Reality TV or Med School?? The Drama of Medical Education

You're a doctor, you're where I want to be, and you're— it's 10 AM on Tuesday and you got your PJs on and I'm chilling and you're chilling on your laptop in bed. 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.

Yeah. And we're recording from the home base now. Not the studio, the home home.

The home home, I guess. I mean, we don't really have like a studio studio, so I think anything could be the studio.

That's true. That's the beauty of a podcast.

Yeah, exactly. We're just, yeah, we're, we're chilling here, here at home base.

Well, I'm chilling. You're fighting for your life.

Yeah, guys, I am. I'm in a battle right now. It's me versus USMLE. And I'm losing the battle.

So that's, uh, step 1, what we used to call Boards Part 1, and it's the, the first of the 3 tests you have to take to become board certified. Well, actually, the first of the 4 tests you have to take. There's Boards Part 1, 2, and 3, and then you take your specialty boards. So, but, and this is the hardest one, I think everybody would agree.

Yeah, I mean, we've talked about it a little bit on the podcast, but now I'm like really in the I'm in the thick of it and it's just crazy right now that I am in my room studying so hard, just like trying to, you know, pass this exam. And then I go into the room next to me, which is you, which you're a doctor, you're where I want to be. And you're, it's 10 AM on Tuesday and you got your PJs on and I'm chilling and you're chilling on your laptop in bed. I'm like this. Is what I'm working towards?

Yeah, man, that's life.

All of this for that?

All of this knowledge so that you can sit on your butt. Yeah, it does seem a little weird, um, but you know, that's just— that's the way it is. Then you can just relax. That's what it's all about. It does just— the whole thing, it's just a ridiculous amount of knowledge that you have to have for this exam.

Mhm.

About 98% is also just totally worthless.

Yeah. Yeah. But yeah, it's not, um, yeah, it's definitely hard for people to understand who like are not. Yeah. It's just like very, it's just a very unique experience. Even I thought it was gonna be better than something like the MCAT because in the MCAT I wasn't really friends with a ton of pre-meds in college. So I was studying for the MCAT. I didn't really know a lot of other people that were also taking the MCATs. So it was pretty isolating. Um, my friends who were not in pre-med didn't really understand. And then I was like, oh, well, Step 1 will be better because, you know, all my friends are going through the same thing. Um, but I quickly realized that it, even though we're all doing the same thing, everyone's journey towards the goal point is so independent and different.

That's so weird.

Yeah. It's just, I don't know. It's, um, different things work for different people. It's just some people are really good at just taking tests, um, you know, it's just, it's, yeah, it's definitely a different beast than anything I've experienced.

Yeah, there's some stuff is a little bit different too. We all took it on the same day at the same time at our school with pencil and paper and a little Scantron. Um, so we we all had to take it the same day, and we had to pass it in order to start our clinical rotations. So that was a lot of pressure on the whole thing. But yeah, we just, man, I went to the bookstore, bought a bunch of books to study, and we didn't really have lots of practice questions. So you would just go through and review all this material, and you really just had like a couple days for each thing. So you're like, okay, I'm gonna study my biochemistry for a day and a half and then do the next thing. It was— and I remember I was taking off a couple days before I started studying. We had like 3 weeks to study, and I said, oh, I'm not that stressed about it. And I remember my friend Anne saying, you're going to be stressed when you do your little schedule and when you realize that you only have, you know, 1 day to study this topic that you studied for a whole semester in med school. Um, but It all worked out for me. It's all gonna work out for you.

That's, you know, that's that. Yeah, I have— it's kind of a bummer too. I feel like I, like, you know, this is just consuming my whole life. So I feel like such a, uh, what's the word I'm looking for? Just like a two-dimensional person right now, you know? It's just like, this is my one focus, my one thing. But I know it's just a phase. And, um, yeah, I've been making some TikToks about it, about just struggling through it. Which is definitely different than content that I've made before. I feel like I like to put positive stuff out there because I want pre-meds and people to see that like med school's not all a struggle, but at the same time, like I've talked about this before, there's, there's gonna be ups and downs and like there's gonna be times where you're, you are gonna struggle. So I do think it's important for people to be able, I've had people reach out to me and say that they appreciate me sharing that because it really is isolating when you feel like everyone else is doing fine and you're falling behind or not doing the right thing or whatever. So just to see that like someone else is also going through the same thing at this time, I think has been helpful.

Yeah. Just is, it's just so brutal. I just, it makes me just sad as a mom. I go by and her door's closed and she's just in there studying. The life could be hours and hours and hours.

The life could be so much worse though. It's like, you know, you have to have some perspective on the whole thing. You can get so ingrained in just like, this is it, which it is tough, but at the same time it's like, yeah, again, I just have to study. It's not like I, you know, this is not life or death.

You have food. Yes. You have shelter.

Exactly. Exactly. Life could be a lot worse. But this is the point I'm at right now.

I'm like, you know, I could be on fire.

I could be on fire. I could be, you know, Struggling for food.

Well, it is kind of funny because your dad was off hiking the Pacific Crest Trail while you were studying. And so he was slogging along in 95-degree heat with a big old backpack.

Acting homeless.

Acting homeless.

For fun.

For fun. Yeah. The difference was he chose to do that.

I mean, I chose to do this too. I, you know.

Yes. But if you could have skipped this part, he would have.

Yeah, yeah, yeah.

He now he would have chosen to have better weather, but still he was choosing to be hiking up and down, doing about 20 miles a day. He did, he did 200 miles of the, of the PCT and then is going back for more.

He would love to be on here to talk about it. Everything goes back to the trail.

Yeah, but we're going to take a break from trail talk for a little bit.

Yeah. Well, speaking of trail talk, what do you know about wilderness medicine?

I, I have seen people say that they do that in wilderness. Isn't wilderness medicine just like first aid?

Well, that's what, yeah, I am a little bit confused about. A lot of people do emergency medicine and then they'll, uh, like do a fellowship in wilderness medicine. And I think some of it is like what I did in India, where you go to communities that don't have access to healthcare and like you're able to provide them stuff that they need. And some of them, they're so remote that like you have to like hike through the wilderness to, okay, get to it. Um, and I think some of that is, um, I guess more on a larger scale, just being like, what are— figuring out what the necessities are and kind of like planning for that. Um, but some of it, yeah, is like in a national park you have the park rangers and people that like, you know, but then I guess there has to be a doctor.

I guess mostly you just got to get out of there and get to a real place where you can get medical care. Although there are places like base camp for Everest. That would be an example. I think there's doctors there and, you know, they're dealing with all kinds of altitude sickness and other things when especially when people go up and then get back down to there.

Yeah.

So That would make sense to me.

What do you— speaking of just like acute problems, like somebody drops down while hiking in the wilderness, like, or some, you know, someone goes into cardiac arrest on a plane, something like that. And people are like, oh, is there a doctor around? Like, what do you think that a doctor in some sort of, you know, acute setting could do that is like different from, maybe different from a layperson or different from like a person in healthcare?

Yeah, it's, that's a great question. And it is funny when they say, is there a doctor on the plane? And then people respond. I, they, they had that when I was on a Frontier flight, which was pretty funny because I've heard people say like, don't ask for a doctor on board a Frontier flight because there won't be any. But sadly there were many of us and I got up and then there were already 3 people there. And so I can't stand having a whole big crowd and you don't really know the people. And so I was like, whatever, they just, they got it covered. But one guy seemed to be very, very involved. And so then at baggage claim, I asked him what kind of doctor he was. He was a first-year PM&R resident. And I was like, oh man, dude, you should have stepped aside. Like, I feel like I could have done that much better than you. Well, what did he do though?

Well, like, and what was happening?

Oh, I don't know. I don't think it was.

Oh, well, that's a good example then. Then what could have you, what could you have done that he couldn't have done?

Well, yeah, I don't know because I don't really know the case, but I did have, so I had another case again where they called for the doctor on the plane and I went over there and there was a nursing student and a paramedic that were working on this guy and the Paramedic was about to try to start chest compressions on this guy. And it— and I looked, the guy was breathing and he had a pulse.

And I said, hold on a minute, he's got a pulse.

And he's like, no, that's— you know, he's like, no, no, that's, that's, that's not a pulse like that. Like you're feeling your own pulse or something. And I'm like, dude, look at him. His eyes are open and he is talking now. And he— and the guy kind of wakes up. He's like, oh, okay, blah, blah. And what I know happened to this guy is he took some sort of drug, probably an opioid.

Yeah.

And he had respiratory depression that may or may not— I mean, his heart might have stopped briefly. I don't really know. But at the time he was having respiratory depression, but then kind of he got him all stimulated. He woke up and he was like, leave me alone. I'm fine. He didn't want anybody fussing over him. And those people sat there and did stuff to him all the rest of the flight.

Oh my God, that is mortifying.

Like doing like sternal rubs on him and trying to get other vital signs. And I'm like, he's, he's fine. And, and the other reason I stepped back was because I could tell right away that this guy who claimed he was a paramedic, I don't even know if he, you know, you don't know what people really are. I think he could have just been a dude like he's and he wanted to take over and he wanted to bark out orders. And again, when he was about to do chest compressions on a guy who was fully awake, I was like, I gotta get out of here. I want nothing to do with the liability that is, you know, perhaps gonna happen here.

Yeah. So, but again, back to the good thing though. It's just like, okay, if the guy is, if his heart stopped, do chest compressions. If he's not breathing, check the airway. Like that sort of stuff. But then you don't like, it's in a, like it's a setting like that. It's like, you don't, you're not doing a whole diagnosis. Like how could, that guy just sounds like a bad paramedic.

Yeah. Yeah. Yeah. So it is, it's a lot of the stuff that you do for, you know, first aid, CPR, all that kind of stuff. Now, Dad had a time. This was not that long ago. We were on a plane. I was listening to a book with my noise-canceling headphones. And this was on Southwest also, where you could just sit wherever you wanted. And so I sat down on a seat thinking Dad would sit next to me, but he decided to sit in the row behind me because he liked that seat better. I'm like, what are you doing? And he's just like, oh no, I want to sit here. Okay, whatever. So I sit there and listening to my book. And I guess they had, and this was the very beginning of the flight. They said they, you know, they called for a doctor on board. And, and again, I didn't hear that. But then I saw dad jump up and, and go up to the front where this was happening. And then the woman next to him went with him. His new friend on the flight who happened to be a critical care nurse. And they did work on this guy the whole time. The guy was— he still had his armband from the hospital on his wrist. He had just gotten out of the hospital and somebody went and dumped him off on that flight to get back home to see— to like stay with his daughter. And so He, he, he needed, he, he had had like, he had COPD or something like that and was having trouble breathing. And so they were working on him. Now I do think one of the, so the critical things that dad was doing there was number one, just trying to get the whole history, figuring out what was going on, what he just got out of the hospital from. And so apply, you know, doing, you know, getting the, they did have a fair amount of stuff. I mean, they had like a pulse ox, they had a glucometer. You know, they got the guy oxygen. But then the question is, do you need to land the plane right now?

Okay.

Or can you keep going? And then you start talking to—

give oxygen, not give oxygen. I guess I didn't realize that they had oxygen. Yeah.

Yeah. So there were, there were a few things to do, but a lot of it was just like trying to get us, trying to get a diagnosis of what is causing the underlying issue. And can this person go for another 3 hours until you can get to this place now? This is going to sound terrible, but one of the things you think about when you've just taken off on the flight is, oh God, I really don't want to turn around and go back to the airport.

Yeah.

And have to like get off and get on another flight. But I knew with Dad at the helm that that was very unlikely. It's like Dad's going to be able to treat this guy and he'll be like, no, no, he can, he can last another 3 hours. We'll get him there. And, and they did. And then they, uh, You know, the paramedics came on the plane and got him off the plane. And then he went to the hospital in the town where we were, the city where we were, instead of the hospital he had been in, in the city where he was from.

That's a bummer though, man.

Yeah. Dad was super excited because he got to be busy the whole time during the flight. He wasn't bored. He was entertained. Yeah.

I feel like most people would be like, oh, I'm going on my vacation. I don't want to have to work.

But he He's like, "Oh no, it made the flight go by fast." But that was actually good because he and this critical care nurse worked together and, you know, so I think that there was some of that, but you're right, most of it is just, you know, your ABCs and you don't need to necessarily have the diagnosis. Now I have heard of people flying across the ocean, there was one case where they actually put a chest tube in somebody because he was having a pneumothorax.

Oh my goodness.

Yeah. Wow.

I didn't know they had that.

Well, they made a chest tube.

You got to go really back to the basics. Do some, like, hyper-resonance to percussion there.

Like, start doing something like that. I don't know how they made that diagnosis. There were two doctors and one was— he was, he was like a critical care attending, you know, whatever, really knew his stuff. And the other guy was like psych resident or something. Useless. But he was another pair of hands. And helped them out, but they bring something out and they put this tube into like a thing of water. And I don't, I don't remember how they did it, but so, so that was— so they did, they needed, they did it more than needed more than just the basics.

Yeah. So I guess that's also some of the wilderness stuff is like, okay, you have some, you know, like you're in this setting, like being able to figure out what resources you can use if somebody has something like that.

Like, yeah. Yeah, I don't know, that's pretty impressive. I don't know, I just feel like, uh, get them to a hospital. Yeah, yeah, somewhere where they can get some real help.

Yeah, well, speaking of, uh, residents and different fellowships and stuff, uh, Match Day just happened.

Yay, Match Day! Congratulations to all the people who just matched. And crazy thing though, it is a crazy thing, and it is Just like sorority rush. Yeah, I really—

I was talking to somebody who, uh, they told me that apparently the person who created the match system— so I mean, for those of you who don't know, it's essentially that you interview at all of— you go through medical school, you interview at all of these different residency programs, and you rank them, and then they rank you, and then you end up getting matched on this day. You open an envelope and it tells you where you're going to be for the next 4+ years. Um, so, uh, which is very similar to what happens during sorority rush, but the person who created the system, the match system was, uh, an economist who apparently won some sort of Nobel Prize for creating this system, which is crazy because like if he won a Nobel Prize for creating a match system, then every single sorority girl, anyone who's been the recruitment chair at any sorority deserves a Nobel Prize. I wonder which came first.

Do you think the sorority rush match— that was probably around before the match.

I feel like that was probably—

I feel like he copied—

I feel like he copied sorority girls. They figured it out first.

That's just so typical, isn't it? A man just takes something that women have been doing for a long time and just rebrand it and then win a Nobel Prize. Yeah, exactly, exactly. Yeah, well, and That's it.

For those of you who weren't in Greek life, that's what you do. You get around the table, normally it's like with the whole sorority, and you put somebody's face on the screen and then you stand up if you talk to them during Rasha, if you know them, then you say pro, con, pro. So something good about them, something bad about them, and then something good about them.

We did pro, con, con, pro. We had a double con.

Oh, well, maybe there were some double cons.

You guys were, you were nicer. Yeah, but the— we didn't really so much do that as I think that, that they started and they— so maybe our program director or somebody put up the list and the way that they thought that it should be. And then we got to talk about people and move stuff around.

I was going to say, like, up and down. How much as a resident did you have say? And did you, when they came in, interviewed, did you talk to them? Hmm. Because then how were you?

How were you? Must have. Well, and then there's some people that you knew they were, you know, they were med students at your program, so they might have rotated with you. And yeah, I guess maybe we must have interviewed them. Yeah, yeah. So there must have been some of that. But then there was even people spilling the tea. I specifically remember this one guy telling a story that one of his friends was a server at this restaurant and this woman had come into that restaurant and been really awful. And, you know, it kind of hurt her chances in residency.

Wow.

Be nice to the servers.

Oh, that's just a lesson for being a good person. Be nice to the servers. But also, you never know.

You never know. You never know. And yeah, and she was not a very nice person. But people talked about certain things. Or like, for example, there was this one intern who was darling and Well, she ended up matching in our program and she was darling and we loved her and she was a great intern. But when we were going through the process and talking about different people, one of the residents, I think she was the chief resident at the time, she said, now I know everybody likes this girl, but her boyfriend or fiancé is doing a 2-year fellowship, orthopedic fellowship here at our institution and he's, and he has just one more year. So when she finishes her intern year, he's going to be done. What are the chances that she's going to want to stay in our program when he finishes and maybe is going to go off anywhere else in the country? And sure enough, she left after intern year.

How do you leave after intern year?

Well, you got to find another program that wants you.

You can transfer programs?

Yeah, you can.

I didn't really realize you could do that, but I mean, yeah, I mean, that's important. I mean, you can say the same. Well, I mean, for you, kind of the opposite, like when you matched. So yeah, I think you should tell people exactly your match situation because Dad was a year ahead and you— and he was at Florida, so you were aiming to go there. And like him already being there, that helped your chances, right?

Yeah, it probably did. Um, and we had— when we were looking at programs, that was part of the reason that he chose—

back up a little bit. So you were a year below Dad?

Yeah.

Yeah.

Okay. And even though I'm actually a month older than he is, but he's very advanced. So he was ahead of me. He took a gap year. And so we, the, we liked— I didn't even know for sure what I wanted to go into. Right. And so he was doing internal medicine. I thought I wanted to do either family medicine or internal medicine. And so, and so this, the program that he chose was good because it had a really good internal medicine program and there was a good family medicine program there. And those two things are not always in sync. So That was something that we— so we both liked those programs. And so I did a sub-I there and we used to call them away rotations. I did a rotation there to make sure that I really liked the program. And I did, even though I worked with this nutball resident who then tried to blackball me. But anyway, everybody knew she was a nutball, so I survived that and they still— and I still matched there. But You know, I know that there was also like, so that was our agreement was I said, I'll try to go to wherever your program is, but if I really decide that I hate it there or I don't want to go there, then he agreed that he would transfer to another program that I liked better.

Well, then I guess like, when did you make that? Like when he was making his rank list, then did he put— so you guys ended up at University of Florida. So did he Like, did he want to go to Florida?

Yeah, yeah, he did. He'd know. He liked, he liked the program there. I can't remember why. Internal medicine programs are really big, and, uh, I don't know. I don't know why. I cannot remember why he really liked that program there.

He probably couldn't either, right?

I'm sure he can't remember. Well, one of the reasons they did graduate people who wanted to actually do regular internal medicine. Some places are really just focused on subspecialists, and he didn't didn't necessarily want to go— he, well, he knew he didn't want to do any other fellowship besides the primary care sports medicine fellowship, which is just one year, but he didn't want to do pulmonology or cardiology or any of those things. So I think he— those were some of the things he liked about the program. However, he probably could have found another program that he liked just as well.

Yeah, but I mean, it's— I just feel like, I mean, just seeing match, like, I knew people who went through match and everything, just seeing people's posts and all of that, I just feel like, I don't know, like seeing you guys, he wanted to go to Florida and then he matched to Florida and then you, uh, like wanted to match to Florida and then you got it and matched to Florida. Like I just feel like majority of the time I feel like people don't necessarily get what they want.

Yeah. Remember you do hear the stories when people don't get that.

True. True. Also you guys were doing internal and family.

Yeah. So that, that's different than if we were doing orthopedics and neurosurgery.

Yeah. Yeah.

But remember we had very early on our podcast, Dr. Bain, Andrew Bain and his wife Kirby. And I mean, she was doing radiology and he was doing surgery and they did match to their number one spot, which was UT Southwestern. But they were couples matching. Yeah, there was couples matching. Right, right. Which is a different thing. But they were happy with that. You know, they were lucky they ended up at their number one place.

Yeah. And to their point, they were saying like sometimes it kind of worked out to their advantage because one of them would get an interview somewhere and they they would say, hey, like, my partner and I are couples matching, so then that they could get an interview for their partner.

Yeah.

And I guess, like, I feel like maybe the same thing for you looking at, uh, like, for Florida, it's like, okay, well, my partner goes to this program, so, like, I guess that's more of a likelihood of them interviewing you and being interested. Yeah.

Yeah. And for them, they know that I'm gonna rank them number one.

Yeah.

So that's helpful to the program. They want people who want to come to their program. You don't want to be somebody's, you know, 10th choice or something. But, but just back to the rush thing of like dirty rushing, you know, there's dirty rushing with match day stuff.

What does that look like?

Well, what it looks like is people telling people, hey, so, you know, What do you think you're gonna rank us? Do you think you're gonna rank us number 1? Because we want you. You are gonna be in our— so if you have like 8 spots in your program and you say you're definitely gonna be in our top 8, um, so if you match— rank us number 1, you're gonna match here. Person ranks them number 1, does not match there.

Why do they? And also, I guess there's probably not any rules. So for those of you who were in Greek life, in sorority rush, the— so dirty rushing, yeah, you, you know, you want your If I'm in the sorority and I'm rushing people, we want our, um, like, we want to have all of our spots filled. We want to have the best retention rate. We don't want people dropping us as we, as you go through the week. So, but because of what my mom just described, you can't tell someone you're definitely in. You can't tell, like, there's rules about things that you can say. Like, if you say that, that's against the rules. But I don't know for residency if it's like against the rules.

I mean, I'm sure it is. It is like, but I think what happens is you open up your, because this happened to a friend of mine, opened up his envelope and he waited to even open his up because he was couple matching. And wait, wait, do I need to describe what happened? How we used to do the match day? Maybe. And that's so nowadays.

They still do the envelope opening. You don't have to do it anymore, but.

Okay. It's not required. Well, it was required. There's no other way you could find out where you were going. Anyway, they would call you up to the front of the group. You'd walk up there, they'd hand you an envelope, you'd open it up, and then in front of everybody, you would, you know, say where you were going to go. Now, you knew you matched because if you didn't match, you would— you found out before this day. So you knew you got something on your list.

But that would be brutal if you opened it up and there was nothing.

Empty. Yeah, yeah, yeah. I could see them doing that back in our day. Anyway, but people who are couples matching, they would wait until the second person got called up. I don't know, just for more drama. Anyway, he and his partner ended up— she was one of the very last people called. And so, and he was just like, oh yeah, I didn't feel the need to even open mine because I knew where I was going. They told us that we were coming to this place and then she got hers. They both opened them up and they were just shocked. They got like, they didn't get their first choice. I can't remember what choice it was. It was a place that they were not very excited about, but You know, this place had told them, definitely we want both of you. And so then after the whole thing's done, I don't know, what do you do? Do you like— I mean, again, they're the type of people that are like, whatever, we're just gonna move on, we'll go to this place, we'll make the best of it. But I feel like there should have been some consequences to the residency program because it wasn't like some random person, it was the program director that told him that.

Yeah, um, I mean, yeah, I mean, that— I definitely see that. I mean, I just— watching match videos, I mean, obviously you see ones that It's like, yes, the person knew exactly where they were going. They opened up their number one. Yeah. But then I've seen video. There's this one kind of viral one of this girl opening up and she's like excited and she opens it up and she's like, oh, I'm going to wash you. Like, and she was just like not, she was like very confused.

Wow. Yeah.

And people, it's like, okay, it's not necessarily— and she's like, it's not that it was a bad program. She was like, I just, I expected a different program.

Yeah.

And I opened it up and then I was like, wait, now I have to move to St. Louis. Like, yeah, she said that in the comments. She was like, yeah, I just like, it all flashed. Like, my partner lives in Chicago and now I have to move to St. Louis and I didn't expect that to happen at all.

And like, yeah, because— and, and who knows, I don't know what exactly the rules are for the programs, what exactly they can say and not say, but pretty poor taste to say you're gonna rank somebody in your top whatever spots and then not do it. I don't know. That's just, that's hard to, to understand.

Mm-hmm. Hey, yeah. Do you see it happen in sorority rush too?

Yep. Yep.

I mean, that definitely happened to my friends. They, I mean, as again, there's rules about what you can explicitly say. You can't say, yes, you are going to, you know, whatever. But you know, pref night, you have two sororities left. You go to both their houses and one of 'em, they say, you know, we really love you. We really love you. This is it. This is it. You rank them and then you open it up and it's not it.

It's the other one, right? So they didn't love you while they loved other people more. Well, and just similar to sorority rush, you know, back to the pro, con, con, pro. Now, this did not happen in, in residency. As you're going through and you're talking about the different people, nobody started crying and saying, I've got to have them in my residency program.

Which is funny that people are crying about the sorority and not about the res, because the residency program is a much bigger deal. That's a much bigger deal.

Well, I don't think— we weren't kept in isolation for 2 weeks and then you put all these girls all together and then they're like, I need her to be my little sis. I've known her for 4 days. Yeah, yeah, yeah, yeah.

The drama. Yeah.

So that wasn't— That wasn't quite as bad, but certainly people did disagree about people and how good that they thought would be. And, you know, from a resident's perspective, I— we didn't give a crap about people's GPAs or anything else. I want somebody that is going to work hard and see a bunch of patients and not be a loser. That's all we care about.

You should make a TikTok about that eventually. Just like I don't know. I mean, people are gonna be like, oh, it's different now, whatever. But I do think it's important for people to understand that, again, like, you're applying for a job.

Yeah.

And it's not like— I was even talking about somebody with this, with, um, like, residency applications and stuff. Like, obviously, all of this is specialty dependent and stuff, but I think even maybe it's the same with college applications and stuff too. Just, I don't think people care about essays anymore, about writing things, because AI is everywhere and like you can't tell if somebody, if it's them or if it was ChatGPT that like wrote something. And it, I just think that they're gonna put less emphasis on like, not, not that they cared that much about your essays, but like, yeah, I think that they're putting less emphasis on essays and that sort of thing. And you know, I, I really think it's your Step 2 score and then like But aren't the essays—

isn't that how they kind of know what sort of person you are? Isn't that the point of the essay rather than being well-written essay?

I don't— I mean, I don't know. I don't know. This is all just— I'm theorizing.

Okay.

But I think— I mean, I feel like the interview is more important for that, you know?

Yeah. And I guess, um, other evaluations. I'm sure that, that part's on there.

Yeah, for sure. Um, for each rotation you get an eval, and like that goes into a big letter that then like like they send to your—

but just like lots of other things, I mean, your med school wants you to get a good residency because that reflects well on them. So I don't know, if your med school is writing you a letter with all of your evals, they're not going to put any bad stuff in there.

Yeah, 100%. And like, yeah, so like they— and every med school is doing that. So it's not— I don't think you can really distinguish people. I really think it's like your Step 2 score and then If, like, like you said, I think it's about like being a hard worker because again, at the end of the day, you're applying for a job. And yeah, yeah, and a lot of the stuff, it's just, it doesn't—

you're gonna learn everything that you need to learn. I mean, and, and yeah, I really— one of my worst residents was from the most prestigious med school. Wow. Yeah, he was lazy. Yeah, he was so lazy. Um, and then had other people that were, you know, again, I have no idea how smart anybody was, but other people who were just scrappy, you know, and they were just like working hard and getting those patients discharged. That's what you want. I want them off my service. I want them out of the hospital. Those are the things that really made you shine as an intern.

I, I think that that is important, especially for someone like me who's just in the nitty-gritty, just, you know, looking at B cells and T cells and the cell receptors that elicit any sort of immune response. And I'm just like— and I like, I'm like, I'm in the— I'm in— I'm down to the cell, to the microcellular level. Yeah. And like, this is determining when— I can be scrappy, man. I can get in there and work hard and discharge patients. You're very coachable. I mean, I'm very coachable.

Oh, it's always one of your things. You're very coachable.

Um, I can learn on the job. I can, like, I can do that if I apply. It's just, this is like, it's just so, it's so different, you know what I'm saying?

Yeah, those skill sets are all— yeah, they're, they're totally different. And it's ridiculous that these are the things that then decide people getting into residency. Let's— I don't know, even all of that, I just, I would love to see some data about, like, even all the things that get you into medical school. Okay, yes, you have to get— you have to be a good enough test taker to, you know, so you got to do decent on the MCAT because then you've got to take all these other stupid tests and, and do well on that. So you have to do that. And as a med school, you need to have people that are going to be able to do all those things, and you need to have people who can do the work. But do, like, any of those other things— oh, they had all this clinical experience or a bunch of volunteer work— is there any evidence that those people are any better doctors than somebody who didn't do those things. I would like to see the evidence.

I think the one factor that I would argue that it does help is just that you really want to do it.

Yeah.

And like making sure that you have some sort of exposure to all of it because retention of like finishing med school and stuff like that.

Yeah.

I mean, you look at other countries, I mean, you could probably do a study on this. Like you look at other countries who they go straight from high school into med school and, you know, you don't have, you don't have that clinical experience. You kind of just like, if you score well enough on this test, then you go to the best thing, which is med school.

Yeah.

And their retention rates are lower then. Hmm. But, you know, who knows? So many confounding things in that, right? You change as a kid and all of that. So not directly correlated to like your, the time spent in a hospital prior to starting med school, but But still, I mean, all of that can be a part of it.

Well, also, though, we— people are kind of indentured servants here because they take out so many, so much money in loans that they don't have a choice. They got to be a doctor at this point, even if they hate it.

Yeah, true, true.

So if you go to some other country and it's sometimes even paid for, then you're like, okay, I'm a doctor and I don't like that much. I'll go do something else.

Yeah, well, I think more so retention of finishing the school. Oh yeah. Not necessarily retention of being a doctor.

Being a doctor.

Because after that point, I think you actually do have to work. I think it's a similar thing. You have to work a certain amount and your school's paid for. Yeah.

Okay. Okay.

It depends on the country.

Yeah.

Yeah.

But even for us, I mean, like, once you've taken out those loans in like first year, you can't quit.

Yeah, for sure. I mean, yeah.

Well, on that note, back to the grind.

Back to the grind. Not, not quitting. Keeping up. I could use do some divine intervention, some prayers, uh, some rituals, anything, anything honestly. So if you guys are into any of that, anything spiritual, I'll take it my way. Stephanie Davis is my name. Step 1 is the test.

You're gonna do great. All right, you got it.

Uh, you guys know where to find us at generations.md on TikTok and Instagram. And Mom, you want to plug your, uh, my TikTok is Dr.

Davis PGY30.

And you can email us at askgenerations.md@gmail.com, and we will talk to you guys soon. Bye!