotten in trouble for rolling my eyes at somebody you in your eyes. I know I did my eyebrows. Holly Conger: I know can’t [00:52:00] remember the example. I think being able to give them like, Quote, unquote negative feedback is also a tremendously undervalued skill. Cause I think a lot of people just like won’t ever do it, which is a problem. You know, cause if no one ever tells you anything you’re not doing well or could do better than you never know what to work on. Hopefully they deliver it in a constructive way, Emma Barr: to do the positive sandwich thing, Like part something positive, then the constructive and then more positive. So hopefully you leave them with a good, yeah. Dave Etler: Like I really liked the way you do X, but you killed that patient. But good job on that form. Holly Conger: Good job on the death certificate. Dave Etler: All right. That’s our show. Albert Emma, Holly, Nicole. Thanks for being on the show today with me. Thanks for putting up with my harebrained ideas, Holly, especially, Holly Conger: I, I want people to be happy too. I just thought I want patients to be safe. So I was pointing out this, the concern. Dave Etler: Whatever. And what kind of, and what kind of games gallbladder would I be if I didn’t. Thank you. Shortcodes for making us part of your week. If you’re new here and you like what you heard today, subscribe to our show. Wherever fine podcasts are available. Our editors. They’re AJ Choudhry and Erik Bozart Alex Belzer, Al Alex Belzer is our marketing coordinator show is made possible by a generous donation by Carver college of medicine, student government, and ongoing support and the writing and humanities program. Thank you. Writing in humanities program. Loved those guys. Our music is by Dr. . Don’t let the bastards get you down. Talk to you in one week.

COVID stressed healthcare but showed us a better future. TL;DR COVID revealed what’s broken in healthcare, and also offers a glimpse of how it can be fixedDistributed, decentralized and digital isn’t about technology, but about putting patients at the center of healthcare. Read Dr. Nundy’s book Care After Covid: What the Pandemic Revealed Is Broken in Healthcare and How to Reinvent It. Care After COVID…by Shantanu Nundy, MD This episode is sponsored by Panacea Financial, Member FDIC. Panacea is banking for physicians and medical students! Shantanu Nundy, MD, is no stranger to healthcare policy and patient care. He’s a physician, entrepreneur and technologist “passionate about reinventing healthcare for all.” He’s a CMO for a company working to improve health outcomes, a primary care doc in the Washington, DC area, and a lecturer in health policy at the George Washington Milken Institute for Public Health and advisor to the World Bank Group on digital health and innovation. So we were grateful that he offered to sit down with Dave, M4 Holly Conger, M1s AJ Chowdhury and Rick Gardner, and M3 Emma Barr to talk about his new book Care After COVID. He shows us a future that COVID has revealed as possible for healthcare if we have the will to make it happen: in which technology is a tool that puts patients at the center of everything physicians and systems do. 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 360 Care After COVID Dave Etler: [00:00:00] Welcome Back to the short coat, a podcast of the university of Iowa, Carver college of medicine. I’m Dave Etler. That’s not important right now with me in the studio recording and being live stream to our Facebook group. The Short Coat Student Lounge, which you should join is the incomparable AJ Chowdhury over here is the unparalleled Emma bar. [00:00:55] The transcendent Holly Congar is over here and in a class of his own it’s Rick Gardner what’s up homies. But if you were thinking that that was all shortcodes well, that’s where you’d be wrong. Joining us today is Dr. Shantanu.  a primary care physician technologist business leader. He’s got a new book. [00:01:15] Care after COVID what the pandemic revealed is broken in healthcare and how to reinvent it out. This may from McGraw-Hill education. Welcome to the show Dr. Nandi. [00:01:24] Dr. Nundy: [00:01:24] Thank you. I was, I was waiting to hear what adjective I would get, but maybe I have to burn it. [00:01:29] Dave Etler: [00:01:29] Yeah, we just, either we just, we don’t just give these adjectives. [00:01:33] Dr. Nundy: [00:01:33] You’re going to make me work for it. [00:01:34]Dave Etler: [00:01:34] Thank you for, thank you so much for hanging out with us today. I really appreciate it. [00:01:37]Today’s episode is sponsored by panacea financial division of sauna bank member FDIC. Panacea is banking for medical students and doctors. I’ll tell you more about them later in the show. [00:01:46] So Dr. Nandi we took a look at your book. I think you’re arguing in the book that COVID has given us an opportunity to see a new future for patient care. Can you elaborate both on this vision of decentralized digital and distributed? [00:02:00] Care and how [00:02:01] Dr. Nundy: [00:02:01] it might work. There’s a lot to that. So I think that most of us understand that this has been a once in a century pandemic. Right. But I sort of optimistically look at it as a once in a century opportunity to reinvent healthcare. And there’s really two reasons for that. [00:02:17] Right. One is healthcare chain has changed more in the past year than it has probably at any time in its modern history, right. Like me as a patient doing my first virtual visits, I did virtual physical therapy on my low back. Right. You know what I’m doing with my own patients. And the second reason is because I think it’s really magnified, not just for doctors, not just for patients, but for really every stakeholder  in our country for just how deeply broken healthcare is. [00:02:48] Right. Like, I think I don’t have any conversations anymore where people don’t talk about health equity like that. Wasn’t. Unfortunately the case a couple of years ago. Right. Or we’re talking about mental health or so I just think that it’s because of both the changes that have happened, but also sort of the  understanding that is much more widespread that this is really a special moment. [00:03:07] So that’s really, the core idea is it’s like kind of the classic, let’s not waste this crisis. Like we have this moment now, what are we going to do with it? [00:03:16] Dave Etler: [00:03:16] So taking these ideas of decentralized digital and distributed one at a time, I guess what is decentralized? What does that mean  in your vision? [00:03:26] Dr. Nundy: [00:03:26] Yeah. So first of all, let me explain sort of why I think these three words matter, right? Cause I think that like, you know, someone once told me words, create worlds, right. That the way we think about things and conceptualize things really shift. Our minds and then shifts our behaviors. Right. So I’ll ask you to maybe let’s start with distributed first. [00:03:46] That’s the easiest one to sort of grok, which is I’m sure a lot of us have heard like, Oh, carers become virtualized. Care’s become virtualized. Right. But I always ask, like, has it, I mean, yes, I’m seeing patients maybe through video or through phone. But someone still have to stick a Q-tip in their nose to test code. [00:04:04] Someone had to get blood work. Someone had to take a medicine every single day. And so I think saying that care has been virtualized is a little bit of a misnomer because it hasn’t a component of it has, but overall  , it’s just shifted. It shifted out of clinics and hospitals to being distributed into the community and into people’s homes. [00:04:26] And so that’s what the concept of distributed is. It’s it’s care happens where health happens digitally enabled. Right. So a lot of people talking about well, AI and EMR and all that stuff. And I think to some degree, we think that those are the technologies that are going to change care. But most of us have seen patients know that the EMR doesn’t really change care. [00:04:45] Right. It’s we went from a paper form to, we scanned it onto a computer that costs us a hundred billion dollars, but it didn’t really change the way we deliver care. So digitally enabled is saying. Really the role of technology and data is to strengthen the relationships between providers and patients, right? [00:05:02] That you’re digitally enabling that core interaction. And then do these centralized. It’s sort of a counterpoint to the word value based care. Everyone’s saying value based care, value based care population health. But to me, the key is you can’t just, , wake up one day. He said, Hey doctor, guess what? [00:05:18] You’re now accountable for that patient’s risk. Like you’re going to manage their risks, right. To do that. You need resources and you need authority. And so decentralized. Power has to shift you. Can’t just give doctors the bag and say, well, guess what, you’re stuck with it. Now you have to give them the tools and the resources and the authority, like simple things. [00:05:37] Like,  my nurses aren’t allowed to go to someone’s house and draw their blood and most States in this country. And so if you want to be able to shift care for people, we need to be, we need to get more than just bearing the risks, which is what most of the value-based care is about. So those are what the three, you know , terms are trying to conjure up. [00:05:54] Dave Etler: [00:05:54] Thanks [00:05:56]friends. You’ve stunned them. [00:06:01] Holly Conger: [00:06:01] Oh, well, I just, I think we’re feeling like we’re talking to an expert, so I’m not sure what I have to add to it, but I know like,  I’m an enforcer. So I think  as someone who’s about to join the workforce,  when I think about like telemedicine and all of its opportunities, I think it’s a great chance to improve healthcare in a lot of ways. [00:06:16] But you know, the feasibility of it is something that worries me. You know, I think there’s a lot of barriers in place systemically and economically and blah, blah, blah, all those things. And so I just wonder if it will actually be able to happen, you know, cause there’s a lot of patients without digital access. [00:06:32] And is it actually cheaper to hire a massive amount of MTS nurses, paramedics, or whoever to go home, to home, to home because right now, , all the IMTS and things that we have are just doing emergency care. You know, like I can’t imagine the workforce needed, if all of a sudden there’s that big shift you know, is a virtual visit going to be reimbursed the same way for a physician, because if not, that’s quite the motivation not to do it as a physician. [00:06:55] You know? Like I just am curious about overcoming a lot of the things in the way. [00:07:00] Dr. Nundy: [00:07:00] Yeah, no, I think all those are salient points. And again, going back to why I prefer the word distributed, right? Because virtual is a part of it that might work really well for me. It might work really well for you, but for other communities that might be a community health worker coming into your house. [00:07:15] MTS, I think is a really cool idea. Even just going back to house visits. So like actually house visits have gone up dramatically over the past year. Right? Cause people are afraid to go to a clinic and they’re rediscovering the value of that actually. One of the stories that talk about the book that really did shift. [00:07:33] My thinking was as you get older, you’re an M four. You don’t have to deal with this yet, but as you get old, like me and you got kids running around upstairs I decided to get life insurance. And I actually had to get a physical exam in order to get life insurance. And of course, like most people and non-compliant patients, like I didn’t get one for years. [00:07:50] So every time I’d fly it, freak out that like something was kids. One of my friends had, you don’t have to like go somewhere to get your blood work and physical exam they’ll actually come to your house. And I said, Oh, okay. So, you know, I finally signed up this nurse, came to my house, you know, and it was an amazing experience, like actually on the table that I’m sitting on right now, how I got my first EKG I’ve ever had. [00:08:17]She drew my blood work. I got to like pee in a cup, but in my own bathroom. But the experience was really interesting cause I started putting my myself in her shoes. Right. Like, so she’s driving to my neighborhood where she kind of sees all the tricycles in the yard. Right. She’s walking up my sick stairs. [00:08:33] She walks in and she sees my prize possession on the right, which is my grand piano. And on the left, you know, as you enter my house, you see like the cities that I’ve lived in and like where I’m married, my wife and where I’ve traveled to. And what made me realize is like, wow, like literally walking into my house, she understood more about me than as a PCP. [00:08:53] I understand about unfortunately, so many of my patients. Right. And, and that was really profound. And this was an insurance exam. Imagine if this was actually about chronic conditions or actually around mental health or things like that. And so. So, yes, I completely agree. I think thinking of of distributed as, as only about virtual, I think is narrow. [00:09:15]I think virtual is got a lot of potential. And in many respects, actually the virtual we do is actually the opposite of what we should do. So what happens today with virtual is we actually make urgent visits  virtual, which is actually not a good idea. Yeah. That’s what [00:09:28] Dave Etler: [00:09:28] we were talking about. [00:09:33] Dr. Nundy: [00:09:33] It should be the primary care follow-up visits that are virtual, because you’ve already met me. I’ve already diagnosed you and done an exam and everything. But now I’m just being like, Hey, how’s the blood pressure medicine going and okay. Are you taking it? Oh, you didn’t get it yet. Okay. Let’s like, so anyways, so much to unpack there. [00:09:49] Holly Conger: [00:09:49] Yeah. I’m going into emergency medicine. So I think that virtual urgent slash emergency care, it’s probably not a good idea, especially because in this litigious society, like nobody wants to say, you’re fine. Don’t go to the ER, don’t go to the urgent care. You know, like in my experience, almost no one gets told that and they get sent in any way. [00:10:06] And so then you just have to pay for the virtual visit and the actual visit. But I think that there are a lot of times like any clinic that I’ve been to where I don’t actually do much of a physical exam that could have been a virtual visit, you know? So there’s definitely room for [00:10:18] Dr. Nundy: [00:10:18] it. Yes, totally. [00:10:21] Totally. Yeah. And then even on the Homebase, like there’s a organization on, if you guys come across some call ready responders, like they, to your point sent EMT to people’s houses, they can do chest x-rays at home. They can do IB fluids at home. They can give medications at home. Right. So it’s. It’s really interesting, you know, asking the question, like, what is the right care setting? [00:10:39] Like, it’s kind of like, that’s the whole idea of distributed. We have to get sort of location agnostic, you know, on some level, like, I think it’s right now, it’s just, it’s synonymous with a hospital or a clinic. And I don’t know if that always makes sense. [00:10:53] Dave Etler: [00:10:53] Yeah. And there are organizations, you know, like I know the  visiting nurse association we’ll send people to your house for, care. [00:10:59]I mean, as you say, there are organizations that do this. It’s just that we don’t always think of it. When the time comes. To do this. And maybe even providers , sometimes don’t even, don’t even think of it, or they might not have the wherewithal depending on where they are in the country or, or you know, if they’re rural versus urban practice, I mean, there’s all kinds of factors there, but it’s not unprecedented. [00:11:19] It’s just perhaps  under utilized and under funded, I guess, [00:11:25] Dr. Nundy: [00:11:25] probably. Yeah. [00:11:28] Emma Barr: [00:11:28] Kind of wondering if you have what your thoughts are, if you have any specific thoughts on how this kind of distributed health care works with medical education I’m an MP3. So I went through my core year during the pandemic, having a lot of visits, turn into virtual visits and televisits, and I feel like it impacted my education, but I’m wondering kind of how you see that if we’re doing more distributed care, how can medical students be involved in, you know, still get quality education? [00:11:55] Dr. Nundy: [00:11:55] Yeah, that’s a really good question. And wow. Yeah, I’m sure you and I could talk for awhile about what he saw this year. It , must be fascinating, but yeah, I mean, I think that at least my training which was a couple of years ago, we did a pretty good job teaching people, clinical medicine. [00:12:13] We didn’t really teach them to practice the medicine, if that makes sense. Right. And so w and what’s interesting is that the places that are really good at teaching you clinical medicine may or may not be the best places to learn the practices. [00:12:25] Dave Etler: [00:12:25] So maybe you should elaborate on the difference. [00:12:28] Dr. Nundy: [00:12:28] And by the way, that’s my own nomenclature. [00:12:30] That’s not, you know, [00:12:31] Dave Etler: [00:12:31] I mean, yeah, because I’m. Not a doctor. I don’t, I don’t know everything about medicine. We have listeners who are themselves, not yet doctors. [00:12:38] Dr. Nundy: [00:12:38] So yeah, of course. Yeah. So what I mean by that is clinical medicine is like, you know what in a textbook or something you’re supposed to do. [00:12:45] Right? So if somebody comes in with chest pain, what are the questions to ask? What are the tests to order? How do you interpret the test? Right? It’s like, The science part of medicine versus the practice of medicine is, you know, how many minutes did you see a patient for that has chest pain? And, you know how do you get them to tell you the truth about whether they’re drinking or not? [00:13:07] And how do you make sure that you spend enough time with them, but also get your paperwork done and that you get your coding right? And right. Like all those things. That’s what I kind of need. It’s like the, between the difference. And I think what happens on both sides actually in studies show, this is that if you look at practice variation, meaning differences between me and you and other doctors or other nurses, most of those differences, even 20, 30 years out, or a product of where we be trained, which is fascinating. [00:13:36] So for example, like I’ll use this  blood pressure medicine. And my colleagues in my free clinic will order this blood pressure medicine. And if you ask them. Why it’s not because like we read different papers or like we went to different conferences or because like one of us is smarter than the other it’s because I trained there and she trained there and that’s the medicine that they use. [00:13:56] Right. And so. My point in this is that when it comes to the science and medicine, lots of places do a great job when it comes to the practice of medicine and particularly distributed care, these sort of newer forms of care, traditional academic medical centers. Aren’t like, they’re the best that the science of medicine, but there may not be the best of the practice of medicine, right? [00:14:17] They have really long patient wait times. And like, you know, they don’t doctors don’t spend it. Like the experience is not that good, but the problem is because of that 30 year overhang, those habits that we learn about how do you build trust, then? How do you listen and how do you document efficiently? [00:14:32] And where are you even see patients at home or whatever, how soon you follow up all those habits, we’re learning from kind of not the best places. And so,  super long sort of responses to your, your comment, but. I think what we need to do is in training is increasingly expose our trainees to those places and do like away rotations at places that do really good  telemedicine based care, or do really good home-based care or do really good population based care. [00:15:03] And that’s going to mean for many people that you have to leave your school or your residency and go to. The real world where there’s truly places at the cutting edge of how to do that the right way. [00:15:14] Holly Conger: [00:15:14] Yeah. I think depending on your residency program, that is, or is not built in really well. I know for emergency medicine, at least I will have several months where I’m at a private practice, ER, you know, and so I will get to see like the non-academic version and I I’m going to be at like a County hospital. [00:15:30]And so I’ll get to see that too. And so I think like depending on where you are and what specialty you go into, some of them build that in and some of them don’t, which I think it’s a great thing because how are you supposed to choose? I want to be an academic physician versus I want to be a private practice physician, if you’ve never seen it. [00:15:45] Did you [00:15:45] Dave Etler: [00:15:45] make that choice when you were looking for programs [00:15:48] Holly Conger: [00:15:48] would never have wanted to sign up where you only get one flavor because you know, how do you, how do you know otherwise? And like he mentioned, you know, Where you are really dictates how you practice a lot of the time, I’ve even seen it as just an M four. [00:16:01]And I think in Korea, one of the most valuable things that started to grow is actually just my like clinical experience, quote unquote, is where you start looking at a patient and determining that sick or not sick. Like you start being like, I’m really concerned about this person picking up on things and getting better at making clinical decisions. [00:16:17] I wonder if there’s many studies on, if that still goes well, virtually,  you know, like, are you more likely to miss something or is a patient less likely to be honest, virtually or in person? You know, I don’t know. Either one could be better or worse. I just wonder how they compare. [00:16:32] Dr. Nundy: [00:16:32] Yeah. Yeah. Lots of questions. Yeah. It’s probably [00:16:35] Holly Conger: [00:16:35] some of you that we don’t have the research yet, but you know, Oh, it’s interesting. Cause it’s like, wow. If my patient is like three times less likely to tell me that they’re feeling suicidal, Via telemedicine, then I’m not going to like that. You know, like I don’t want to risk that or, you know, like whatever the thing may be, you know, that would be something to look into. [00:16:53] Dave Etler: [00:16:53] You spoke about getting a window into people’s lives that you might not otherwise get with with a more distributed definitely valuable model, which is which I would, I guess not assume is the wrong word, but I would wonder if you know, seeing somebody in their home would make them more likely to talk about their world and the things that are really bothering them. [00:17:12] Dr. Nundy: [00:17:12] And it [00:17:12] Holly Conger: [00:17:12] might be, you know, they might feel more comfortable in, so maybe it would be even better for certain specialties. [00:17:16]Dave Etler: [00:17:16] Hard to know at this point, I think it’s funny cause , we’ve had this ability for a long time. And it took COVID to get us to start thinking about these things, which it makes total sense to me because, so we get so stuck in our ways and ,  you need you need something to shock you out of , your comfort zone. [00:17:35] And I think that the most fascinating thing that we learned out of COVID is that not only could we change, but we could change really damn quickly when we had to adapting. So I think that’s really interesting. I you know, one of the, one of the most interesting things to me that came out of COVID was our, , influenza like illness clinic that seems to appear. [00:17:56] Overnight. Yeah. And then our telemedicine treatment where we were treating people at home through visiting nurses and visiting appointments and things like that, and blood and, and, and monitoring of O two SATs and all this kind of stuff, which again, seemed to happen overnight. And which was. [00:18:16] Probably critical and keeping our hospital from being overrun. So really neat to see that sort of thing happen  I wonder if it’ll last, . I hope it will because I think it makes sense in a lot of ways. [00:18:27] Dr. Nundy: [00:18:27] Definitely. No, that, that is a really important point. [00:18:30] Not even just on virtual, but it’s like, it’s like the three most important words I learned or the Ben it maybe is yes, we can. It’s someone who has spent my whole career sort of mucking around and trying to change healthcare. And I’m like, wow, that’s complicated. It’s hard. It’ll take time. And it’s like, yes, we can now will we? [00:18:52] And do it. And, and part of, I think, what policy makers, cause I get a chance to spend time with some policy folks. I was on a couple of presidential campaigns and stuff is a lot of them are looking at us and saying, wait, when we let safety net doctors text their patients, like we didn’t have all these massive privacy violations that doctors practice across state lines. [00:19:12] Guess what? Like fraud, didn’t just go up through the roof. Right? So I think part of this, I think the reflection which we have to call it out, if we wanted to see happiness to say, when you actually deregulate parts of healthcare, shit, doesn’t blow up. Actually a lot of it gets better and it enables, this is the whole point of decentralized, by the way, it’s this idea that let the front lines decide. [00:19:34]  AJ Chowdhury: [00:19:50] so I worked as a scribe at a community practice when the pandemic first hit. So for a couple of months, all my experiences were. Typing while the doctor was sitting next to me in their office, talking to patients through a webcam. [00:20:02] Now I was thinking, wow, this will be really, really helpful for getting more and more patients in to the clinic. But what about when you do go from one clinic to another, from one health system to another, and you change EHR, is that decentralization of data de-centralization of systems, will that hinder or help in that regard where you can have records from one patient be available over Epic, but maybe not [00:20:28] Dr. Nundy: [00:20:28] over-serving yeah. [00:20:30] Yeah, totally. I mean, first of all, I’m, I’m usurping the term decentralized and decentralized means specific things to specific people. I’m sort of specifically labeling it in a, in a certain way. That’s different than how most people think of it. Right? Cause like, so for example, like I think most people, when they look at COVID, they say, well, the fact that every state can decide who’s eligible for the vaccine, the fact that like. [00:20:50] You know, testing was done by different local departments of health was like a failure of decentralization. I’m not talking about that decentralization. I mean, I think, but what you’re talking about is really critical, which is as care gets more distributed, even it’s there is a risk and the risk is that it gets more fragmented. [00:21:07] Right? And that’s true today. Like if I’m a patient, I can go to my primary care doctor. I could go to the hospital. I could go to an urgent care center. I could call up a digital solution. I could even go to Walgreens and Walmart and see a doc, right? Like care’s already been fragmented like that, that cat is out of the bag. [00:21:25] But as we move to a more decentralized world where now, or distributed world, excuse me, where you can actually have a home visit too. And you could have an ER person in your home giving you IVs fluids, and you can write, maybe go to the barbershop and get your blood pressure medicine. That’s only gonna increase the risk of fragmentation. [00:21:42] And so sort of under digitally enabled, I talk about this idea of connected, which is that it creates a much, much greater need for connectivity. And I make the point that connectivity is not just the way that most of the industry thinks about it today, which is okay. Let’s connect EHR, which is critical. [00:21:59] It’s also has to be true that you have to connect. Care teams and processes, right? Because I mean, already today in my EMR, I have more information than I could ever sift through. Right. And so just the fact that I can have access even more information doesn’t mean that when the patient walks in from clinic a to clinic B, that, you know, I’m creating a connected experience, you know, but if that clinic called me, if we had like a little handoff or other things like that, that plus the data connectivity will create that experience. [00:22:29] Because I talk about in the book, how, like the, the question that patients dread more than any other question in healthcare is what brings you in today? And the reason is right, because they’re like, wait a second. I called your clinic. And I filled out a form in the waiting room. Then I told your medical assistant, then I told your nurse and baby, I even told the doctor who told me to come to you because you’re the specialist. [00:22:51] And I walked in and the first thing you asked me is. I didn’t. So like, what brings you in today?  [00:22:58] Holly Conger: [00:22:58] Kind of damages trust. Cause a lot of patients look at you, like, why am I supposed to trust you with my care? If you know, I’ve told a hundred people this and somehow you guys still don’t know. [00:23:07] And sometimes it’s because there’s that, you know, communication breakdown where you actually just don’t know. But sometimes it’s just, everybody wants to ask because sometimes patients stories change or they say it in a different way and they just want to make sure they got it from the horse’s mouth. [00:23:20] You have a good [00:23:21] Dave Etler: [00:23:21] reason for this, but the patients don’t know, [00:23:26] Holly Conger: [00:23:26] but I’ve been a patient too, you know, and that’s super frustrating when it’s like, I’ve told like six people in the last 10 minutes. What I want and what I’m here, why I’m here? Like, why can’t you just like communicate? [00:23:35] Dave Etler: [00:23:35] This is the thing I always think of, like calling, calling  your gas company. [00:23:39] And then, you know, the first thing they ask you that the phone tree asks you to input your account number, and then you get, and then you talk to the live person. They’re like, okay, tell me your account number. [00:23:51] Dr. Nundy: [00:23:51] But [00:23:53] Holly Conger: [00:23:53] I think the frustrating thing about the EMR in general is if it’s not written down in the EMR, like doesn’t exist. And so like, if you get care from multiple places that are not just under the university umbrella or whatever umbrella, it’s like really hard to like get documents and records and everybody on the same page. [00:24:08]But I don’t know if. We would all move to like, you know, the Epic monopoly and they just take over the world and they’re the only EMR maybe that would fix it. But yeah, but you know [00:24:17] Dave Etler: [00:24:17] what I mean? It’s 20, 21. Yeah. You know, like data is data. The key is in my fevered non-expert imagination. The key is making it readable from one system to another. [00:24:29] I mean, we have ways to do this, you know, whether you’re talking about, , XML or , markup languages, whatever,  we can do this in computers. It’s just that we are really bad at it right now. [00:24:40] Holly Conger: [00:24:40] Yeah. Yeah. I think like the EMR overhead is also like kind of killing private practices a lot of the time, which is probably a separate argument, but that overhead is just so massive that like small businesses, quote, unquote, like just make it very hard for them to exist at all, which is a different argument. [00:24:55] But, you know, it’s just, I don’t know if that would get better if we’re trying to get like small town, primary care physicians to be able to serve a larger reason region because it’s virtual, you know, like how are they going to support, you know, blah, blah, blah. There’s just lots of questions that this whole telemedicine thing. [00:25:08] Dave Etler: [00:25:08] Well, and I think, I think sometimes of you know, you’re talking about data from the  EMR. And then there are all these sort of   , newfangled devices that people are able to get now, like for instance, you know, the Apple watch  where you’ve got, a device that can read your  heart rate, it can  get your blood pressure. [00:25:25]  , they’ve even begun to experiment with glucose monitoring all this kind of stuff, and you can log it and you can keep track of it and you can give it to your doctor and all this kind of stuff. And  sometimes I  read articles that are like, this is it. [00:25:37] This is a boon to healthcare. And then I think, yeah, but I know doctors, it’s not that they don’t want that. It’s just that the data becomes overwhelming at some point.  How do you sift through all that data for each patient? And you know, I can think of ways around this, like machine learning and all that kind of stuff, but. [00:25:55] IBM is selling Watson. I don’t really know that that has come to its fruition yet [00:26:00] Dr. Nundy: [00:26:00] either. [00:26:04] I think I’ll add that it has to, we have to start with the patient and you have to, you have to go to the care model and then the data and the technology has to support it. Right? So like, let me give, like one of the examples that talk about in the book, right? My mom has had type two diabetes for 25 years, right. [00:26:21] And for 25 years, what does that mean? That means that she goes to the doctor in 10 minutes. He tells her a bunch of stuff and tells her to like eat healthy. And it says, great. Then she goes home and for a week she does a decent job. Maybe he calls her a week later with her lab results. And then it’s radio silence for six months. [00:26:38] And then she goes in again and does the same thing. And it’s been 25 years of that. And if you think about the connectivity, let’s imagine that, you know, she had access to all that data from her clinic visit on her mobile phone. Awesome. Let’s imagine that her doctor, every time she saw him every six months, He had a synopsis of all her blood sugar readings, but she hadn’t really looked at this month. [00:27:01] Let’s imagine that when she goes to an endocrinologist, all the data pops up in a second. Well guess what? She would still be struggling with her diabetes because the . Care model of seeing someone every six months and hoping that they’re going to change their behaviors, doesn’t work. Contrast that to what happened to my mom, which is in June, I’m super proud of her. [00:27:20] She joined a program around diabetes reversal. Where she was given a, a coach that you can interact with 24 seven. She was given a box that showed up in the mail that had a glucometer and in a ketone meter and a bunch of recipes. She was connected to my family’s from India, another Indian patient who lived in Chicago, who had learned a bunch of recipes that work really well with Indian food. [00:27:44] And she had an endocrinologist through that same program. And within two weeks, she went from 25 units of insulin to 15. And within a month she was off insulin and it’s been six or seven months. My moms. He hasn’t taken a single shot insulin. Wow. That is amazing. And, and by the way hundreds of thousands of patients have done that now and most talk about medical education. [00:28:08] Most people that graduate from med school don’t know that you can reverse diabetes. But that’s a whole nother conversation, but my point is that that is how we need to think about solving these problems, right? Because otherwise healthcare becomes this sort of very insular world with like, Oh, well, hospitals are going to connect data to make it easier for doctors to do it. [00:28:25] I’m like, eh, the job of health reform isn’t to make, I’m sorry to say doctors, licensure, hospitals, Izz, or helper, but our job is to help patients. So how is that connectivity going to help the pain? Now it might, but we got to think about an end to end care model that solves their problem, which is my mom. [00:28:44] Doesn’t like taking insulin. She wants to get the fuck off of it. If you can, what is the care model required to do that? And then how does technology and data scale and enable that is the question. And I think,  we only have a finite amount of resources. You know, Joe Biden, they, they have a hundred dollars to spend on healthcare and for every dollar we spend doing something. [00:29:04] That perpetuates a broken care model is a dollar we’re not spending on building new care models that actually solve problems for patients. And so that, that’s part of the message I’m trying to give is like, yes. AI. Yes. Connected, I guess. Yes, yes, yes, yes. What about what patients need and want? [00:29:20] Dave Etler: [00:29:20] This is, yeah, I was thinking about,  how healthcare, just how the physical plant of healthcare is set up. [00:29:27] You know, it’s, it’s all about the, the, the convenience for the system, the convenience for the doctors and the nurses and the PAs and all those people  to. Have the patient come to the hospital and have the patient  , they’re present in that environment. But , it’s definitely not for the patient. [00:29:44]So I guess that’s kind of a similar idea. [00:29:47] Dr. Nundy: [00:29:47] I mean, the most classic visceral example is  when we help deliver babies, right? You probably all know about this, but , why are women in stirrups and lying on their backs during delivery? The opposite of what you would want to do, which is let gravity do a job delivered babies in Uganda. [00:30:03] It’s completely different. Yeah, we do that because it’s like better for the doctors back and they can see it. They can sit in their stool and like, right. Just like the [00:30:13] Dave Etler: [00:30:13] heart rate, the fetal heart rate monitor. Thing which didn’t work out all that well for my wife. I remember but you know, it’s there to collect data and send it to the nurses station. [00:30:23] All it couldn’t do. It didn’t work. It was just annoying to my wife. [00:30:30] Holly Conger: [00:30:30] Yeah. There’s some study that  those heart rate monitors don’t actually change outcomes at all because yeah. And so like, there’s plenty of that in healthcare, but I think our whole system, like it’s broken because it’s designed to be reactive instead of preventative, which is like the main problem with our system. [00:30:45] And, you know, I think a lot of it comes back to, you know, funding, the preventative things, cause putting every person on time with type two diabetes on this program, like your grandma would be wonderful. And I think we would make a lot of difference and avoid a lot of like the long-term sequela of untreated diabetes. [00:31:01]If we could do that, but it’s just like insurance companies tend to only want to pay for like. Procedures and medications and doctor’s visits, you know? So I was just like, I think restructuring that is our biggest barrier. Same with telemedicine is I’d be curious as do we have insurance companies like treated that like a normal visit, you know, like, do they [00:31:18] Dr. Nundy: [00:31:18] recognize that? [00:31:19] I mean, they just it’s temporary still, but they did make that change where they are reimbursed for telemedicine that was changed during the pandemic, which has been a huge enabler. I will, I will though half agree with what you said. So it’s absolutely true that we need policy to change. Like there’s no question about that. [00:31:37] Right. And it’s true that there’s a lot that we can do. As doctors and med students and individuals. Right. I feel like there’s a little bit of a learned helplessness, like good example, you know, the fact that we’re doing drive-through testing. Now we, as my clinic, we could have been doing this for, for years for a lot of things. [00:31:56] Yeah. I mean, the idea of putting someone during flu season in a crowded waiting room waiting for 30, we could just have someone standing outside spa and people’s no, we could have done that, but we just, we didn’t lead with that. Like I now prescribe my patients, you know free mindfulness, you know, apps that they can get. [00:32:13]Even my mom’s, example’s an interesting one, because if you look at how much she’s been paying out of pocket, For her insulin and test strips and stuff like that, versus how much she’s spending on this service. It’s actually almost on par. It’s slightly more that she’s paying for this service which obviously for some patients would be a deal breaker, but  I think sometimes we’re like, Oh, well, let’s wait for policy to change. It’s like, nah, we can do this. There’s guard rails that limit us, but there is way more we can and should do for our patients. [00:32:42]Dave Etler: [00:32:42] I’m gonna take a break  to talk about our sponsor for this episode, our friends at panacea financial. Panacea financial was founded by two young doctors because they found other banks, business practices and compatible with the physician lifestyle. They were frustrated by other banks high interest rate co-signer requirements, restrictive loan terms flat-out rejections, inconvenient access to customer service. [00:32:59] So they built banking specifically for doctors and doctors in training . Panacea offers PRN personal loans for medical students with fast decisions and funding in as little as 24 hours. No co-signer required because you’re adults that’s, you know, why do you need a co-signer anymore? And, and with rates less than half of a credit card, they also offer a totally free checking account with all ATM fees reimbursed across the country. [00:33:22] So you can take them with you. Wherever you go for medical school, into residency and beyond. Best of all, every customer at panacea gets their own private banker. Their private bankers are supported by a live concierge desk service 24 hours a day, seven days a week because they work doctor’s hours, not bankers hours, and they have a nonprofit arm, the panacea financial foundation investing in doctors and training and working to improve the leaky pipeline. [00:33:46] For underrepresented, ethnic and racial minorities in the medical profession with scholarships and grant programs.  Go to panacea financial.com/match to learn more. Panacea financial is a division of sauna bank member FDA. I see. Thank you for your sponsorship  [00:34:13] Dr. Nundy: [00:34:13] Does [00:34:14] Holly Conger: [00:34:14] insurance cover any of your mom’s program for the diabetes that’s helping? Does it cover [00:34:18] Dr. Nundy: [00:34:18] anything? [00:34:19] It is. It is. They are. So what they did, what they did was because through the program, some of the test strips and things come with like her care package every month, they reimbursed that part. [00:34:31] Holly Conger: [00:34:31] Okay. But they’re not covering the like additional services, like the [00:34:34] Dr. Nundy: [00:34:34] coaching, but again, compared to the copays that she was, you know, the $25 every time she saw an endocrine, like if you actually add it all up, it’s almost the same amount. [00:34:44] That she would have paid it slightly more like on the order of 50 more dollars a year. So it’s pretty close. And then you can think over time about like, well, what if this avoided an ER, visit and stuff, which, you know, there was like, you know, another copay for that and stuff like, it may actually be, you know, cost savings for her, but it’s clearly a barrier. [00:35:03]You know, but, but there’s also room, I think more room than we think patients paid for a lot of stuff out of pocket, a lot, [00:35:12] Holly Conger: [00:35:12] like one hospitalization for a heart attack or a kidney, something or anything, you know, it would be worth it to the insurance company. Cause that is so expensive versus paying for this life coach for. [00:35:22] Or this, whatever the name is diabetes for like 10 years. Yeah. [00:35:30] Rick Gardner: [00:35:30] Like in this model and you were saying, , like with this example, this anecdote of viewer mother and being able to, if we could like mainstream or inform a, the broader medical community of this, maybe we could start getting people on board with this. [00:35:43] And that’s the shift having that information and people decide, well, if it’s going to be equally costs you know, the cost is going to be the same, but it’s going to be more efficacious. Maybe we start doing this and that’s where it catches on as a paradigm shift. How do you think that would be implemented or. [00:35:59] What do you think would be the catalyst for that? Because I mean, I agree it, preventative care is always going to be better. And we should be less reactive. [00:36:07] Dave Etler: [00:36:07] Well, first of all, you got to get all the old physicians to die. [00:36:11] Dr. Nundy: [00:36:11] I’m sorry. Retired. [00:36:14] Dave Etler: [00:36:14] No, I’m kidding. But you know, there’s, [00:36:16] Dr. Nundy: [00:36:16] there’s inertia. Yeah, no, it’s a great, it’s a great question. [00:36:19] I don’t know if I have a brilliant answer for that, other than like, this is why I wrote this book. Right. Like, I think that, like, like I said, if you ask most of your classmates graduating from med school the day how ask them is diabetes of reversible disease? What percent do you think will say yes. [00:36:34] Type [00:36:34] Holly Conger: [00:36:34] one or type two [00:36:39] Dr. Nundy: [00:36:39] I think your classmates, I’m guessing less than 10% of them will think it is maybe less than five, maybe less than 1%. And so, and, and that, that’s, that’s another thing we don’t talk about. Right? So in healthcare, right? It’s the classic, it takes 17 years for new clinical guidelines to make it a mainstream clinical practice and were doctors like, Oh my God, I can’t believe those other doctors. [00:36:58] Like, nah, it’s all of us. Right. And, I talk about in the book, \ it’s like 17 years ago, the iPhone didn’t exist and we went to blockbuster to watch movies. And that’s what it’s like when you walk into a healthcare clinic today in 2021, you’re getting 2004 care. So [00:37:14] AJ Chowdhury: [00:37:14] speaking of inertia I want to ask since you’ve started to really look into how things have changed with virtual care, since the pandemic began. [00:37:24]So my aunts are radiologists and whenever anyone asks, if AI is going to replace her, she always responds with no, cause you can’t Sue a computer. What has the legislative landscape will look like since tele-health started getting more insurance coverage and now there’s more actual legislative policies in place to support [00:37:42] Dr. Nundy: [00:37:42] it. [00:37:42]So is your question more specifically on like, what’s happened with malpractice around it or started? What, what aspect of it are you referring to specifically, [00:37:49]AJ Chowdhury: [00:37:49] Big picture view of the landscape surrounding policy and virtual care. Is it moving in a direction that’s better for the patient right now? [00:37:57] Or is it still early in [00:37:59] Dr. Nundy: [00:37:59] the process? Got it. Got it. Great. Great question. So first let me tell you what the current state is, and I’ll tell you my opinion of it. So the current state is I think there’s broad consensus on sort of both sides of the aisle that con you know, compared to pre pandemic, telemedicine will be reimbursed. [00:38:15] Going forward at scale. So like no more requirements, like you have to have seen them in person first and then afterward it can be virtual and no, like what only in places that are medically underserved or only for certain spent, like, I think. The broad consensus is that this is, this is a valuable modality to practice medicine. [00:38:34] There’s some edge cases that they’re going to figure out, but I think that’s kind of the current state and we’re just waiting for all that stuff to get finalized. My opinion though, is that I have a lot of concerns about how exactly we’re going to do that. So for example, one of the debates right now is like, well, audio only telemedicine can get reimbursed just the same as video based and just the same as an in-person visit. [00:38:58] Like for some of the reasons we discussed earlier on urgent care and like sick, not sick, like that’s, doesn’t make a lot of sense to me. The other thing is that there’s a risk that telemedicine becomes really transactional, right? Where instead of a proper clinic visit where you like get to know them and all that stuff, that was just like, okay, well, what do you have low back pain. [00:39:15] Okay. Here’s some ibuprofen, right? And unless we put in place the right framework, whether it’s quality measures or value based care or whatever, I think what’s going to happen is you’re going to sort of. Cater to the lowest common denominator and you’re going to have all these clinics and all these private companies and stuff really just, you know, per, you know, provide frankly low quality care over a virtual telemedicine type service. [00:39:40] And so I, I think to me, that’s the biggest policy risk is that we’re not really using it to re-imagine that care. It’s not really like the, my mom example, it’s like worse than an urgent care type of example becomes like, you know, as like from a reimbursement perspective, it’s gets reimbursed the same as if you spent 30 minutes on a video, really getting to know them and like taking a tour of their house and like building a trusting relationship. [00:40:06] Each of those are going to get paid equally the same, and so guess what’s going to happen. And so there’s going to be a missed opportunity, I think to not structure the legislation in the right way. You get to what we all want. [00:40:16] AJ Chowdhury: [00:40:16] It seems like right now there’s mostly bandages being put in order to treat a symptom, but not addressing the actual underlying cause of what is a, essentially a broken healthcare system. [00:40:29] Dr. Nundy: [00:40:29] Yes. It gets [00:40:30] Rick Gardner: [00:40:30] broken at both a like a small scale individual personnel, personal based matter as well as the grand scheme of things is also broken fractured from top to bottom. When you were talking to like the words that came to my mind were like healthcare, industrial complex. We’re going to move to this just. [00:40:46] Like massive rollout of just proficiency with no excellence in the care or no quality. [00:40:53] Dave Etler: [00:40:53] Yeah. That was one of my concerns as well in thinking about all this, as, you know, the temptation will be just like with the EMR, a desire to make things more efficient, which, and, and more, you know, sort of cost effective, which I’m not sure that those things always result in good health. [00:41:12] Holly Conger: [00:41:12] I mean, that system is kind of already still in place now, you know, like people are paid based on how many number of patients do you see a day, which is quite the driver for a lot of doctors to see 50 patients in a day, 60 patients in a day. And it’s like, if you divide up the physical time, that means you’re spending almost no time with each patient, you know, and that’s even an in-person visit. [00:41:31] So that system is already kind of. There. And so I only imagine it being worse. If you could just get away with a five minute phone call, you know so unfortunately I think that’s a problem we already have. And it’s not unique to the telemedicine idea, but it’s interesting to me that the insurance companies in the billing were just so easy to adopt reimbursing the virtual visits, because they’re so strict about, like, if you want to be billed for this level of patient, you need like a 10 point review of systems. [00:41:59] You need at least five systems on your physical exam, blah, blah, blah. I’m like all that just vanished, which I think is kind of interesting. [00:42:07] Dave Etler: [00:42:07] Well, like we’ve been saying all along, Suddenly, we surprised ourselves by how many things were not necessarily necessary. Yeah. [00:42:14] Rick Gardner: [00:42:14] And it’s funny that we could even like, know that and like have that understanding beforehand, but we still don’t want to change because we’re like either that stubborn or just that stuck in the rut. [00:42:27] Dave Etler: [00:42:27] I don’t think , many people suspected that those things weren’t necessary, but yeah, [00:42:31] Rick Gardner: [00:42:31] I would use the example just from like a personal anecdote, like being in the hospital and someone who has a history of Marissa and we still have to put on gowns. But they don’t have an active infection. [00:42:41] That was something that was happened, but because of PPE, shortages and logistics would, that was something that was early on taken out in this, like, okay, now we can go in without gowns. They don’t have an inactive infection. I, I’m not, well-versed in the science. I’ll preface with that, but it’s like, that’s something that I feel like could have been done earlier, but I guess there was a need to, and it’s surprising that we just didn’t do it earlier. [00:43:00] Like logistically, I mean, cost effectiveness is still there. And money drives a lot of medicine and a lot of just life in general and especially politics, you know? [00:43:10] Dr. Nundy: [00:43:10] So yeah, a big area we didn’t talk about, which relates exactly to that is, is. I’m also a really big believer that patients should be allowed to do a lot of stuff themselves. [00:43:18] Right? So like early independent, the whole reason I wrote this book is because early and pandemic, I wrote a piece that people should just be able to test themselves. And it was crazy to see the response to that. Like I was like in rolling stone magazine, like, it was crazy. My wife’s like who the hell? [00:43:33] Like, but when I talk to policymakers, like I was in USA today, and this was like, mind boggling is one physician said, how can patients test themselves? Because how can they interpret the result? It has to be interpreted by a physician. Who’s known them for many years to interpret a COVID. [00:43:55] When was the last time you practiced? Like how many of us. No, our patients for many years, like medicine’s become unfortunately for so many people, so transactional. But then like you said, out of necessity, , we are letting patients test themselves now, right? Like, like door dash delivered to your house and CVS, you can have a little cartridge and test yourself, but been doing this for [00:44:16] Dave Etler: [00:44:16] years with pregnancy tests. [00:44:17] I mean, it’s [00:44:18] Dr. Nundy: [00:44:18] exactly like, [00:44:20] Dave Etler: [00:44:20] but you don’t need a doctor to, I mean, yes, you might need medical guidance, medical guidance, [00:44:26] Dr. Nundy: [00:44:26] but a hundred percent. So diabetes is a great example. Pregnancy diabetes. If you have diabetes, you can test yourself for your sugar. Right. But you can’t diagnose yourself with diabetes with the same test. [00:44:39]And that’s like, you know, and so like, again, if somebody is sitting there saying, I want to get screened for diabetes, because I’m just worried about it. It’s a whole rigamarole it’s I have to have insurance. I have to look up who’s available. I have to find a doctor, which by the way in America is about a three week, wait on average, then I got to take a half day, all this stuff just to test themselves for, for whether or not to teach themselves whether or not they have a risk or have diabetes. [00:45:04] And so it’s, it gets to your point. It’s like, I think it’s, it’s forced us to question things that at least I’ve been questioning for years. And now the question is like, Yeah. Are we going to revert? And then for a bunch of other stuff that doesn’t make sense, that’s not related to COVID. I mean, most healthcare that’s changed. [00:45:19] The vascular is like acute COVID, upper or viral respiratory stuff, but can we take that same sort of fresh thinking and apply it to all parts of healthcare and say like, do women really need, who’ve been on an oral contraceptive for 10 years, really need a refill from me. Oh my God, [00:45:40] Dave Etler: [00:45:40] this is the exact thing that I was thinking about was, you know, like I’ve been on this medication for 20 years and yet I still have to you know, get that prescription reauthorized every single year. [00:45:52] And I have to do it in person with my physician, which I understand part of it is to just get me there so that he can actually do a well person physical but Oh yeah, [00:46:01] Dr. Nundy: [00:46:01] every year I’m like so many people, like maybe you have a job that allows you to make it, you have held, but imagine for people who can do that. [00:46:09] And so then we’re like, Oh, they’re not compliant. They fell off their medications. They’re just like, well, they’re alternative. Isn’t just an annoyance. Their alternative is actually no care. Yeah, right. And so again, it’s like, are we going to question these things and are we going to change things? Are we just going to let it all go? [00:46:25] And that’s, that’s part of what I mean by decentralized is putting power resources and, and, and responsibility onto frontline teams and to patients like patients can do a lot more than we give them credit for. [00:46:38] Rick Gardner: [00:46:38] I really liked even. So you made a reference to another book you had written and I’m like . Working with my dad to like, try to make sure he’s a healthy individual and you wrote a book and I, I forgive me. [00:46:47] I can’t remember the name of it. But essentially like here’s a guide for like every, I think it was like decade of life and what you need to do. And I think that education, because I think we’ve talked about previously medical education and health education within America has failed. So people don’t know how to take care of themselves. [00:47:02] And so having a book like that and, and information of how to take care of yourselves and giving at least power to the patient and the person to make actionable steps towards their own health is, [00:47:13] Dr. Nundy: [00:47:13] is correct. Yeah. Yeah. And that’s, you know, I want to end on a, on a sort of a positive note, but I think that’s some of the real revolution that’s happened. [00:47:20] Right? Like I think they think about patients they’ve realized that they can actually prevent the flu, like who they touch, how close they stand. Right. You’ve had, we don’t know the numbers, but I have had countless patients by their first blood pressure cough. Use a pulse oximeter for the first time, right. [00:47:37] At home, like find where to get vaccines themselves, find where to get tested. They know what a sensitivity and specificity is like. They’re reading about every single day. Now through social, like I think there’s been, you know, we’ve been wanting patients to take more control, but this, this has created a massive cultural shift that I don’t think we fully understand and policies can change, but I think culture shift, like you remembering, , and sort of the impact of you finding your own test, your own vaccine, you know, managing your own refills. [00:48:09] Like I think that is going to sustain for a long time. And I think it’s going to create enormous opportunities to improve [00:48:17] Dave Etler: [00:48:17] health care. Yeah. it sort of reminds me of the fact that ,  the other day I was  marveling that I a have not gotten a cold this winter  and B despite the fact that I’m not supposed to get a flu shot. [00:48:29]I haven’t for the first time gotten the flu in a while and you know, all that is because I learned to wear a mask.  And, you know, also was home a lot, but I keep thinking, I had like next year, am I going to, am I going to wear a mask? When I ride the bus to work? Am I going to wear a mask? Like you made [00:48:46] Rick Gardner: [00:48:46] a point in your book that like you compared it to nine 11 in that there is a before and an after, that’s something that I’ve said. [00:48:54], I think we have faced a point of no return that things just cannot go back to where they are. Like the example with the mask. I think we will see more masks. Our generation  of individuals will they’re in like commuting to work using mass transportation, or even  out in the restaurants and such a mask will be more visible. [00:49:11]Which is something that we haven’t seen in America. And I think other things within healthcare politics socio-economics what, may have you I think that’s a huge thing as we have entered into a new era of [00:49:21] Dr. Nundy: [00:49:21] life. I wonder if the next normal, yeah, totally [00:49:28] Dave Etler: [00:49:28] speaking of the post COVID era do you have a listener question? [00:49:31]Justin would like to know. Yeah. Living in a post COVID 19 era, do you believe that there will be bigger push for developing technologies? And his example is , remote, robotic surgery, more prevalent in the healthcare setting. That’s a, that’s like a, that’s like a [00:49:47] Holly Conger: [00:49:47] big, that’s a big, that’s a big, [00:49:50] Dr. Nundy: [00:49:50] yeah. [00:49:51] Yeah.  I think absolutely. I mean, I think that as care moves out of facilities into clinics and then into homes and to communities, that’s going to require a whole shift in technologies. Right? Part of it is taking existing technologies and making it actually consumer friendly, right? [00:50:08] Like if you’ve ever operated like an event or like even trying to figure out how an IV pump works,  like once we start delivering that at home and patients are doing it themselves, it’s gonna right now, basically the technologies that are built are like the ones that get the biggest discounts and sort of cost plus pricing. [00:50:25] It’s going to shift towards ones that are actually functionally useful. And those that’s going to be a whole dimension. And so I think that that is going to take existing technologies to do that. And then I think it’s going to drive a whole bunch of new technologies. Like one of the like backend ones that I think is gonna be huge is how do you manage and to end supply logistics, which is not that sexy, but when you’re in a hospital and someone orders that antibiotics, it’s pretty easy to like, get it up to the floor. [00:50:50] Imagine if you’re being hospitalized at home, how do you get someone that’s that antibiotic, or if you are getting oxygen at home and suddenly the tank runs out. So how do you manage that? That’s going to require a whole new set of new technologies. I think there’s going to be a lot of delivery technologies. [00:51:05] Obviously drones are increasingly more common. And I think you’re right. I think we’re going to start to see procedures as well start to happen in homes and communities. So I think it’s a really, really interesting time. [00:51:16] Holly Conger: [00:51:16] Hi, brain surgeries are a little further out just cause like, you know, with robotic surgery and something [00:51:28] Dr. Nundy: [00:51:28] into your house. [00:51:29] Holly Conger: [00:51:29] I mean, it’s more just like, you know, robotic surgery is great until something goes wrong. Like the machine breaks, you hit something and need to convert to open surgery. If the surgeon is not there. Yeah. [00:51:40] Dr. Nundy: [00:51:40] Yeah. Yeah. Although again, I think, you know, the play, my sort of like engineering nerd counter to that is like, I think we don’t often think about the counterfactual. [00:51:50] Like how often do surgeons make mistakes? You know, we shouldn’t be operating anymore. And, and then the other one is disparities. How many people live in a place that don’t have any surgery at all? Like up in Alaska and certainly all the places around the world I’ve worked when I was at the world bank. [00:52:05] So you’re right. But I think this is the point of distributed. We have to think about each local context and think what is the best model starting patient first? And, you know, we may surprise ourselves. Like, it’s like when the first autonomous car crash, I was like, Oh, the car crashed. Oh my God. It’s like every day. [00:52:25] Right? [00:52:26] Dave Etler: [00:52:26] So it’s the same, it’s the same concept with the vaccines, you know, every time there’s a vaccine. You know, adverse reaction, that’s very serious. It ends up in the news. And so we end up thinking more about that than the fact that the vaccines are actually, you know, [00:52:38] Dr. Nundy: [00:52:38] and [00:52:38] Holly Conger: [00:52:38] I think it’s like, it’s all about responsibility is like, that’s the holdup is who’s responsible. [00:52:43] If the telehealth visit, you think it’s fine. And then the patient dies from something you missed. Who’s responsible if the remote surgery goes wrong and nobody’s there to fix it, you know, like a lot of questions, it’s all about the responsibility reactive. Right? What did you as part of it, which is unfortunate, but that’s just like what I think. [00:52:59] We’ll probably be in the way. [00:53:01] Dave Etler: [00:53:01] So I guess  my question to you doctor, before we go is you know, we’ve talked about whether doctors are ready for it. [00:53:08] We’ve talked about whether the system is ready for it, or the patients ready for this. Are they clamoring for this or do they even know what’s possible? [00:53:16] Dr. Nundy: [00:53:16] Yeah, I mean, I, I think so. I think that’s that cultural shift, right? That I think that. People that have had their first virtual visits, you know, have for their first home visits, you know, that have, you know, found their own vaccines, found their own tests. [00:53:32] I think that they are realizing that a, the healthcare system it’s magnified how bad it really is and, B) it’s shown them what’s actually possible. And I think that’s unleashed something that I think will be a mega trend over the next several years. And one that I’m super excited about. Look [00:53:51] Dave Etler: [00:53:51] forward to seeing  how this all shakes out, loved the book. [00:53:53] Thank you so much for sharing your ideas and your book with us. Care after COVID. Where can listeners find out [00:53:59] Dr. Nundy: [00:53:59] more? Yeah, so the book’s coming out on May 4th apparently, but he can already pre-order it on your favorite online store. And and I also have a little website care after covid.org, or I’m going to a lot of the additional pieces that I write or conversations that I have we’ll, we’ll kind of be up there. [00:54:16] And so, yeah, I would love to build community around this and just this overall change. I mean, I think, I really think it’s like that once in a century opportunity. And I think that the folks that are listening, you guys have as big a role in it or bigger than I do, given that I got a few less years ahead of me, but you know, like it’s all it’s on us. [00:54:36] This is our moment. Well, [00:54:38] Dave Etler: [00:54:38] thank you so much. That’s our show. [00:54:41] Dr. Nundy: [00:54:41] Emily, Emily. Jesus, [00:54:46] Emma Barr: [00:54:46] take me [00:54:46] Holly Conger: [00:54:46] a minute. [00:54:48] Dr. Nundy: [00:54:48] I [00:54:48] Dave Etler: [00:54:48] told you [00:54:50] Rick Gardner: [00:54:50] that was in assigned seats. [00:54:54] Dave Etler: [00:54:54] Hey Jay, Emma, Holly, Rick. Thanks for being on the show with me today. I’m happy to be [00:54:59] Holly Conger: [00:54:59] here. [00:55:00] Dave Etler: [00:55:00] And what kind of Mexico intestinal fistula would I be if I didn’t. Thank you. Shortcuts for making us a part of your week. If you’re new here and you like what you heard today, subscribe to our show. [00:55:09] Wherever fine podcasts are available. Our editors are AIG Choudhry and Eric Bozart and Alex Belzer is our marketing coordinator. The show is 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. [00:55:24] Fox and atmosphere. Talk to you in one week.

How did COVID affect the 2021 Match? Photo by muffinn This week’s sponsor, Panacea Financial (Member FDIC) is giving away $500 to five students participating in the 2021 Match. Check it out! Match Week is huge for senior medical students. It’s the week they find out if they will continue their training (yikes!), and where in the country they will go to complete it…and this year’s match was even more-than-usually anxiety provoking due to COVID. Were our fears–of large numbers of unmatched applicants, programs with many unfilled positions, and students unfairly penalized by virtual interviews–realized? We try to figure it out with the stats available to us just an hour before recording. This Week in Medical News Some Grand Rapids, Michigan residents were very bad on Instagram. Hey, future and current students–keep other peoples resected organs off social media, and while you’re at it, you really aren’t supposed to take pictures in the OR without consent. M’kay? 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!

The Art of Compliments Photo by Ross Dunn Our sponsor, Panacea Financial, is having a giveaway! 5 students in the 2021 Match will get $500 in their Match Day Giveaway, so head on over to find out more! It must have been a bad week for someone, because Dave thought it’d be great to have a compliment festival. Of course, compliments have a huge role in learning, though Dave wasn’t sure there were enough opportunities for getting compliments during the pre-clinical years. So he asked M1s AJ Chowdhury, Nicole Hines, and Rick Gardner, and M4 Marisa Evers to join him in complimenting each other just for fun. Here’s the benefit Rick mentioned in the show: Shooting Hoops for Shelter House. And just in case this whole medicine thing doesn’t work out, we took a very scientific BuzzFeed quiz to decide on our alternate careers. 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!

No school, employer, or profession is perfect; and lots of times, you have to step up to fix it. Photo by Georgie Pauwels This episode’s sponsor, Panacea Financial, is having a Match Day Giveaway! Med students in the 2021 Match can enter to be one of five students who will win $500! Enter at panaceafinancial.com/matchday. Long time SCP listener and CCOM M4 Austin Kazarian joins us on the show to talk about the personal finance course he proposed and helped create. Wait, isn’t there enough to learn in medicine? There is, but as long as med school debt is a problem, it’s important to learn how to deal with it, as well as many other financial issues that exist for new residents. Join him, MD/MBA student Gabe Conley, and M4s Joyce Wahba and Tim Maxwell for a discussion on how medical students can fix the inevitable gaps in their schools’ curricula, and why it’s important to look for a joint that’ll take your suggestions and let you lead with them (and see this article, and the Academic Medicine commentary discussed during the show). And if you want to bring Austin’s personal finance for physicians curriculum to your school, he’ll share his proposal with you to get started–drop him a DM @AustinKazarian. Also, Dave gives the crew a news quiz. Were you paying attention these past few weeks? 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!

This episode is sponsored by Panacea Financial, a Division of Sonabank, Member FDIC. Panacea is banking for medical students and doctors. Every once in a while, Dave likes to just get to know his med student co-hosts better. This time, in order to accomplish that goal, he invited each of them–M1s Rick Gardner, AJ Chowdhury, Alex Belzer, and M4 Tim Maxwell–to bring some converation starters with them. Is it relevant? Sure, if you squint your ears real hard, jeez, can’t you guys give up on clinical relevance every so often and just have some fun? 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!