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The Clinical Excellent Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence is a biweekly podcast hosted by Drs. Adam Cifu and Matthew Sorrentino. The podcast has three formats: discussions between doctors and patients, discussions with authors of research pertinent to improving clinical care and the doctor-patient relationship and discussions with physicians about challenges in the doctor-patient relationship or in the life of a physician.
[00:00:00] Dr. Cifu: On today's episode of The Clinical Excellence Podcast, we have Christian Essman talking about medical school admissions.
[00:00:10] Mr. Essman: I hear this all the time when we're talking like, "Be yourself," particularly on interview days, like, "Try to be yourself," and I think that's an abstract concept because we have different selves of who we are, like my professional self is different than Saturday night self. And I wouldn't bring Saturday night self to my interview so I think what we're trying to say is be your authentic and genuine self.
[00:00:36] Dr. Cifu: We're back with another episode of The Clinical Excellence Podcast, sponsored by the Bucksbaum Institute. On this podcast, we speak to patients and doctors about all aspects of excellence in clinical medicine. I'm Adam Cifu and today I'm joined by Christian Essman. Christian has been the senior director of admissions and financial aid at the Case Western Reserve University School of Medicine in Cleveland since 2005. Mr. Essman has a background in healthcare-related occupations, including experience with organ donation and transplantation programs. Reflecting Christian's care about the success of medical applicants and his passion for providing students with helpful information to make the medical school application process less mysterious, he created a popular podcast for medical students called All Access: Medical School Admissions, where he interviews medical school admissions representatives about their schools and the admission process. Christian, thank you so much for joining me.
[00:01:32] Mr. Essman: Thank you for having me, Dr. Cifu, good to see you.
[00:01:34] Dr. Cifu: I have to say I feel a little bit intimidated interviewing a more experienced podcaster.
[00:01:38] Mr. Essman: We've done this before.
[00:01:40] Dr. Cifu: True, true, true. Hey, so to start, I really wanted to ask you how you ended up in your position. I sort of don't imagine many people go to college and say, you know, "I want to be an admissions director." So how did you end up kind of where you are?
[00:01:55] Mr. Essman: Yeah, that was me. I wasn't in college thinking that. Yeah, it's an interesting question, thank you for asking. I guess it was a little bit of serendipity and a little bit of positioning myself or the skills I had at the time at the right time. I was pre-med at one time when I was in college, and then afterward I worked in emergency departments as what was called at the time an ER tech. And I really enjoyed that but after a while doing it, I kind of realized that, I don't know, watching the physicians, like, I don't know if I really want to do this. And also, I think at the time in my early twenties, I wasn't mature enough to really be putting myself out into the medical school application process. I mean, I see some applicants now and their level of maturity is just so impressive for the age that they are. And I realize now I wasn't that, but I knew that I wanted to stay within healthcare because I really liked being a part of a team that cared for others and that kind of altruistic aspect.
So that's when I moved into organ donation, transplantation, doing recovery with transplant surgeons, and assisting them. And then I got into more education up here in Cleveland with the organization up here. And I created an elective for the medical school to teach M1s and M2s about organ donation and transplantation with a transplant physician. And we took them out when we had recoveries, they came with us and stuff, it was really cool. And during that time, the admissions office here was undergoing some restructuring because the dean was retiring and so they created some new positions and they never had a director of admissions. And so I kind of threw my name in the hat, I got to know people around here, apparently, I left a decent impression on them because they kept calling me back for interviews. And the next thing you know, they offered me the job and that was 18 years ago this month.
[00:03:48] Dr. Cifu: Wow, wow.
[00:03:49] Mr. Essman: Yeah. So it's been really a fun ride.
[00:03:53] Dr. Cifu: Yeah. You mentioned the skills that you have that sort of serve you well in your position. And I know it's always hard to, you know, talk about yourself and compliment yourself, but what are the skills that you see among you and your colleagues, you know, that make you successful in your jobs?
[00:04:10] Mr. Essman: Admissions is a... Boy, it's a lot of different, I think, not necessarily disciplines, but sometimes it's acting, it's marketing, it's like FBI, it's a little bit of everything. And so I think we also have to be curious, innovative, able to deal with abstract or ambiguity and also how to navigate political, you know, environments. So I think my strengths are curiosity, creativity, and communication.
[00:04:50] Dr. Cifu: Yeah, it's interesting hearing you say it because when I think of the admissions people who I've worked with, what I am always impressed with is the actual curiosity in other people because we come... I feel like we come upon so many people both in healthcare and in life, who are very happy to hear themselves speak. And I think one of the real keys to people in admissions is the ability to ask a question, but then really attend to what the applicant is saying to sort of understand who is this person and what you can read into them.
[00:05:26] Mr. Essman: Yeah. It's really about quickly building like resident relationship, like you're caring about that person enough that you want to ask a question and then step back and let them answer to hear about who they are. And that has become a skill. It's something that isn't always intuitive for everybody.
[00:05:46] Dr. Cifu: Sure. So getting to your actual job, you know, COVID has changed a lot about medical school admissions. And I feel like in so many places, you know, we didn't know that we could change until we had to change. And I think that that really happened in admissions with remote interviews, fewer campus visits. And then even before they get to you, you know, students less able to shadow doctors in the run-up to their applications. And I guess I just wanted to ask you, like, how are we doing with this? You know, are we successful? Have we lost something in it or do you think we're kind of doing just fine and the students are spending less money, which is a good thing?
[00:06:27] Mr. Essman: Yeah, we'll come to that, but I think COVID really put breaks on "the way we've always done it," and really made us, all of us nationwide, step back and reinvent what we'd always been doing, taking something we'd done for literally decades, which was in-person interviewing and turn it on its head and figure out, throw spaghetti against the wall and figure out how do we do this differently and sometimes better? And so I think what we're seeing now in talking with friends in our community is a lot of admissions offices are going to stay virtual interviewing for like you mentioned, the financial aspect for applicants, saving them tons of money from having to travel around the country for these, what were used to be in-person interviews, but I also think that yeah, there are some trade-offs. I think we're losing that aspect on the interview day, the energy in the conference room with the applicants, and applicants are not able to, kind of on the interview day, feel the vibe and the energy around the school but also at the same time, I think it's become convenient for not only the applicants but say, for faculty interviewers. I mean, I live in Cleveland and we have four large hospitals across the city and they used to have to travel here, leave their clinics, come find parking here, interview, leave, go find parking back at the hospital. And we would lose people because they're like, "This is not sustainable. I'm getting late back to clinic." Now it's easier to walk down the end of the hallway, pop into an office, jump on Zoom, interview a candidate, and then get back to work.
[00:08:06] Dr. Cifu: I'm sure we don't have any actual data on this, but you do miss something, as you say, being in the conference room, and I was sort of shocked meeting some of our students at the very beginning that, you know, they had no idea, like, sort of what the medical school building would look like. They've never set foot in our hospital. You know, do we have any idea if there are students who are kind of less satisfied when they arrive, or if it just takes longer to get adjusted to the place that they're going to be?
[00:08:39] Mr. Essman: Broad stroke question, I don't know if I can answer it for everybody but I know that a lot... Case included, and a lot of my friends at other schools, have transitioned back to having in-person like second-look weekends or revisits or open houses after they're accepted. And I think that's the opportunity for them, then when they want to spend their money, they're getting a good bang for their buck because they know they've been accepted. And now they're able to come with a fresh lens, not wearing their stiff suits and uncomfortable shoes, and come to see the school maybe with family or partners and get that sense of the environment and to see the physical plant of the institution.
I don't know if there's data on, you know, do they feel dissatisfied but I think a lot of students then... Again, a lot of schools do have these revisits, and I think a lot of students take them up on that so they can come and see, you know, look around. "Do I see myself coming to school here? If I have, you know, options."
[00:09:38] Dr. Cifu: That's a terrific point because it's sort of rather than seeing, I don't know, you know, ten places as a nervous buyer or, you know, you go and you're like, "Okay, this is the place who wants me. I can be very comfortable here. I can kind of turn the tables." And then for most students, it's probably just, you know, in the end, two, three places that they're really serious about and were lucky enough to get into that they're comparing. That's a great point that I didn't think much about.
You mentioned your colleagues, and this is something else I wanted to talk to you about. Since your primary full-time job is not quite enough, you also host a very successful podcast, that's the All Access: Medical School Admissions Podcast. The podcast has been going on, I think, for more than four years now.
[00:10:25] Mr. Essman: That's about that, yeah.
[00:10:26] Dr. Cifu: People could have gone to medical school, graduated from medical school in the time you've been doing it. I've found the podcast an amazing resource of kind of application tips, news. You interview people from schools sort of everywhere. It seems like dozens and dozens of medical schools have been represented and it's absolutely become a resource sort of for me to send, you know, applicants to, to say, "Ah, you know, you got to look through the catalog of topics that have been covered to help you out."
So I'm interested in sort of what themes you noticed talking to medical educators from across the country, sort of, you know, what just comes up all the time? What are the things that you guys kind of all worry about?
[00:11:10] Mr. Essman: Yeah. Well, first of all, the frequency of my podcast does ebb and flow because I mean, I find that you know, sometimes... If my admissions work didn't get in the way of my podcast, I'd be doing it way more. And also the people that I interview and stuff, they're busy. And so sometimes the stars really have to align for us to get somebody on but you know, there are some things I hear, some themes like you mentioned over and over again, and one of them would be, you frequently hear people say, you know, "Find activities in college that interest you, not just ones that you think we want to see."
Now, there's naturally some, I think, that most med schools are looking for, but it's an opportunity to kind of stretch yourself, you know, go hang out, find different people, immerse yourself in different environments. Do things within the campus bubble and kind of sometimes try to get outside of the campus bubble and get out into the community to kind of, again, find ways to kind of grow and stretch as a young college student. And so I hear that a lot from our colleagues when we're having these conversations.
Another one would be, I hear this all the time when we're talking like, "Be yourself," particularly on interview days, like "Try to be yourself," and I think that's an abstract concept because when you think about we have different selves of who we are, like my professional self is different than Saturday night self. And I wouldn't bring Saturday night self to my interview. So I think what we're trying to say is, "Be authentic and not try to be somebody who you're not." And we understand that the majority of people that we're interviewing are in their, say early twenties, "Don't try to be or pretend to be somebody who's in their mid-forties, you know, we understand the context of who you are. So try to be your authentic and genuine self."
[00:13:06] Dr. Cifu: I love listening to that because as I think forward, you know, I always think that as a physician, right? Part of what we do is play roles, right? I always feel like, you know, I've got my empathic primary care doctor that works with, I don't know, 80% of my patients, right? And then one has to play different roles at different times with different kinds of people. I wonder if there is some role that we like... We force students into roles as applicants to say like, how are you going to adjust to this in ten years?
[00:13:39] Mr. Essman: Yeah, it can be difficult because then I think some students, they become robotic and they're not their genuine selves and it comes across as stiff or wooden, and then you feel like they overprepared or something that they're just not who they really are. And you often wonder sometimes like, "I wonder how they'd be not in the interview environment."
[00:13:59] Dr. Cifu: Yeah, yeah. This is something that's just come up to me. You know, I'll admit I don't think I've ever been terribly successful as an interviewer for people at like every range of the process but there have been some interviews I've done where I feel like people kind of blow it with me and I almost want to stop and give them advice after the interview to say, "Ah, this went poorly, this is why, you know, think about this for the next interview." Are those things that ever happen with you or come up with you in your role?
[00:14:31] Mr. Essman: Where I pause somebody and try to give them advice?
[00:14:34] Dr. Cifu: Where you sort of are tempted to give advice to applicants for their future interviews.
[00:14:40] Mr. Essman: Yeah. Sometimes it's more behavioral, or there's repetitive verbal things that they do, like I've met people that say, "like," like every other, like word, and it takes away from the content of what they're trying to share, but because they're using one word all the time, or they end every sentence with, "and whatnot." And so I would like to, you know, kind of get your hands on them and say, "Maybe practice or record yourself doing an interview with somebody or look at a transcript because now on things like Zoom, you can print a transcript of the audio and then you can see maybe the "like" shows up a thousand times and it maybe stands out to you in the written format or you notice some other kind of verbal kind of repetitive behavior that's being done." And so sometimes I wish you could pause and say, you know, "This might help you if you worked on this a little bit."
[00:15:37] Dr. Cifu: Boy, that's such good advice. And I feel like where I've learned from it, I remember it took until I was a resident to actually have the opportunity to have lots of patient encounters recorded, and it was amazing to see me with patients. And, you know, there were certainly things I did and said which made me cringe and really helped, you know, me, my sort of future as a physician. And this is an important time in life and why not, you know, practice and really get better at something? Which sure is not going to be your career, but it's going to be important in dictating what your career looks like.
[00:16:20] Mr. Essman: Yeah, absolutely.
[00:16:22] Dr. Cifu: Are there things that you're looking forward to in, you know, the changes of medical education coming up and you know, maybe the challenges of the next generation of students who you're going to be looking at? Things either that keep you up at night or that you say, "Wow, I can't wait to see, you know, what, I don't know, we even call this next generation sort of presents to me."
[00:16:45] Mr. Essman: Yeah. I think there's a couple of things. One would be, I've seen more recently in the like say, the last couple cycles, applicants talking about wellness and their own wellness. And I think that's another offshoot of COVID is that we really started to talk about our own personal wellness after COVID. And I see students writing about that and we rarely saw that before then, how students prioritized some life balance. And I think that will ultimately bleed into your profession because I think we're going to start to see medical students start to say, "I don't want to be like you. I don't want to be the one who's working 55-60 hours a week," and that might be kind of disruptive to the profession in the next several years when we see this cohort starting to come through because now, as you know, colleges are promoting wellness and life balance. And so I think that's probably here to stay. And I think that might be some future characteristics that we see kind of built into these young people. And so I think we might see that kind of change in the profession down the road.
[00:18:03] Dr. Cifu: I do love it. I think all of us as educators, you know, love it when we see the new people in our field changing the field, you know, from the bottom is probably the wrong way to say it but yes, the field changes with every new crop that comes into it. And it's exciting to hear things like that.
[00:18:21] Mr. Essman: Yeah, but I anticipate it's going to be disruptive because there's going to be the older generations who say, "That's not how we did it, and we had to go through those pains to get those gains," so there's that. And the other thing I'm excited about to see is how AI is incorporated into medical education and whether that's helping students complement what they're getting in their education, like if they're able to attach, this is where a student is doing well, but also could have some supplements, and the AI tool would be able to know "Here, let's give them..." Students love these Anki decks, you know, could AI tell them, this is the type of Anki decks or similar Anki "things" to be doing to complement their learning? And I could see that going into coaching. As medical students you're getting one-on-one coaching with your student affairs dean or an advisor of some kind, but then have an AI coach that's helping you prompt you through your app and practicing certain behaviors that... I think it's a really exciting thing to think about is how can we really help make our students have wonderful experiences as medical students.
[00:19:37] Dr. Cifu: Yeah, I am also super excited for the future in medicine, and I feel like we're not even creative enough at this point to know what's going to happen and how we're going to use it. You know, everybody says, "Oh, yeah, there'll be decision support tools." And you know, I'm sure that's going to happen, but how does that get incorporated? And how do we get patients feeling comfortable with that? How do we get doctors feeling comfortable with that?
[00:20:02] Mr. Essman: And unfortunately, I feel like sometimes academia is a little bit slower to pick up some of these innovations because there's companies out there that are already, I mean, compared to academia, light years ahead of us. And I wish that sometimes academia is a little bit quicker to embrace some of these things, but there is the comfortableness aspect of it 'cause we have to take into consideration patient care and things like that, but opportunity certainly is out there.
[00:20:28] Dr. Cifu: Christian, thank you so much. You are the first, I guess, non-doctor, non-patient on The Clinical Excellence Podcast and this was really terrific. Exactly what I was hoping to hear you talk about.
[00:20:38] Mr. Essman: It was great to be here with you. Thank you so much for having me.
[00:20:41] Dr. Cifu: So thanks for joining us for this episode of The Clinical Excellence Podcast. We're sponsored by the Bucksbaum Institute for Clinical Excellence at the University of Chicago. Please feel free to reach out to us with your thoughts and ideas via the Bucksbaum Institute webpage or on Twitter.
The music for The Clinical Excellence Podcast is courtesy of Dr. Maylyn Martinez.