A Genuine Approach To Residency and Beyond
As I get ready to wrap up my time in medical school, I can’t help but reflect on the mentors and educators who helped get me to the finish line. It would be an understatement to say the stage of medicine has changed since I started school. Step 1 was still scored, Residency interviews were in-person, and COVID-19 wouldn’t enter our thoughts for another six months. It was the efforts of enthusiastic mentors who helped me survive the changes, navigate specialty decisions, and set me up for the next stage in my career. Soon, I will be pressing submit on ERAS and await hopefully (with chattering teeth) for interviews, praying I did enough these past few years to keep the dream alive. With all the recent changes in curriculums, boards, applications, and so much more, we can never get enough advice on how to push on with our best foot forward. So, whether you hope to begin medical school one day or whether you’re readying for residency and beyond, you will appreciate the insight of Paul Tran.
Paul and Peds:
You may recognize Dr. Paul Tran for his cleverly comedic and positive content as Alimentaryschool on TikTok and Instagram, but Paul prides himself on his work in education and mentorship as a Pediatric Gastroenterologist. For those of you stressing about figuring out your place in medicine, keep an open mind and take in all that life has to offer. For a long time, Paul was certain he would become a teacher. Education had always been a pillar of his life, and he loved the idea of guiding others and helping them reach their potential. As a college junior, he shadowed a pediatric geneticist who was giving a difficult diagnosis of Prader Willi, and a new vision formed.
“I couldn’t help but take in how patient and encouraging the physicians were with the family, giving them as much time to absorb the news and ask any and all questions. That was kind of where I realized I wanted to be able to be that source of strength and reassurance. To support children and their families and approach medicine with my initial education interest in mind. If there's one field in medicine with endless educational opportunities, it’s pediatrics. Children are often innocent bystanders of their own health. So, in Peds, you really get to advocate for the most vulnerable individuals not in a position to advocate for themselves. And I see myself as a pure educator in every way. I get to educate both patients and their families. It’s double the responsibility but double the fulfillment.”
For those of you wondering if Pediatrics is right for you, but not exactly sure if you “fit the Disney mold” so to speak, bear in mind stereotypes are not rules. What’s important (for any field, not just peds) is what drives you to care for your population.
“There is absolutely a peds personality, which people can make fun of a lot. It’s ok, I have it myself. Every specialty has its stereotypes, but you don’t have to be that person, you know the person on the floor the second a kid is playing to play with them. You don’t have to be Patch Adams. You don't have to be loud. You don't have to be extroverted to just enjoy working with children. You can simply love kids, enjoy working with them, and want to care for them for pediatrics to be right for you.”
Now, I know a lot of readers already have visions of subspecialties beyond residency. Maybe it’s the subspecialty that drove you towards medicine in the first place. Some questions that get thrown around are, “How much should we make known our goals for that subspecialty during residency interviews? Should we make it the centerfold of our app, or keep our interests broader?” Whether you have a specific fellowship in mind or have absolutely no idea what to do beyond residency, Paul might be able to help.
“If you want to hook someone to your field, give them a cool procedure to do. Let them take the reins, support them, nurture them, and let them take off. When I was on my pediatric GI elective, I was handed a scope, and I was hooked. I came into residency knowing that, and my residency program director, on my interview day actually called me out on it in front of everyone else. He went around the room and asked everyone what they wanted to do in pediatrics. You certainly don’t need to know for sure, as one of my colleagues at the time was a self-described "pluripotent’ pediatrician. If someone wasn’t sure, he would say ‘That’s great, you don’t need to. Our program can really help find it.’ And when I said GI, he said, ‘That’s great, our program has _____ to help you excel.’ So, you absolutely don’t need to know what you want to do when starting, but if you do, you can start finding mentors in those areas early. Remember, it’s no longer an audition. Don’t work to impress, work to learn and form life-long relationships. I ended up meeting my current boss as my GI mentor intern year.
Another point though, don’t put the cart before the horse. Even if you know what you want to do long-term, you’re a pediatrician (or whichever general specialty) first. You've got to learn how to be a doctor. Don't overextend yourself trying to make connections, trying to do research, and all of these things when you need to learn how to communicate with patients. You need to learn how to take care of yourself when you're busy and your life is not on your own schedule. Even if you’re set on a subspecialty, become a really, really dang good general physician first.”
We’ve covered a lot of pursuit-melding careers, and why I continue to find more is because every single person injects a unique energy into their work and lifestyle. No matter what your creative interest may be, there is room for it in medicine. I can promise that.
“I remember telling my wife asking me as my TikTok grew, ‘What’s your goal?’ I told her I'd met my goal to fill the gap that I felt existed on social media. There is so much advice on how to succeed in the first two years of medical school. And there were crickets for the advice on the years after…and if there was something, it was usually negative. There was a gap for advice and positivity. I wanted to make education videos for residents, for med students of all levels. I created it really to be able to give advice for the third year, poke a little fun at toxic culture along the way, and then really build and advocate for kindness and compassion medicine. It's been a tremendous right-brain release for me. Medicine can really stifle creative thoughts, but having this platform just unlocks creative energy in everything I do.
For those trying to build creative platforms or pursuits with medicine, ask yourself why are you doing it? Just like your personal statement, really everything in life, what is your ‘why’ for what you do? Even if the ‘why’ for creativity is just a way to blow off steam, perfect. But, if you’re doing it to build a following, to fill insecurities, I think it can become a vortex for unhealthy living. For me, social media for me fits into my mission to advocate and educate. If it ever became about something else, I pray someone in my life would sit me down and set me straight.”
Advice for Residency:
Now that you all know a little more about the mind behind Alimentaryschool, let me share some wonderful insight into his approach of residency and beyond. Paul was kind enough to offer his take on some of the more common questions med students have regarding the applications and the residency process as a whole:
How important is program size? Do larger programs have more opportunities, or do smaller programs reduce competition to get proper experience?
“Think less about the numerical size of the program and instead about the exposure that you're going to have to mentors, subspecialists, subspecialty experiences. What are your goals for residency? For fellowship? Do you want a specific fellowship, or is the idea of fellowship completely closed off? That’s where the size and resources of a program may be a factor for you. A smaller program may have less ‘fighting for opportunities’ so to speak, but it also may take more ‘fighting’ to get to a given fellowship elsewhere. Think also about your time in residency. A smaller program might help you know and bond with your co-residents more, but a larger program may offer more grace for coverage when you’re sick or life events like a wedding pop up.”
How do I assess the culture of a program in a virtual format to see if it’s a good fit for me?
“Two words: prove it. They need to prove their culture to you, and it’s your job to ask questions that make them prove themselves. You put a program in a selling mode when you do that, and I'm telling you, there will be people reading this and shaking their heads. But, you don't want to go in with a losing mentality. This is your career. This is your life for the next few years. You must make sure you’re getting the best picture of these programs, and honestly, they have an incentive to make sure the right people are coming to join them. And if a program judges you for the questions that you ask about culture, that's not the program for you at the end of the day. Here are some probing questions to consider:
“What happens when things break down? What would you say are the most difficult aspects of your program? How do people respond to those?”
“What systems are in place for when an intern is sick? When residents are on nights, is there an attending in-house? If not, who do the residents call if they need help?
“What do residents do on nights to support each other? (For attendings) Do you welcome or expect questions/calls from residents? (for residents) Do you feel comfortable calling attendings at night?”
“For a struggling learner, if there is an intern who's not carrying their weight or a senior who seems unresponsive, are the chiefs able? Is that something that chiefs kind of take over?
“What is coverage like? Is there, is there someone who comes in? Are the other interns expected to share the load? Does the senior take the load? Does the attending take the load? How rigid is the cap?”
“Do classes really get along or is it really just the intern and the senior? Is there a crosstalk between classes? Is there peer mentorship?”
Don’t ask, ‘What’s the culture like here?’ Make them prove their culture.”
Are there any activities, experiences, or personal statement ideas in general that programs like to see or don’t like to see?
“I would say that's the wrong question. The right question is what is most reflective of your interest, passion, and where you see yourself now and in the future. So, I would run your experiences by the mirror test: do these experiences reflect how I see myself and how I see where I want to go? In the end, the experiences themselves do not really matter. Don’t list anything because you think it will impress someone on the other end. List what you’re excited to talk about and what you’d want protected in a program. Don’t emphasize things you don’t wish to pursue or don’t wish to be known for. If you’re on a first date and say up front, ‘I freaking love kids,’ my date is thinking, ‘Hey, this person really wants kids.’ And if I don’t want kids, one of two things is going to happen: they want kids and will be disappointed I wasn’t honest, or they don’t want kids either and may call it off, making me miss out on a good match if I were just honest. This whole interviewing process isn’t too dissimilar. It’s about clear communication of who you are and what you’re looking for. What should you list as your most meaningful experiences? The things that you can talk about at length with the most amount of energy. That's the bottom line. Your ‘why’ is really important. You don’t need to a sob story or a heartwarming story. Share experiences that illustrate how your ‘why’ came about, but make the focus on the ‘why’ not the examples. Your personal statement should answer three things:
1) Who are you and what are you about?
2) What's your mission/why [insert specialty]?
3) Why do you think you will succeed in residency? What tools/characteristics do you have?
And, if there’s room, an additional fourth:
4) Where do you see your role and career heading after residency?
A helpful tip: sprinkle breadcrumbs. Leave breadcrumbs that you don't fully elucidate that pull in a reader and make them want to bring you in to answer. A personal statement is there to both demonstrate who you are and intrigue interviewers to take steps to get to know you better.”
How do I show confidence in my interviews?
“When do you tend to feel the most confident and in control of a conversation? For me, it's when I’m giving advice. When I can share my experiences, what worked, what didn't, and when I use them to help someone, that’s when I feel I describe my experiences with the greatest strength. So, I tell everyone to approach interviews and sharing experiences as if you’re trying to offer a lesson. You’re not just an applicant. You’re a potential answer for a program, and in focusing on the lessons you’ve gained through your experiences and less on the experiences themselves, programs gain a better appreciation and understanding of you who are. You also get better clarity on what a program appreciates and supports based on how they respond. It’s a mental reframe from them having everything to offer you to coming to the table as equals. After all, you would end up as colleagues if accepted. Make interviews a give-and-take conversation of what you’re excited to offer one another to lift each other higher.”
The Future of Medicine:
I hope you all are taking notes because the number of gems across those answers is unbelievable. He’s absolutely right. At the end of the day, we have a lot to offer as candidates (even though we’ve spent years doubting that), and we need to make sure we approach interview season looking for the right fit. This advice won’t just help us match, but match where we belong.
We’ve spent a lot of time discussing preparing for the next stage in medicine, but it’s also important to look back at where we started and take note of the victories and failures we experienced. It helps us grow not just as physicians, but as people, and it’s key to helping reshape the field of medicine for the better.
“Everyone goes into med school, sees the firehose, and thinks ‘I need to drink faster.’ Doing 1000 Anki cards a day is not good enough. It’s like learning a language just relying on vocabulary, and then going to a foreign country and thinking you can fly. At some point, you have to be able to put it into practice. I wish I could go back and study smarter, not longer. In learning the language of medicine, really put yourself in whatever sphere you're in into what it looks like, speaking that language, you need to frame every disease and treatment in the context of experience and the real world. Form vignettes. Constantly ask yourself questions until you find gaps in your understanding, then go find answers to fill those gaps.”
Buzzwords are for boards, not beyond. That’s a lesson I certainly wish I could go back and tell M1 Tyler. Medicine is a marathon, not just because of its length, but because the more appropriately you pace and train at the start, the better suited you will be to keep the race going.
When I started med school, I had little idea as to what specialty was waiting for me. If I could go back to day one, I would encourage myself to think beyond the high moments each specialty contained, beyond the ideal versions each lifestyle offered, and truly set foot in the common day-to-day of every field.
“There was a brief time when I switched focus to ENT, but I switched back to pediatrics because it didn’t really feel like work. It wasn't a eureka moment, just after a couple of weeks on rotation I realized I was working just as hard as I had in other rotations, but without feeling the same level of fatigue. The days seemed shorter, and I felt mentally more engaged. Don't choose a specialty for the highs. Choose it for the mundanes. Live the bread and butter, and ask yourself how happy would you be doing this for your career?”
The final thought I wanted you all to see is my favorite thing Paul said when we spoke. When I asked if there was one thing about medical education he would love to see change, he said:
“I would love for the system to teach, equip, and empower people to be better teachers. Better coaches of attendings to residents and residents to med students. Not everyone is going to end up in academia, but everyone at some point is put in charge of someone else's education. If we do a better job of teaching how to teach, we can fundamentally improve the future of medicine. We begin to reframe the perspectives of the new minds that enter, and then real change can begin.”
There are no quick fixes to make medicine a better system, it starts with how we approach the next generation of medicine. If we teach the mindset and indoctrinate newcomers with the biases of old, we will keep the status quo. If we teach possibility and hope and encourage new mindsets and new outlooks, we will create the change we need to see.
Thank you so much, Paul, for taking the time to share your life and insight with our readers! Be sure to follow Dr. Paul Tran on Instagram and TikTok for more, and to everyone getting ready to submit ERAS, congratulations on reaching a major milestone in medicine! Think back to your first-year orientation. Can you believe you’re here now?
