Dr. Paul Tran (@alimentaryschool) on Empowering Med Learners

Would you like to be addressed? Mr. Smith. John. What. What brings you in today?

Yes.

Hi, everybody, and welcome to the podcast. This is Generations md. My name is Stephanie, and I'm joined here by my colleague, Dr. Sarah Davis, who's also my mother. And today we have a very special guest, Dr. Paul Tran. You might have seen some of his clips on. On social media, all of his comedy sketches. He's also a pediatric GI doctor, and we are so excited to have you on the podcast. Welcome, Paul.

Welcome.

Thank you so much to both of you. It's awesome to be here.

Yeah, we're so excited to have you, particularly your OSCE sketches. Me and my classmates send them to each other all the time. I think they're absolutely hilarious.

For our listeners who don't know who are my age and don't know what an OSCE is, it's basically a mock patient interview. And he does these hilarious sketches of, like, what it would be like to do a, you know, a patient interview, like, kind of in real life. And you have, like, tons and tons and tons of them. I agree. They're hilarious.

Thanks. It's like, it's limitless content, really, because a little bit of my role is actually at two medical schools. I do clinical skills or doctoring, so for both first and second year. So it's like double trouble at two schools. So I see. I see that whole progression from first year, second year as people are learning clinical skills, and it's all in good fun. I do it more as a coach. I view it really as a coaching role. But there are times where I'm like, man, I remember doing this exactly. Or I know exactly what it's like to be in a room and completely blink and then have your SP or standardized patient try to prompt you, and you're not catching what they're putting down. And you're like, I can't wait to not watch this clip at the end of this. I'm never watching this. This is never going to resurface.

Yeah, I have my first, like, big, full physical one in a couple of weeks, so really looking forward to that. But I didn't realize that you were actually, like, a teacher as well. Like, you taught clinical skills, so you're a part of it. Can you tell us a little bit more about that?

Yeah, absolutely. So my role is very interesting. So I have a mission statement that's kind of emblazoned in short form at the top of my social media, which is I want to encourage and empower learners to be advocates for their own Education and I want to encourage and empower people, patients to be advocates for their own health. So I have kind of dual interest both in the clinical world. But then a lot of my time is actually spent with education, formally and informally. So as a pediatric gastroenterologist, I did three years of GI fellowship. I was the first fellow in my program to do education research. I did feedback research in how fellows, GI fellows learn endoscopy. I was the assistant course director for the first year GI block at the School of Medicine. As a fellow, I did curriculum for third year. So everything I did, I was like, I'm going to do education. I want to be a mentor. I want to be a big E educator. In academia, you call it biggie or little E educators, like the bedside educators versus the people who really have formal roles. So I jumped into my first job. I'm, I'm. I just finished two years as a attending, so I started, still consider myself a baby, baby doctor. And I started here. I started in that teaching role at one medical school and quickly became two. So the doctoring Clinical Skills foundation or that, that kind of precepting program, I am this year. I started as a co clerkship director for the pediatric clerkship. So that's where a lot of ideas and, and thoughts for the pediatrics content that I teach comes from. I mean, I mentor probably 10 to 15 students, residents, fellows at a time. I do medical education research. I try to invest in resident and fellow education too. So I mean, I try to do anything and everything. If it means impacting a learner or someone in the stage of learning, I think it's just something that really fills me up.

Yeah, just backing up to your medical education, like, how did you want to get involved in, you know, medical education as you are now?

It really came from my training. I, I think I was pretty mediocre at best. You know, I was, I was floating by. And I think one of the things that if I had a memoir, it would be like the acceptance of mediocre to the pursuit of mastery. That's kind of the progression of my professional career. Very like my very short professional career. So far, I was okay with mediocre, okay with just being good enough. In the first couple of years of med school, like, I wanted to be excellent, starting to think about step one and clerkships, and I still wasn't there. And it wasn't really until residency where I went to UT Southwestern in Dallas to be a pediatric resident. And I was like, man, you know what? I want to be great I want to be the best for my patient, for the family, for the patient that's in front of me. And then that pursuit of mastery really made me think, well, this is not something that people know how to do. In my experiences as a medical student, you kind of float, you know, you. You kind of find your way. You find your mentors. You might stumble upon someone interested enough to invest in you. You might stumble upon someone who's, like, really pushing you as a colleague. Your classmates, like, hey, I want to make you better. I want you to sharpen my me. How do we do that together? You don't really see that unless you have the chance encounters. So I started seeing more and more of those experiences and having more good and bad experiences. And I remember making promises to myself, like a lot of people do. I will never be like this person when I'm a grownup, when I'm an attending. I will never be like this person when I'm a resident. I will never treat my medical students this way or conversely. Wow. I love the way that person invested in me. Wow. That person took the time to acknowledge me. I want to be like that when I grow up. And I've never forgotten a single one of those promises. I can remember where I was when I was and who I was with when I made those promises. So that's really what's inspired me to get to where I am now.

Yeah. And I think that your. Your content shows a lot of that. It's really. It's interesting as I look back and I. You do a lot of the things of the medical student, you know, kind of like into a rotation, and you don't really know what to do or where you're supposed to be. And kind of the way you get treated, I have to say, it was a little bit triggering for me. I'm like, oh, wow. I have suppressed all of these memories. And I'm like, God, that really sucked. It was so mean the way people, you know, treat you or, you know, here you are, you're there, you're so excited to learn, and then you're just kind of like, you know, cast aside. It's hard to watch sometimes, but I can see that, you know, by doing that content, it really has a bigger meaning of, like, this is. This is not the way we want to be.

I really appreciate you saying that, Sarah, because obviously you can see who my audience is very quickly. It's not just medicine. It's not. It's not patients. It's not. Not physicians. It really is people in the thick of it. It's medical students and, and. And residents, really trainees and students. And even in medical students, it's like even a subset of medical students. But I realized this year is when I really started doing more skits. Before, I was doing kind of everything, talking heads, little funny things, memes for a while. I have an interesting story about how that content has progressed. But what I realized is it wasn't the Stephanie's of the world that made me feel really good when I had students everywhere being like, thank you.

Wow.

How do you know, like, the comments of where did you get this videotape of me? Or how do you know my experience? Like, clearly we. We don't have any unique experiences. Those comments are really funny and kind of inspire me to keep going. But it was the Sarahs of the world. It was the surgeon of 30 years messaging me privately saying, I don't know how you're doing it, but you are unlocking so much suppressed memory or you are giving me so much ptsd, I can't believe it's still like this. And that's when I was like, whoa. That's how you affect culture. You don't just show the people and validate the people who are going through the experience. I make people who are in a superior role in a position to change things. If I just incept into your mind and show you, hey, this is still a problem. Oh, wow. What was triggering to me and traumatizing to me still exists now. Maybe I should do something about that. I think is how you start the ripple effect. And I was like, I've really stumbled upon something. If I'm getting. Speaking of generations, the generations now acknowledging what each other are going through.

100. And I love that. Just the idea of like calling this culture out. Have you faced any, like, pushback from either institutions or other, like, peers? Because it is a big step being able to be like, hey, this is an issue. These are things I experienced. I'm calling it out. Have you felt pushback with any of this, the skits or anything else?

Thankfully, no. Not. Not too much. And I've been able to bring a little bit more voice because I think I have the weight of, hey, I have thousands and thousands of comments and messages that say something to the effect of, this is my experience. Right? This is not me. This is not me sharing my personal experience. This is me personifying a fairly universal, generalized and shared experience. You should pay attention to the numbers. Something is happening. So I'll give you an example. When I was able to go to kind of leadership of the school of medicine or even programs that I'm participating in and share about something that's really important to me. Feedback. And you'll see, Stephanie, in the clinical world, maybe now, even, like, when you're doing the clinical skill stuff, feedback varies. Feedback generally sucks. And people don't like giving feedback. And they were asking me about my perspective. Now people are actually saying, hey, what is actually your perspective based on what you see from social media, the mentees that you have and what you do? And I said, there's actually not a culture right now of malignant feedback. Believe it or not, what I experience and what I see, and then what people tell me is that people aren't overtly mean. That's not the prevailing problem now. Culture has shifted where people aren't malignant. They're apathetic. People just don't care to give feedback. So I'm like, the students I work with are actually craving feedback. But the feedback that they get is, good job, good student, or they're getting, hey, you did a really good job, Stephanie. Nice job. And then on your evaluations, two months later, it's, you could have improved this, this, this, this, this. And you're just saying, I kind of wish you had told me that. And I've compared it to having something stuck in your teeth all day, and you walk around in clinic, or you're walking around the hospital, you're giving a le. You realize it's been stuck in your teeth all day and no one said anything. So I've been able to, in a positive way, bring those things kind of to light. I haven't had too much pushback. I think the pushbacks is more like it takes the form of, huh, we'll take that under consideration, you know, rather than like, no, you're wrong, or you need to stop doing this, which is great.

A lot of personality types that are in medicine are, you know, not necessarily the big extroverts. And, you know, sometimes people are like, I'll just stay in my lane and, you know, be polite and just kind of move along. I mean, do you think that's part of it, is just that the attendings, you know, you know, they could give some better feedback to the person at the time, but it's just, oh, I don't know. They just don't really feel like saying something that maybe, like, it's easier to write that down and send it to them two months later than to just kind of say it to their face at the time.

Yeah, there's there's this concept, a lot of concepts in psychology that I've looked at, like radical candor and something that pediatricians in particular, I'll call out my own field are very guilty of, which is being too nice and not being kind. So I didn't want to save face. Stephanie, I'm working with you. I. I want you to. To feel good. I want you to think that I'm nice to you. So I'm going to say, hey, you did a good job, really nice job, so that you can save face publicly, so that you can leave with the warm and fuzzies, only to have that dramatic drop off the cliff later when you're like, that was not concordant at all with what you told me in person. And instead, we need to be kind and embrace kindness, which kindness is sometimes saying, hey, got something in your teeth? Looks kind of nerdy, you know, or, hey, you, like, you've got coffee breath. Like, I just want to tell you, you're leaning in close and you got coffee breath. You can say it nicely. But the kindness sometimes is honesty. Actually, kindness is honesty. And I think people are trying to save face and trying to be overly nice. That's one thing. And I think the second thing is people just don't know how to navigate conversations when I don't really know what your goal is or how to. How you want to improve, how you want to grow. So I'm just going to say something super general, and instead we could approach it like, stephanie, what's your goal? Oh, I just want to be a really good communicator. I want to be an excellent communicator because I've seen my mom be an excellent communicator, whatever. And I want to exemplify that. Great. What? Like, well, how do you. What do you think that your mom does that you don't do? Oh, you know what? She talks like a quarter of what her patient does. I've seen that, like, the. The ratio is like this to that. I want to be like that. Great. Okay. And then now I give feedback based on that goal. So that shared goal. So I think sharing goals and expectations is really nice to have beforehand. So, for instance, I say, I talked about this at a grand rounds about. About this, and a resident was like, hey, I love that. I love that you said share goals, mutual goals, and then you can get feedback on that goal. But sometimes I don't know what I'm working on. Like, I have no idea. Like, you're telling me to create a goal, but I Don't know what to do. I said, well, that's. That's great. Now we can have a conversation about expectations before. And this resident was like, I think expectations would be very helpful. And now I started implementing that into practice. So if I say, stephanie, sorry I keep picking on you, but, like, like, Stephanie, what's your goal? I have no idea. I have no idea. I kind of want to do something about communication, but I don't really know how to be more specific. And then I would say, well, let me. On this topic of communication during an osce. You know, whatever, bare minimum for me is that you're able to at least get the information you need efficiently. That's bare minimum. That's what we teach you how to do. The. What an exemplar student does, or. So what someone really does in clinical practice is weave information getting and rapport building. So it's not like, oh, I am so sorry that you stubbed your toe. It makes sense that you feel frustrated that you stubbed your toe and like, what? I kind of play up in my skits instead. It's, man, that kind of stinks. I. I mean, you're. You're a runner. You're probably out of commission then. Yeah, you're right. You're now weaving in the fact that they were a runner into their experience now with their chief complaint. And. And I'm like, that's. That's an exemplar. So find a goal that's somewhere in between. Find a goal that's not just getting information, but not that person that weaves effortlessly. Find somewhere in between where I want you to be able to apply one concept. You know, break it down like that. And I think those conversations, they're not on you as an educator. They're also on the person as a learner. And it's them talking, like, right. Like, I mean, tell me. I mean, with parents and children, like, I would say, as my mom, like, sometimes my mom will get mad at me. I'm like, I didn't know that was an expectation. Like, I don't know why you're mad. It's not fair that you're mad right now. You have to, like, tell me why you're mad or tell me that you expect something before you can get mad. You can't just be mad because I didn't do something that I didn't know I had to do or shouldn't do.

Yeah. 100. I guess, like, as a student in a clinical setting, how do you bring about that conversation of, like, okay, like, this is my goal. These are shared goals. Like, to the educator, I love it.

These are all the things that I. I want to empower every student and every person I talk to. Like, I'm bringing these things. None of this is my original thought. This is all based on authors who are just thought leaders in the world. Adam Grant is my favorite author right now, organizational psychologist at Wharton, and it has some amazing TED talks and a podcast. He gave the most practical tip, which is ask for advice. Don't ask for feedback, ask for advice. So instead of. Dr. Davis, do you have any feedback after my. You know, after what you saw today? Like, is there. Do you have any feedback for me, Paul? You did. You didn't. You did. Well, yeah, it was good. It was organized. You know, people don't like the word feedback. But instead, Dr. Davis, I. I appreciate you kind of watching me with a patient today. What advice would you give me to be a little bit smoother with how I got the history, or what advice would you give me to be more like an intern? Because I feel like I'm still like that medical student role. What do. What do interns do? What advice would you give me to get there? Because what do you. What happens when you ask someone for feedback? They feel kind of icky. They don't want to hurt your feelings when you ask someone for advice. Stephanie, if you ask me for advice, ooh, I feel really good. I. You. You think I'm wise? You think I'm worthy of giving you advice? Well, I'm. I feel better. I'm going to give you advice. And also when I give you advice, I'm investing in you. I want my advice to make. To succeed, because then it makes me look good, like, even if I don't know the results. So I'm going to give you more truthful or more maybe even helpful information. So I think just shifting to what advice would you give instead of asking for feedback?

That's a great pearl.

That's huge.

Yeah, yeah, yeah.

Do you have any. Yeah, no, that's off. That actually is huge. And I can. That makes. That makes total sense. Do you have any advice on receiving feedback as a student? Because I can see, you know, I'm in MS.1. I, you know, I'm a little baby right now. I don't know anything. I've not stepped into the clinical setting, did rounds, any of that, but I can see that being something that is difficult for me and probably is for a lot of students. Do you have any. Any advice on that?

Yeah, I think the fact that you're asking that means you're. You can think about what you're hearing because like it or not, you're going to get really bad feedback and really bad advice. People, we know that feedback, when you even get it, it usually stinks. So what do you do? Well, there's all this talk about growth mindset, growth mindset. Growth mindset is just using opportunities, viewing opportunities and failures and setbacks as opportunities to grow or improve. It's not like a catch all that, like, how do you get better growth mindset, you know, like, people are using it a little bit too much like that. Again, I'm all about, like practicality, like, what can you do to answer that question directly? I think shifting your mindset to realize that feedback or advice is a gift. And sometimes you get really sucky gifts. Sometimes you get gifts that you're like, I have five of this. I don't need this. But I'm going to say thank you. Hey, thanks for the gift. That, that was really thoughtful. And you can choose whether to use the gift, re gift the gift, throw away the gift, or set in the closet and not hurt that person's feelings by saying, I don't want this. But you're like, grateful for the gift. Especially in today's world where people aren't giving gifts if it's apathy that we're seeing. Like I said what I think I'm noticing, people aren't giving feedback. No one's giving feedback willingly or giving advice. No one's really taking an active role in mentorship. And by no one, I mean there are certainly people. But I think people are chomping at the bit for more. Learners are chomping at the bit for more. So when someone takes the time to give you advice, even if you deem it as, this is the worst advice ever. Hey, I appreciate you saying that. I'll take that under consideration. And then I put it here, and then I look at my gifts in an entirety. Well, Sarah told me this, Paul told me this, Bob told me this. And then I've got this over here. That's completely different. Is that different? Is there wisdom in being different? Or is that just like that's an outlier that made me feel bad just for the sake of feeling bad. That's not a gift that I need. Discard viewing that has helped me realize that, like, you might have a different perspective and you might not know the context with which I operate or whatever. Thank you. I appreciate that. I'm not going to apply it to Myself, But I appreciate you saying something. Whatever your motives may be, may be selfish or not. That's. That's one practical, like, mental thing. Think about.

No, yeah, that I. I love that. And that's a good way to switch the mindset, I guess, since I'm not in, like, the clinical setting now. What. While you were talking, what I was kind of thinking about is just all of the advice that I'm getting from older students right now, just as an MS.1. And it does feel less of a feedback thing, but still kind of just like, you should be doing this, you.

Should be doing this.

This is how you need to study. This is how you need to study. And it's like this thing, this thing, this thing, th. This thing. And sometimes it's hard to switch my mindset from being like, okay, this thing is right, this thing is wrong, whatever it is, and more switching it to like, okay, all of these things can be different perspectives that I can take in and I can accept that and use that to, like, figure out what path I'm going to take.

Yeah. Resource overload is crazy right now, and I think everyone has found a way to. To get by. But I think a lot of the focus has become. I mean, it's always been. Even for me, it was step one. It was trying to get all this fire hydrant information. But I think there's a shift to this flashcard mentality, whether Anki or not, but this flashcard mentality where I use this analogy all the time. Like, if you study Spanish flashcards or vocab, you start with vocab, learning a language. But if you studied vocab for a year and then went to Mexico tomorrow, what would your Spanish sound like? And people are always like broken, halting, gringo, you know, all this, all these words. And then I said, does that make you stupid? Are you stupid? When you know you have all the knowledge in your head, you just don't know how to, what, hold a conversation? And then what happens? People get into the third year, the clinical world, and they have all of the knowledge in their head from step one, from studying, but they don't know how to apply it, how to use it in a conversation. And what are the attendings of the world asking you? They're not asking you, what is the answer to this question? Here's A through E. They're asking you, what do you think about that requires a conversation? What do you think's going on? What are possibilities? What generate a differential diagnosis? A string of vocab and idea behind it so the sooner that you find a way that helps you actually comprehend and then apply. It's not just about knowledge acquisition, it's also about knowledge application. That I think is really important and unsolicited tip for you, Stephanie. One of the best things that someone told me is if you can, if you really want to test to see if you know something, try to explain it to someone who's not in medicine. Can you explain something to someone who's not in medicine? A friend, a significant other, a family member, without using medical words or if you're using medical words, you have to explain the medical word.

Yeah. I've seen like tiktoks of people having like big like PowerPoints for their grandma. That's like this is what I learned this week and stuff.

Yeah.

Because you know when you're talking to patients, you do have to get really good at that. You've got to stop using all that medical lingo. You have to put it in ways that patients can comprehend. And if you start just kind of going blah, blah, blah with all these big words, they're just, they, they kind of nod and they're like, okay. And then they just leave and they have no idea what's going. So I think that's something that you, you do get better at as you're talking to patients. But it's a good thing to practice doing early on.

Yeah, especially when you're, you're like building the foundation for your career, the knowledge base for your career. Why not practice applying the as you acquire it and then you can avoid being that physician. That is like in the non medical world. What is the biggest complaint about physicians? They didn't listen. They, they ignored my concerns, you know, well, what if it's someone who's breaking down like sharing, being very transparent and open about what you're thinking and being able to communicate in a way that's, that's encouraging, that's, that's honest. I, I think those are the things that I, I what oskies do for me. OSCE's, the checklist is really hard. OSCE's are a really good way of showing, okay, how do you be efficient yet don't lose that bedside factor, that empathy, that compassion. To me, the best part about OSCE's is when you get a preceptor or an SP who's giving you true communication feedback. I'm like, the physical exam, this might be blasphemous to say. I'm like, let someone else check that off. Like I, I come in and I'm like, I'm focused on like, hey, how did. Hey, you. You realize that you were taking notes and then you went, as you were taking notes, you were like, I'm paying attention to everything you say. Like, you didn't even look up when you were saying that. Like, look at your patient at least and put your notes down and be like, hey, what's going on today? What brings you in? Do you mind if I take notes then grab your, your clipboard or whatever? Are you. Do you have to write down their name, their date, like the, their. Their date of verse? Like, you can look at that later.

Yeah, I like on those huskies, how you. You also come in on your skits and say, yes, do you need anything? Would you like a glass of water? Oh, sure, that'd be great. Okay, let's begin. You completely ignore the fact that they asked for a glass of water or.

How would you like to be addressed? Mr. Smith? John. What. What brings you in today?

Yes, that's good. Just you had touched on that beginning, like, because I just sort of am interested in your, like, how you started doing those TikToks and at what point in your career was it when you first started doing this content and kind of how you came upon, you know, what, what you do now?

Yeah, thanks for asking that. I just jumped in. I just jumped in right into like feedback and like super esoteric things. My story was really started in the end of fellowship. Something that I don't really think people know at all is how honestly kind of dumb it is that we have a pediatric subspecialty shortage. Fewer people are going into pediatrics and fewer people are going into subspecialties. Yet people don't know that it's a three year fellowship for things like GI cardiology, where in the adult world it's for the most part, two, except for cardiology, gi. And in pediatrics, it's mandatory two years of research, the second and third years of fellowship. So I am training for six years, two of which are dedicated research, and I'm not. And the vast majority of people don't end up in research when they leave, when we have a shortage. It just doesn't make sense to me. But anyway, I'm in the midst of that research year, third year of fellowship, I'm winding down. I'm done with my education stuff. And I realized after taking a sabbatical from social media, I kind of came back full force and realized that there was this gap, massive gap on at least short form content. Maybe not YouTube, but short form content where a lot of learners are. And I'm like, there's a lot of medical educators on Twitter. X a lot of people echo chambers on LinkedIn. I'm like, there's no one, there's no students there. There's no residents there. They're on Instagram, they're on Tick tock, they're on YouTube. Why are we not addressing people where they are instead of talking about it on Twitter? So I kind of deviated from that, went and looked at TikTok really initially first, and I was like, all I see on medical school stuff here is how to have beautifully crafted notes and how to have this Enya playing in the background when you have incense burning and a nice light that's shining as you click on your Anki remote. It was like very, very like, they're all the same. And I was like, there's no information at all on how to succeed in the clinical world. Like third year rotations. There's nothing about fourth years and finding a specialty and succeeding on sub eyes and nothing about residency and communication and nurse communication and all these things that I was like as a fellow, I tried to instill and tried to really look out for people. I was like, I don't see this. So I jumped in full force and I started my early content for about, probably about six months. So this was third year fellowship, so really starting in 2022. And then I, for about six months, I was like doing tips. If you look at my profile now, I still have playlists, clerkship, boot camp, intern boot camp. It's just like talking heads of tips. When a nurse says, I have a concern, you know, you respond like this. And then about six months in, I had a post with another creator and I was just saying, like, changing the culture of medical education because that was my purpose. And then I had a follower reach out to me. He really impacted me. Doesn't know this. I should make a post appreciating. He said, no, hate, I love your content and follow you, but how are you changing the culture of medical education? It seems like you're just giving us tips to succeed in a present culture. I was like, I was like, whoa. Like I. I made a response video. But like, that really got me thinking. I was like, oh my gosh, you're so right. Like, thank you for showing me the kale that's been stuck in my teeth this whole time. You know, like, it was very honest feedback. And from that point on, something shifted. Where I've always kind of naturally been kind of A class clown. And I started doing more memes, like, memes and funny things for about. Probably about six to nine months, mostly because I was a new attending. And if you want imposter syndrome, there's. Yes. First year med school. Sure. Third year medical school. In the clinical world, sure. New intern, new doctor. Putting in orders first. Sure. New fellow. When you're a sub specialist, sure. Nothing compares to being a new attending when your name is on it and you're like, no one is watching me. And I just did this for a patient. What? And I'm fighting insurance by myself. You know, nothing's imposter syndrome like that. So I kind of took a. A break from active creativity and just more lazy. Got lazy memes for a while. And then this year, really in earnest. I had just a lot of ideas, and I was like, I'm just gonna do. I'm gonna do skits, because I think they're. They're funny. I. I like. I like them. And the guy who really inspires me, Glaucom Fleckin, is probably a huge, huge inspiration. And then Preston Press. Row Press. Like, we. We've connected, and he's just, like, brilliant, brilliant sense of humor. So those are two people who really inspired me and, you know, really helped me get to the point where, you know, I feel very comfortable now, natural, doing different things. That's kind of the evolution of how my content has changed. And like I said, like, I really feel like, wow, now I'm actually seeing some culture change, very in small amounts, not because of the people, the audience that I'm directly addressing. It's almost the indirect audience that I'm starting to see. Tinges of reaching, which is really, really inspiring to me.

Yeah, I mean, I definitely have a lot to say about that. We love Preston, too. We had him on the podcast, and that was just, like, an awesome episode. But, yeah, just about the skits and all of that. I. And I mean, also, as someone who's, like, starting out in the creator field, y' all are my inspiration when I'm starting to do stuff. And I started doing these skits a little bit that got some traction just in regards to, like. Like, that medical student. Just someone who is contributing to the toxic culture of, like, a superiority complex and having an ego and making other people feel down about themselves. Especially, like, my mom and I talk about this a lot on the podcast as I'm Somebody has. She's a family medicine doctor. As somebody who is interested in going into primary care, there's lots of that, like, talking down to me because of that. And I've, like, kind of made videos like you, inspired by your videos, just like, addressing that culture. I've gotten a lot of pushback from my institution saying that, like, it's not that I'm making medicine look bad and I'm making the students at my school look bad. I guess, like, do you have any tips for that? Because I'm trying to do. What you're doing is calling out the sculpture and being like, hey, like, this is an issue. Let's shift. Yeah, I guess you have any.

But you're at a different point in your career. You know, it's a little bit different to be an attending or a, you know, a fellow and call it out other than a first year medical student. So, yeah, I'd love to hear your thoughts.

I would say, hey, keep this in the podcast because that is honest. That is amazing. You're making a change. You're, you're, you are making a difference. And that's a, that's evidence right there. If you were not making a difference, they would give a crap. They would not care. Unless it hit a nerve. Unless it was like, ooh, ooh, I don't like that this is here. I don't like this. Well, guess what? Change it, right? Like, do something about it. Then instead of shutting it down, you. So I think that a. My first reaction is, no matter how hard it is, you can find a way to calibrate. I think that's the. Don't cancel, don't stop. Calibrate. So what is socially acceptable? Calibrate the loudness of your megaphone. Yeah, I think that's, that's what I would tell myself because when I started as a fellow, I think I was met more with eye rolls than, than with, like, you can't do this. This is unprofessional or whatever. And I was very, very, very clear. Like, I think one of the things that you need to be very aware of, and I can't wait to check out your skits. And I'm gonna watch every single one.

But only made a few thus far, but they've gone.

Then I'm totally gonna watch every single one in entirety. I think one of the things that you really need to do when you're starting out is being like, kind of declaring. This is clearly satire, right? This is clearly commentary. This is not reflective of. I am not campaigning against the institution of my, my own school. This is like my experience that I am satiring for people to relate to. I think, I think sometimes you kind of toe the line a little bit where you, when you're like, is this satire? You know, you, some of those videos out there, those creators and in non medical spaces where you're like, I cannot tell if this is actually you and you're like this or is this satire? Like, I think you have to be very clear that it is. And I think having a open conversation with your school saying, well, these are the experiences of your students. I am not alone in this. If this is gaining traction, this is gaining traction for a reason. Can we think about ways to actually help address this rather than sweeping it under the rug and just saying, you can't do this. It starts with a small megaphone and then, and then you can calibrate over time as you go through. And I think to be honest, satire is the perfect way. It's not like you're, if you were saying, I want to change something and you actually sat there and you went on rants, you know, rants. And like, this has got to change. And this is what my school is doing. And that, that's where I would say, in kindness, I would say you got to calibrate all the way down.

Yeah, yeah.

But satire is the way to go, I think.

Yeah, yeah, it is, it's, it's funny. And yeah, I think that those, you know, it's, I mean, and when she did some of those ones, it was relatable in lots of other fields outside of medicine as well. So.

Yeah, and I love this, the idea of doing something like a satire skit to elicit this change, to try to shift the culture. And I like, I love what you're doing and it's really inspiring to me. So like, thank you for that.

Oh, thank you for saying that. Who knows? Like, I'm like, I, sometimes I'm like, even if one person looks, watches this, like truly, if one person watches this and said and says, wow, I am not alone. And I thought I was completely alone. I thought I was crazy or I thought that I, I'm the odd one, everyone else has it together and I'm the one that is struggling to find a, like a specialty, you know, like, no, this is, this is like the majority of people, they're just not vocal about it.

Yeah, well, and along those lines, I, I, you have on your, your tick tock a couple of those ones pinned at the top with you talking about your Match day experience and then another really viral one with a lot of different people talking about their Match day experiences. And I, I love that because it's you know, it's not just a bunch of people saying yeah I got my first choice and I'm so great and blah blah blah. It's all these people who had, you know, really mixed results from their match. And you know what? It was all okay yeah.

Can you speak a little bit about that?

I shared my Match Day story probably about two years ago in very brief and just as a word of encouragement during match week 2022. And then I did more of a long form one that I've pinned. Wow. The that was polarizing to say the least across platforms. You know I would say probably million and a half, almost 2 million views and comments were like comments were overwhelmingly I connected with so many students who DM'd me and then I actually talked on the phone or on Zoom with just stories of encouragement. Stories of like I feel so, I feel so validated that I I, I was feeling selfish for feel for like wanting the best for myself and and everyone was telling me I was crazy for matching my third and I was like well I I should be happy right? Like right because I matched but I, I feel so defeated inside like I'm not good enough and and all these stories were so inspirational. I knew going in that like I wanted to reach because Match day was so hard for me. I still think it was one of the worst days I've ever had. And when I shared my personal experience my experience being very raw to uplift those who are going through the same thing the other end of comments. Oh my gosh. They were vile vitriol vitriol. I I've screenshotted them and my wife actually we have a Google Photos we share. She cannot look at those pictures because she's like I get so disgusted and I get so angry that people would do would say things like this. You are the most selfish ungrateful brat I have ever heard of. How could you be like this? If this, if this is the physician that complaining about their fourth choice I will never take my kids to see I will never see you. If this is the representation of medicine, blah blah blah. I shared how my sister and I were in the same med school class and she kind of suppress her celebration because she saw how upset I was. Clearly someone hurting for their child I believe who maybe went through the match didn't match. I'm not quite sure the details but was like you stole your sister's joy in that moment. How unbelievably selfish. Wow. So obviously you could dwell on the the bad but people the people who commented didn't want to watch a seven minute long video because about four minutes in was like a story of redemption. I was like, this is the best thing that ever happened to me. I found my, I met my wife, I met friends. I am where I am today because of the mentors who poured into me. I found faith. You know, I, I have all these things. Like, this was the absolute best thing. I am so glad that the worst day of my life was the turning point. And it happened pretty quickly. It wasn't like years later. I reflect back now, it was like, okay, I, I'm on a mission now to give this program the best resident. It wasn't to prove anything other than like, you're, you believed in me and I'm going to pay you back for believing in me, for trusting in me and giving that story of my own personal experience. And it was like, I'm not talking about this is the worst day in the history of humankind. I know that I am, I, I've had, I'm incredibly blessed. I'm not saying that. I'm just showing my, sharing my experience. So I continued that with going around my hospital and finding colleagues. I was like, hey, how was your match day? Did you match your first day? You know, like, it was kind of weird going around and trying to find people. And I found enough people that I ended up interviewing and I just really wanted to continue that inspiration of like, you can be badass and successful. Like the COVID The, the COVID doctor is one of the most successful pediatric surgeons here. I work very closely with, like, I admire her, like, amazing person and she's like, yeah, that's my third choice, you know, like, best thing, you know. So I want to try to continue to encourage, encourage, like that. I think encouragement is such a powerful tool and I, I, that was one of the most discouraging experiences I've ever had and moments in my life.

Yeah, I think that's, I think that's super helpful and just, you know, kind of goes back to that culture of perfectionism that pre meds have and it's. Oh, and you know, oh, if you. I've just got to work really hard. I have this dream and this is the only thing that's going to make me happy. And it's such a, it's such a lie because there are so many things that can make you happy and you, you know, the bottom line is you have to sort of make your. But I do just love that things are all going to work out. Maybe just not exactly the way you had planned from the get go?

Yeah, yeah. I think about it like there's a picture I can think of in an Adam Grant book. Again, huge plug for Adam Grant. But it's like the peaks and valleys of life. It just feels like that but then sinusoidal. But then you're like zoomed in 100 times and if you zoom out to actually normal, it's like undulating but everything's going up and it's like the stock market, right? Like if you, if you have it on a week view or a debut, it's like oh, what a crash today. But then you have it on a one year view, you're like, oh wow, this went up so much since last year. And then you have it on 10 year view and you're like, wow, this has consistently gone up. So you're seeing daily peaks or daily or weekly or monthly peaks and valleys. But if you look at it like the. Today's. Today's Valley is a heck of a lot better than last year's peak.

You know, I love that. That is like really inspirational. I guess as we're kind of closing out here, we won't take up too much more of your time. We talked a lot about advice and stuff, but I do ask everybody this who comes on the podcast. There's a lot of my peers listen and a lot of just med students. Do you have any closing thoughts or advice for people early on in their medical training journey?

I have two that I share consistently and I've thought about this. One is in today's educational journey, I think not because of anyone's fault. I think it's very system, it's system factors at play. But people go through and it becomes very much about a person. You, the research you acquire to go through the next step, the. The publications that you have to list on your cv, the way that you can acquire more skills. It's just very person focused and it should be what your original goal was, which is people focused. And you lose sight the way that we train now. I think you lose sight of the fact that there are people at the end of the day that you're serving. And I, I have a lot of problems like I alluded to with like research for the sake of research and this what have you. Glock and plugin had a great skit on this. Like what if you just want to take care of patients? When did it not be good enough to just want to take care of patients to the best of your ability? And it is intrinsically again person Focused. And I think if you just remember, even the first step is I'm remembering that there's people at the end of the day. So I need to be better. Not to position myself for the best residency or for the next step, but look beyond the next step, look beyond the next couple steps and hey, what do I need to do to be better prepared when I'm taking care of patients as an intern? So look a couple of steps ahead or right now even two years. Like, let's not look at step one. How do I apply the knowledge I'm acquiring now and to use it for step one. And when I go to the clinical world, right, Like, I think that's one small thing. And then I think the other thing that's kind of a saying like that, that I've noticed is similarly we end up on this assembly line where it's always next steps focus. Like there's always a next step, step one and then rotations and then some eyes. I gotta prepare well and then interviews and gotta interview well and then residency and then fellowship and then we think too much about our career trajectory and it's a lot specialty focus and what your career looks like. We don't think enough about the job, which is interesting. Like, and what happens is you exit medical training. Like me and I was 33 when I finished 10 years of medical school and training. I don't, I didn't know what the heck LinkedIn was. I just created LinkedIn two weeks ago. I, I don't know, I didn't know how to advocate my, for myself. I mean, I had to acquire all these skills. You don't know. Personal finance is one. That's why there's huge communities about this now. But personal finance, how to write a cover letter, how to update your cv, how to write an email, a professional email, how to, you know, have an agenda that people can look at. Like all these things that people learn in their 20s, we delay for so long and then you exit and you have this match mentality of I'll just take whatever you give me. Hey, I'm a pre med, I will take any medical school that accepts me. I'll just take like, just please, I just want to get into medical school. And then I'm just, I just want to go to residency. I please just take me and then fellowship the same way. And then you go in the same mentality as a job and you don't realize that like, wait, wait, you bring a lot of value. You bring up, you are worth something. Instead of just, I'LL take whatever job you have. Like, whatever you get. Like, just pile on me. That's fine. Like, just pile on me instead of thinking about, like, I bring value. What, here's what I want from a job and I want, I know I want this for my career, but what do I want my job to look like? I think these kind of bigger picture things allow you to get to just the big thing, which is my, my word of encouragement, which I've already said is you, you matter. You're seen, you matter. And you, you really make a difference now when you're studying for anatomy, you're studying for your first organ blocks. Like, you actually matter now way more than you know, you think. If you just remember that. I think, I think the day to day becomes a lot more tolerable with that week, month, year, professional life mindset.

I love that. I think.

So I started to tear up there.

No, seriously. I mean like so many people, myself included, and so many people around me just like need to hear that, like so much. Really need to hear that. So thank you so much.

A lot of doctors sort of steer away from social media, like, oh, you can get you in trouble or something else. But you know, it is a medium that can have a huge impact and so we need to use it to our advantage. And so giving a voice to all of that stuff is just really, it's really amazing.

Thank you. And to reply to that, if you google yourself or if you realize patients are rating you, you get, you get reviews, you get patient ratings. If you Google me, it's my videos, it's my podcast, it's my, it's like my, someone wrote an article, you know, all that populates. So you can control a little, you can crowd control a little bit of what your own online footprint is. So it is a incredible tool that people should look towards.

Yeah. Well, speaking of all of those things, do you want to plug all of your social media, podcasts, everything?

Oh, well, I appreciate it. I just. Elementary school is my kind of, is my platform, Tick tock and Instagram. I do have a, A lot cooking like in the next couple weeks. Actually, I'll tell you first, a newsletter. So the elementary school.com I have a newsletter that I'm going to talk about things like this. Just like short things about like, hey, no one's investing in me, no one's giving me feedback. How do I find feedback when no one seems to care if I'm there or not? You know, I have, I have so many resources thrown my way. What do I do like what's actually helpful. How do I sift through this? So a newsletter coming out. I actually have merchandise that makes fun of the way that we give feedback. So I actually have T shirts and badge reels that say like meets expectations. My attending.

I love it.

And then also pens made for attending to take. So Sarah, if you've ever stolen someone's pen, which I have many times, I have like med student pens, nurse pens, resident pens that like this pen was made possible by medical student loans. Like a hard working resident is looking for this pen. Return this pen to the nurse you took it from. Where you're going to get a FYI page at 3:00am yeah, you know where to find us.

You can follow us on Tick tock @Generations MD, Instagram @Generations MD. And if you have any questions or interested in being a guest on the the podcast, you can email us ataskgenerations mdmail.com and we will talk to you next week. Bye guys.

Bye.