 Hi, I'm Dr. Lewis Myers and welcome to Health Care Today. May is graduation season, along with flowers blooming, and across the country a cohort of fourth year medical students will be walking across the stage, receiving their diplomas and becoming new physicians. Most of them will go on to residency training and their specialties. Today we're going to talk to two fourth year medical students, senior medical students at the University of Vermont's Larner Medical School about their experience in medical school and their plans for the future. I'd like to introduce Anna Shambi, who is originally from Princeton, New Jersey. She went to Middlebury College. She did some post-baccalaureate work at University of Vermont and is now a fourth year student at University of Vermont Medical Center. She will be going next year to George Washington University in Washington, D.C. to specialize in obstetrics and gynecology. Mr. Ben Weaver grew up in Bedford, Massachusetts. He went to the University of Vermont for undergraduate and he will be going to Beth Israel Hospital in Boston, Massachusetts to specialize in radiology. Welcome to you both. I know this is a busy time of year as you try and transition and get ready for next year. We're going to talk a little bit about your experiences. It began before you got into medical school. I'd like to ask each of you briefly what made you decide to go into medicine and then secondarily what made you decide to go to University of Vermont Medical School? I'll start with you, Anna. So I knew somewhat early on that I wanted to go into medicine. I had read books by Atul Gawande in high school and ultimately went to Middlebury College where I studied international and global studies because I was interested in how cultures work and societies function and how people exist in the world, but was also really interested in the science of how humans work as well and realized that medicine was really the perfect blend of it. Atul Gawande talks a lot about how medicine is really the art and science of medicine and I think OBGYN, specifically, you see a lot of the sociocultural, sociopolitical workings in how people seek care and how people receive care as well. So that's what drew me initially. And then how about University of Vermont? What about, of course, you went to school in Middlebury. Was there something about Larner Medical School that called to you? A number of reasons. I think studying in a place as beautiful as Vermont was a big draw. Seeing the mountains from the anatomy lab was something that you really don't get to see elsewhere. And then really the active learning curriculum where we as students are not just sitting in lectures but really working together in the first, particularly the first two years of classroom learning. We're going to talk about that in just a minute. It's a very interesting program at UVM. Ben, how about you? What led you into medicine and why you at University of Vermont? Yeah, I think there were a couple of things that were, that I was thinking about when I wanted to decide on a career. I had grown up in kind of a science household. My dad was a chemist growing up and I knew that I loved the sciences. So I think when I was graduating from undergrad, I was kind of considering what direction I wanted to head in. Did I want to, I think I wanted to pursue graduate school but I wasn't sure. So I actually took a year off. I spent a year in Washington DC and I was volunteering full time down there. I was a tutor and a mentor to students in a under-resourced community. And I think at that moment I realized that I really wanted to make sure that I committed my life to helping other people. And so I think it was a really natural thing for me to say, hey, I already know that I really enjoy the sciences and I feel compelled to do them. But I also want to make sure that I'm doing something every day, that I feel confident that I'm waking up and I'm doing something for the betterment of other people, I suppose. And then I saw you nodding your head when Anne was talking about the University of Vermont and the beautiful mountains. What else drew you up here? Yeah, I think she hit the nail on the head, really. I think the other component that she is probably thinking about as well is that just the, I think really great sense of culture and community and I think collegiality between all of us as med students was really, really great here. I know that during my four years here, I really was shocked with the number of close friends that I was able to make and the strong sense of support that I got from both my classmates, but also the administration and the faculty as well. And that does not happen everywhere in every medical school. So that's very nice to hear. Now, traditionally over the past 100 some years, the medical school's been divided into the first two years are basic sciences. They call them the preclinical years and then the third and fourth year, you begin to work with patients and learn from professors who are actually in the field. University of Vermont has changed that a little bit. As have many medical schools now, students are now exposed a little earlier now to clinical experiences. But in particular at the University of Vermont, there's this program that you alluded to the small groups. Do you want to tell us a little more about that? I will say traditionally those basic sciences were taught in large lecture halls with a professor droning or lecturing on students when they could stay awake, taking notes, and then you were tested on what the professor had said. Tell us about what University of Vermont does, which is a little bit different. Ben, please jump in this. But the active learning curriculum is based on a flipped classroom model. So students are prepared for the next day's material ahead of time, either the night before or a couple of days before, and then come into class. And instead of having the traditional lectures, like you said in the rote learning, we engage in problem-based case-based learning and work together. We quite literally sit in groups of tables and work through problems together. And then those are interspersed oftentimes with sort of many lectures to clarify certain topics. But our entire preclinical curriculum was based on this flipped classroom model. Now students, medical students have to take step one of the boards, usually at the end of the first two years. And that goes over the basic sciences. And it's important that they be able to pass those tests. University of Vermont has had this program in place now for several years as the pass rate on step one holding steady. You know, I can't comment. I actually don't know. I imagine so, though. Is that true? I believe so, yes. And when you got to your clinical years, was it helpful to have been in these small groups, do you think? Or do you think it made, of course you don't know from the lectures. But what about this kind of learning help, do you think? I think when you're working in the small groups, you are required to kind of voice out loud your opinions about certain things. And I think sometimes when we're working in clinical teams, that is what we talk about. Or we do end up having to speak out loud about physiology and anatomy. And in a way, working in those small groups kind of helps grease the groove so that we're already feeling comfortable doing those things. I also think it kind of facilitated a really sense of support and community amongst us as students. And I think that translated well to when we got to the clinics, to our clinical rotations, rather. So that we knew that when we were in those teams, we really did want to work as a team because we knew that we were better off supporting one another than we were working individually. Was there any downside that you could see to having the small group, learning through the small group? It's a lot at first. It's certainly a new experience. Definitely, I'd worked in a couple of small groups in college, but not to the extent that we were doing it every single day for most of the day. So I think there is an adjustment period to doing it. Like I said, every single day, preparing beforehand the night before. But then I think you do catch and do a rhythm towards the middle of that first couple of months. And then by that point, you feel like you know what you need to do and you know what sort of things are high yield and important and what sort of things you can maybe just save for a later date. That's super important. So then you move on to the clinical years, third and fourth year. Third year, of course, usually involves going from one rotation to the next, different specialties, learning some of the basics of those clinical fields. Fourth year, you continue to, you can start to choose some electives and also I believe you do an acting internship where you essentially function as an intern but under very close supervision from the rest of the team. Tell us about those years. In particular, I think last year's graduating class was probably even more affected by COVID. But certainly yours may have been affected as well. Talk to us a little bit about how COVID affected your training and also what those clinical years have been like for you. Sure. So I actually did my clinical rotations down at our branch campus in Connecticut where we have two community hospitals that we can rotate at, Danbury and Norwalk hospitals. So the transition from Vermont down to Connecticut was certainly affected by COVID. We had become really quite close to it as a group largely because of the pandemic and also just because UVM fosters that sort of environment. And so being physically separate from my classmates was certainly difficult, but we formed a cohort down there as well and really supported each other through probably, in my opinion, probably the toughest year of medical school. What was that? Third or fourth year? Third year, yes. Because there's a huge transition from being in the classroom to being essentially working in a hospital. And it was, I think, very interesting in Connecticut, particularly that area being sort of the New York Metro area seeing just how much the pandemic had affected people's access to care and also the stress on the workforce. I think particularly in the two hospitals I was in, see the hospital staff working maybe more hours or being completely understaffed as well. And so learning to integrate yourself into that team and not only be a medical student and try to learn, but also balance that with trying to be helpful in a particularly stressful time was something that I think I really got to learn because of the pandemic. How about you, Ben? Yeah, I think I do want to echo what Anna said. About third year kind of being the most challenging of the years of medical school where we are transitioning from a preclinical year or a preclinical curriculum to actually being in the hospital and really trying to apply what we're learning. COVID I think did kind of compound on that and make things a little bit more difficult because not only were we moving from a preclinical to a clinical curriculum, but we were moving from primarily online curriculum to an in-person curriculum. So there was a little bit of an adjustment period of, I guess, learning how to go back into the workforce and be in person and kind of navigate all the different rules and regulations surrounding COVID as well within the hospital. On the plus side though, I did feel like when the pandemic first happened and everything seemed to go remote, we did seem like we were able to still bond and connect and kind of feel like we had gone through a really challenging and unique experience in life together. And I think that sort of fostered a really deep sense of community amongst our classmates is knowing that not only did we make it through med school together, but we made it through COVID together too. Ben and I actually, we were part of a small group where we tried to keep the active learning curriculum alive through Zoom. And so we would still work through problems together as a group, but just do it all over Zoom. And so we did that a couple of times, even though some of us left Vermont and were scattered. Yeah, I came of age during training during the AIDS epidemic. And I think that in the 1990s, and I think there are some similar echoes in that time that you've gone through now with COVID. So you get to fourth year and also along with your electives in fourth year and your acting internship, you're also visiting schools because you're deciding what kind of physician you're gonna be when you walk across that stage and get your diploma. Most people, as I said, go into residency training, which can vary anywhere from three years to case of neurosurgery up to eight years. And it's very interesting, we were talking about this before, there is something called Match Day for fourth year students across the country. And that's one day, it's kind of like the NFL or the NBA draft, because on that one day, everyone gets their envelopes and they see where they're gonna be going based on the choices they had put in prior to that and what the programs, how the programs evaluated them. So it's a very big day. Tell us a little bit about Match Day. What was your experience, Anna? It was a whirlwind of a day. It really ends up being Match Week. It's kind of a two part process where on Monday of Match Week, we get a letter saying we did match and really that's kind of when you get to breathe this big sigh of relief and say like, you know, I'm going to the next step and I'm going somewhere to continue my training, which is what you want when you've applied into the match and then on the Friday of that week is when you get to open up the letter that says exactly where it is that you're going and that's an emotionally challenging and unique experience because I can't think of another time in my life where I'm gonna open up a letter that's gonna tell me where I'm gonna go for the next, in my case, like five years. So, you know, I know that there are some classmates that are thrilled when they open the letter and they're absolutely ecstatic that they're going to their top choice. I know Anna is going to her top choice so she's absolutely thrilled. But I know that there are other people too that are a little bit more disappointed and I think there's, I think, you know, from speaking to my classmates at this point now we're all a little bit, even if we're not going to our top choice, we're still finding the silver linings to things and looking on the positives and kind of seeing it as an opportunity to grow in a different place that we maybe didn't expect. It also feels like the culmination of, you know, eight plus years, college, medical school, and even before that of work to get to where we want to be and so it's really very emotional. Well, you realize you're going to be, in your case, no BG1, you're going to be a radiologist, you're already, maybe it's the first day you begin to take on that, for real, that professional identity. Anna spoke about why, how she came to choose OBGYN. How about you and radiology? You know, I had an inkling coming into medical school that I was interested in radiology. I actually, I'd worked for a minute as a medical scribe for a little while prior to entering medical school and I had an experience where I was working with a physician who I developed a pretty close relationship with and prior to seeing a patient, he wanted to review a CT scan prior to seeing them in the room and he walked me through the anatomy of the CT scan and it was the first time I'd ever opened up and looked at any sort of medical imaging before and I remember just getting this really big grin develop across my face because I was blown away that we were able to look inside this person's body and see what was going on with their, in this case, their kidneys were over-distended. So I have a very specific memory of saying like, wow, that is absolutely incredible that we can do that. And so when I made it to medical school, you know, I still wasn't totally sold on radiology. I felt like I would have a hard time seeing myself in my ideal self as being a doctor but still working as a radiologist. So I definitely still tried to commit myself to several different specialties. I actually was surprised at how much I liked OBGYN. But when it came down to it, when it came to the fourth year, I had the chance to rotate through interventional radiology, which is a specific field of radiology that allows you to do image guided minimally invasive procedures. And I felt like I got to have this perfect balance of doing procedures, working with incredible technology but still getting to see patients every day and feeling like I am the doctor that I wanna be. Well, interventional radiology is a terrific field and in fact, many of the procedures that surgeons used to do now, interventional radiologists do, it's perhaps somewhat less invasively. So it's always changing. I wanna ask each of you a specific question about your chosen profession. For radiology, we've been reading recently, of course, artificial intelligence is having its moment and its moment may go on for quite some time. But the field that it seems to be affecting most immediately is radiology. We're reading that computer algorithms can read mammograms all day long without getting tired and in fact can read them perhaps with increased accuracy and other imaging studies as well. In the radiologists that you've spoken to, are they concerned? Are they happy? Are they concerned about their profession? What are you hearing? You know, it's been interesting for me as I've spoken to different faculty members across the different specialties. The radiologists do not seem to be particularly concerned about AI. In fact, they seem to be welcoming of it because they do understand that there are components of their job that could be automated by computer and probably done with a higher degree of accuracy. But I still think that they know that there is more than just looking at a couple of pixels on a screen and deciding you're able to make a clinical judgment about a patient. So as much as there are components that I think are going to be automated and I certainly welcome those things because I think they're tedious and a little bit boring, there are still much greater components of radiology that I think will not be replaceable for at least the foreseeable future. Certainly the interventional radiologists will continue to do what they do. That's right and I feel, you know, I know that that's a, the direction that I wanna head in with my career is interventional radiology, which I know will certainly not be replaced by artificial intelligence anytime soon because it involves hands-on interactions with patients. Yeah. And Anna, you spoke earlier about the fact that OBGYN brings in different cultures and you'll be in Washington DC, which is certainly a multicultural city and region and you'll be at my alma mater, George Washington University, so I wish you all the best there. You are going into the profession that perhaps more than any other, unfortunately right now is under the political crosshairs. And I'm not going to ask you your opinions on abortion in this interview, but there is so much, particularly obstetricians have been really in the crosshairs of this discussion. How does that impact you or how do you foresee that impacting you? I think like many other future OBGYNs, I've been very, very motivated by that. I think it can feel very overwhelming to think about the gravity of what's happening in our country and the political issues and the intricacies of bureaucracy and figuring out exactly the policies. But I think what I try to focus on is that our day-to-day interactions, one-on-one interactions with patients are what is really going to end up mattering the most. And so I'm hoping to really focus on that while also staying in tune with all the broader political issues. And I think being in our nation's capital will be a very interesting place to be for thinking about reproductive access and abortion rights. Is the field facing a lack of obstetricians in the future? Because of, well, various things. First of all, it's a very difficult residency in terms of the hours that you'll be spending in the nighttime, people have babies all night long. So you'll be up all night long for the next several years. But aside from the difficulty of the residency itself, are there, is it facing a lack of obstetricians? From what you know. My understanding is that actually match rates have, have decreased in the past years, meaning that there actually have been more applicants to OBGYN. And I think largely because it in some ways is a very, very biased, but is a very attractive specialty because it blends the procedural, also with a longitudinal primary care component. And again, I think many people are motivated by the political climate to go into OBGYN and make some kind of a difference in patients' lives or in our society. How about radiology? Are the numbers still robust? I mean, when I remember 20 years ago, it was one of the toughest residencies to match to to get accepted to. How about now? I actually do think this was a record year for diagnostic radiology applicants. I think there were, I think it was also a decreasing match rate is what you would say. So there are more applicants than there are positions that can be filled. And I do wonder if there's a component of the COVID-19 pandemic playing into that because I think during the pandemic, when everybody became remote, I think they started to realize how perhaps attractive a remote position can be in diagnostic radiology, certainly not entirely remote, but it can be and it lends itself well to that. So I do wonder if that played a role. One of the things that you've said here today is how much you've valued interaction with your classmates. My experience is a lot of times radiologists, it's a very singular kind of profession, you're in a dark room looking at a screen and not having that much interaction. What do you, how do you envision that? Yeah, as a diagnostic radiologist, it's interesting because you do get to speak with almost every physician in the hospital. So rather than being a physician that interacts directly with patients, you're a physician that interacts with other physicians, most commonly. So being able to let a physician know in real time that there's something urgently that needs to be done based on a scan, letting them know the details, if they have an important clinical question that maybe involves being in a gray area, so to speak, about what next to be done, those are times when physicians will come and speak with their radiologists. And then there's a sense of camaraderie within the reading room as well. Certainly if you're sitting in a dark room with a bunch of, with your colleagues, for 50 hours a week, you certainly become close with them and you get to share fun stories and get to know them really well as well. In the cave, as it were. In the cave, that's right. Well, before we finish, I thought maybe I'd ask each of you to remember one patient, obviously without names, but one patient experience that affected you in these, particularly in these last two years, third and fourth year. Anna, can you think of one patient in particular? I actually wrote about this patient in my personal statement to residency programs. We had a patient in the gynecologic oncology clinic, so a cancer, reproductive cancer clinic, and this patient walked in and, as a medical student, I go in first and usually you open with, hi, I'm Anna, I'm a medical student. What brings you in today? And this patient said, I actually have no idea why I'm here. And in that moment, I realized how reproductive health in particular, I think, there are some barriers to medical knowledge and access to understanding exactly sort of what goes on at the bottom. What did they mean by that? They had no idea why they were... They didn't know exactly why the appointment had been made and why they had been told to show up. And ultimately is because they were being enrolled for a HPV vaccine trial. This patient had recurrent, was at risk for cervical cancer. And so they had been advised to come to this clinic, but they had thought that there was something wrong. They were experiencing some pelvic pain as well and thought that there was something wrong with their ovaries. And so when I left and came back with the attending physician, he actually sat down with the patient, brought out a blank sheet of paper and started drawing the anatomy of reproductive anatomy. And I realized that in that moment, there's a lot of room for health education and particularly around women's health. And that, I think, has stuck with me as something that I hope to be able to do is to clearly explain to patients and meet them where they're at in terms of their medical knowledge and literacy. Did you ever get to see that patient again? Did they come back? I did not, no. Ben, what do you think? Can you remember one? Yeah, I had one patient interaction that really stuck out to me for a number of different reasons. It was the first patient that was assigned to me on my internal medicine clerkship. And the chief resident at the time told me that there was an admission overnight and it seemed like a typical case of community acquired pneumonia. So it sounded like a great place for a young medical student to start out. When I met the patient, I think this was the first time that I experienced what's called counter-transference where I felt like the patient reminded me of a lot of my dad and that gave me a lot of, I think it tugged at my heartstrings a little bit and made me feel like I was kind of instantaneously connected to this guy. He was a farmer from Vermont. He wasn't somebody that seen a lot of doctors in his life. He was a little bit standoffish and maybe a bit of a curmudgeon, but that kind of made me like him a little bit more. And as it turns out, this was also an interesting case from a clinical perspective. He didn't have a typical community acquired pneumonia. He ended up having a uncommon fungal infection of the lung that actually had disseminated to parts of his spine as well. So from a clinical perspective and then also a radiologic perspective, he had very interesting findings in an interesting hospital course. So as part of the treatment for this fungal infection, we had to give him a pretty nasty antifungal medication that unfortunately he had an allergic reaction to that required a rapid response called to his room because he was having difficulty breathing. And so I remember hearing that and I remember instantaneously becoming a little bit defensive and a little bit upset that, you know, that sort of thing had happened to him. And I think the component that really made me feel defensive was when the infectious disease folks said, well, you know, that is the medication that needs to be given to him. You're just going to have to pretreat him. And it felt like to me at the time as a young medical student that that was a little bit careless and I kind of wanted to protect this person from having to go through that pretty nasty medication again and having that nasty reaction, ultimately everything worked out fine. Obviously the infectious disease folks know exactly what they're doing. But so I think the bottom line of that story is that sense of defensiveness and feeling like I needed to protect this person from what I felt like was a treatment that might hurt him and that would maybe worry about him was the first time that I noticed that I had that sense of counter-transference in seeing somebody that was close to me in a patient that I was working with. Well, it's also the Hippocratic Earth oath, right? First, do no harm. That's right. Which is important. Well, I think that is a really important lesson that both of you talked about. And if you hadn't before, when you go through medical school, you see death for the first time up close and personal. Any particular reaction to that when do you remember first patient that died? You know, so the patient that I just spoke about with when I did follow up with them in a couple of months and by follow up with them, I mean, see how they had gone through the medical system. Unfortunately, it did pass away only a few months after their diagnosis and their treatment and it wasn't clear what had happened to them. Just to say that they had been deceased. So that was certainly a tough thing to see, although it's different when you are seeing the person, I suppose, in real life as opposed to just seeing their chart. You know, when you open their chart and you see the words deceased over there, and obviously your heart sinks a little bit, but I don't think it has the same magnitude as seeing it happen firsthand. Well, speaking of magnitude, it is quite, when you walk across the stage, I don't know if you'll be going left to right, but when you start on the left side of the stage, what is graduation day? May 21st. May 21st, okay. When you walk across the stage, when you get to the right side of the stage, you will be in a very different place. You'll be a physician's. And I remember thinking that the first thought I had was because I was taking a plane the next day somewhere and I said, oh my gosh, if they say is there a doctor in the plane, I'm gonna have to raise my hand, stand up or something. But it is, you're taking on a great responsibility. It sounds like you both have prepared well. And I think that University of Vermont's medical school, Larner Medical School has served you well, it sounds like. And I wish you both all the best. Thank you for joining us today and good luck. Thank you for having us. Yeah, thank you for having us. This was great.