Advice from graduating medical students to new ones [PODCAST]

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“We need you to join the ranks of this time-honored profession with new eyes and determined minds and eyes that see medicine’s problematic foundations and minds that are willing to act on it. Because it is you, future medical students, who will soon take up the mantle of pushing medicine to change — as medical students have done for generations. We look forward to working alongside you. Welcome to medicine.”

Kathryn Crofton, Jay Hwang, and Catherine Jay are medical students.

They share their stories and discuss their KevinMD article, “From future doctors to new ones: We need you.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have three graduating medical students: Kate Crofton, Jay Hwang, and Catherine Jay. Together, they co-wrote the KevinMD article “From future doctors to new ones: We need you.” Kate, Jay, and Catherine, welcome to the show.

Kathryn Crofton: Thanks so much for having us.

Kevin Pho: I’m going to ask each of you to share your story and journey to where you are today. And I’m also going to ask you, because you are graduating, to share something that you know now that you wish you knew back before you started medical school. Kate, why don’t we start with you?

Kathryn Crofton: Sure. So I grew up in rural Wisconsin and have been thrilled to end up in medicine, and I matched into OB/GYN. Something that I didn’t really know coming into medical school, but figured out pretty early on, is that writing was hugely important to my identity. Eventually, I started a writing group and did a lot of writing throughout med school. I think if I had known that sooner, I could have found that community sooner, and my journey would have been even better for it.

Kevin Pho: And Kate, tell me how writing has helped you with the pressures of medical training.

Kathryn Crofton: So I think we’re so privileged to get to witness in medicine, and we witness things that are beautiful and things that are terrible. But sometimes it’s really hard to know what to do with that, especially when I’m always rushing to the next thing. And so through writing, I have this outlet to reflect, and then to create something and share and process with other people. So I wrote a series of essays about anatomy lab early on, and then I have written about more clinical things as our training has progressed.

Kevin Pho: And Jay, if you briefly share your story and journey, and one thing that you know now that you wish you knew back before you started medical school.

Jay Hwang: Sure thing, Dr. Pho. My name is Jay. I graduated from Marie, I majored in political science, and I was fortunate to go to med school. I am going to residency to do pathology at San Antonio through the military. One thing that I wish I had known before I started medical school was really reaching out to your mentors and attendings. I was always nervous when talking with attendings and residents about research opportunities, but I just realized they’re here to help you out. And trying to get experience in research coming from a political science background, I did not know about science as my colleagues. So just really asking out. I wish I had asked more during the beginning years of med school.

Kevin Pho: And Jay, with your political science background, has that come up during your last four years of medical school?

Jay Hwang: Of course. We talked about health care systems during our first year of medical school, and the Affordable Care Act, and seeing the difficulties it took to make that happen. That’s where my political science background came into play as well.

Kevin Pho: And Catherine, if you briefly share your story and journey, and one thing that you know now that you wish you knew back before you started medical school.

Catherine Jay: My name is Catherine. I was born in Toronto, Canada, and then my family moved all over the world. Then I ended up coming to the University of Rochester through their early mission eight-year program, and I’m choosing to stay here for neurosurgery residency as well. So all told, Rochester will be the place where I’ve lived longest in my life, at 15 years.

In terms of something that I wish I knew, I think coming into medical school, sometimes you think you have to be perfect, and you have to know it all, and you have to do the right thing every time. And that’s impossible, and learning that it’s OK to make mistakes, it’s OK, as Jay said, to reach out, ask for help, and ask for advice, and as Kate says, to ask for help to process, to figure out who your people are and how to make sure that you’re turning those opportunities that seem really tough in the moment into a learning experience.

Kevin Pho: So Catherine, I grew up in Toronto, Canada, as well. So coming to the United States and learning about the health care system, what are some of the surprises about the American health care system that you learned about when you contrasted it with back home in Canada?

Catherine Jay: I think I’m always just shocked at the number of questions about insurance, and whether people can pay, and the delays in care that happen because people are afraid of the bills. We talk in Canada a lot about how access to medicine works, and people in the U.S. say, “Oh, well, don’t you have to wait in long lines all the time?” And yes, sometimes you do, if it’s not an urgent complaint. But my grandparents, who needed urgent MRIs, got them the next day. And a lot of patients here, I know, wait weeks with horrific health conditions because they’re trying to support their family and can’t with medical bills.

Kevin Pho: Now, the three of you wrote this wonderful KevinMD article titled “From future doctors to new ones: We need you,” and each of you gives pieces of advice to future physicians. So I’m going to ask you to share the piece of advice that you shared in the article and maybe talk about that a little bit more. So Kate, why don’t we start with you?

Kathryn Crofton: Sure. So one of the lessons that I shared is that I think medical students are really valuable, and I didn’t realize that coming in. Especially starting on the floors, I knew that I would be the person who knew the least, and so I was very humble, and I worked hard and worked with the team. But something I’ve learned through medical school is that we also have a critical perspective as an outsider that I think allows us to think differently and is actually totally an asset to the team. And so I encourage incoming medical students to have that humility and to learn as much as they can, but also to realize that their perspective really matters.

I wrote about a vignette of being concerned that a patient wasn’t fully able to express consent, and that a conversation had to continue in order to truly have informed consent. But I’ve watched my peers do this in even bigger, systematic ways, thinking about vaccine distribution for COVID: Is that being done equitably? Are patients getting appropriate care? So I think this can take a lot of different forms, but students have a valuable perspective.

Kevin Pho: Whenever I talk to medical students, they always say that “my voice doesn’t matter” or “my voice isn’t heard,” especially among the health care team, because medical students are obviously just new to clinical medicine. So at what point did you get comfortable speaking up and sharing your perspective with the medical team that you were working with?

Kathryn Crofton: I think it totally depends on the team and the relationship with the team. Sometimes it’s very easy to just say my opinion, because I’ve been given the opportunity to do that by a resident or an attending. Other times, it’s worked well to ask questions for my learning, with the humility that, I mean, maybe I’m wrong. But I think if I frame something as a question, I can bring it to the team’s awareness, and that’s been a strategy that works pretty well.

Kevin Pho: And Jay, why don’t you share your lesson that you wrote about in the article?

Jay Hwang: This is an issue where, as a med student, you’re faced with a lot of uncomfortable situations, because there’s a lot at first when you attend med school: the first time dissecting a cadaver, the first time seeing your patient, the first time seeing a patient die. And as Catherine said, sometimes we’re expected to put on this front of trying to be the perfect student that you can be. But I feel like sometimes the best way you can be the optimal version of yourself is to really be in the moment, and sometimes that takes embracing that uncomfortableness. Because by embracing that, you’re able to really accept that there are a lot of things that you’re learning about, there are a lot of things that are scary, and there are a lot of things that are going to trouble you at the end of the day.

But by doing that, at least for me and at least for my colleagues, we’ve been able to really take in the moment, really actively listen, and really empathize. And whether it be learning experiences or patient experiences, it is that much more memorable. Now, that being said, I feel like it’s one of the hardest things for me to do, because it’s just so emotionally vulnerable, and it’s something I wish I could consistently do. From time to time, and I’m not perfect, it’s hard, and sometimes I’ll put up my defense barriers. But I think it’s something that’s very important throughout the journey of a medical student.

Kevin Pho: And Jay, you touched upon the issue that I was going to bring up, which is that it’s very difficult sometimes for medical students to show that vulnerability. Because let’s face it, a lot of students, before they go into medical school, are normally at the top of their classes, and they ace all these tests, and medical school sometimes is their first taste of failure. Now, what kind of advice and tips can you share with other medical students on how to embrace that vulnerability, and that it’s OK to not be perfect all the time? Because like you said, it is more difficult than it sounds.

Jay Hwang: One thing that helped me out was just to talk to one of my mentors. We have a big brother, big sister program, so I would talk with my big brother all the time and tell him how I felt. I think another thing is just reflection, whether it be through writing; whether it be through exercise, where you’re able to really think freely as you exercise; or whether it be through doing your hobbies, where you’re able to kind of reflect on yourself while doing those hobbies. And just talk with your classmates. Your classmates are also probably feeling the same thing that you’re feeling about kind of being a little, a big fish in a big ocean, so to speak. I would encourage just talking to others.

Kathryn Crofton: I’ll add to that. In one of my friend circles, we called it the daily humiliations, and we’d just go around the circle and say the one dumb thing we’d said or done in a given day. And that just normalized it. I think you hope that you don’t make a mistake that harms the patient. Often the mistakes are things like, you’re looking through an ophthalmoscope, and the baby’s been whisked away, and you’re still looking at the blanket wondering why you can’t get a red reflex. And it’s things like that. We’ve just got to laugh sometimes. We work so hard, but we’re human too.

Kevin Pho: Great. And Catherine, why did you share your lesson that you wrote about in the article?

Catherine Jay: One of the lessons that I shared was that illness really doesn’t define the patient. So much of our medical training is how do you condense a full patient story. You start as a first year, and your patient histories take two hours together, and you’re gathering all the information, from where they went to elementary school to their favorite color. And through medical school, you learn to hone that down so that you can quickly and succinctly share information about a patient. That being said, it’s so important not to lose the ability to also connect with the patient on a personal level, and see what makes them tick, and see what they really value and what they care about.

I remember one of my neurosurgical patients. I had a moment of just slowing down with him. So much of the service is fast-paced; it’s emergencies, people are rushed down to the OR. And with this patient, I had the time to shave his head before the surgery. As I was doing that, he started talking about his life, and why he was getting this surgery, and also why he left AMA a couple of days before to support his wife, who was struggling with the diagnosis, before checking himself back in for the surgery. And so understanding those key components of why a patient is there and what matters to them, that’s what medicine is really about, because that’s ultimately what we’re trying to support.

And I think you go up these hills and valleys in medical school, where you have to learn to ask the pertinent questions. But as you get better at that, you start having the room to ask these other questions that, at the end of the day, are probably the most important questions that we ask.

Kevin Pho: And Catherine, as you progress through medical training, becoming a resident, fellow, and attending, you’re going to have less and less time to spend with patients, more and more bureaucracy, more regulations, and more things that are asked of you. Now, what’s the one thing that you’re going to do to keep that connection with patients as you progress through medical training?

Catherine Jay: I think the biggest thing is, even if I can’t connect with each and every patient on an individual level in a day, picking one person and having a conversation with them that’s not strictly, pertinently medical.

Kevin Pho: We’re talking to Kate Crofton, Jay Hwang, and Catherine Jay, and together they co-wrote the KevinMD article “From future doctors to new ones: We need you.” Now, I’m going to ask each of you for your take-home messages to the KevinMD audience. We do have a lot of medical educators who also listen to this podcast, so I’m also going to ask you, in general, what’s one thing that you would like to see improved in medical training? Kate, why don’t we start with you?

Kathryn Crofton: Yeah, I think Catherine already spoke about this, and so did Jay. I totally agree that we need to normalize making mistakes and being vulnerable and being a supportive community. And I think that some of my favorite residents have modeled that for me. So I think there’s certainly room in med education for modeling that and creating that space for learners.

Kevin Pho: Right. And if you were to change or improve one thing during medical training in general, what would that one thing be?

Kathryn Crofton: I think, similarly, shifting the culture of medicine would do a lot for medical education, where we all admit that we’re learning and growing and are proud of that, and are comfortable sharing our mistakes as well as sharing our victories with each other.

Kevin Pho: And Jay, what are your take-home messages, and what are some improvements that you would make in medical training in general?

Jay Hwang: The take-home message of our article, I feel like, is to know as medical students that you have voices as well. And, I guess, to the point I had made, just to really embrace the uncomfortable, because that’s, I think, the key way to growth as a medical student. And with COVID-19, we’ve learned about the health disparities among the African American and Latino community, and I’ve learned about social disparities of health. But I would like more time to learn more about, particularly, race and health and class inequalities during my medical school education.

Kevin Pho: And Catherine, we’ll end with you. What are your take-home messages, and how would you improve medical training in general?

Catherine Jay: My biggest take-home is that medicine needs a diversity of voices and perspectives, and we need new, fresh insight to change. And so no matter what your background is or where you’re coming from, you’re needed in medicine, and your voice is needed in medicine.

To go along with that, if there was one thing I would change, it’s that we ask for feedback more, and more effectively. I think we have these formal structures of feedback that tend to happen at the very end of working together, and that doesn’t always improve the process of learning to work together. We need to ask feedback of each other, we need to ask feedback of our mentors, we need to ask feedback of the students that, you know, soon we’ll get to help train as well, and we have to ask for the feedback of our patients and be willing to take that feedback with humility.

Kevin Pho: Kate, Jay, and Catherine, thank you so much for sharing your time and insight. Best wishes during residency, and thanks again for being on the show.

Kathryn Crofton: Thank you.

Catherine Jay: Thank you.

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