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A Mayo Clinic podcast for laboratory professionals, physicians, and students, hosted by Justin Kreuter, M.D., assistant professor of laboratory medicine and pathology at Mayo Clinic, featuring educational topics and insightful takeaways to apply in your practice.
(soft music)
- This is Lab Medicine Rounds,
a curated podcast for physicians,
laboratory professionals and students.
I'm your host,
Justin Justin Kreuter,
the Bow Tie Bandit of
Blood Transfusion Medicine
pathologist at Mayo Clinic.
Today we're rounding
with Dr. Isabella Holmes,
a first year pathology
resident at Michigan State,
to discuss her residency
trading experience so far.
Thanks for joining us today, Dr. Holmes.
- Thank you so much for
having me Dr. Kreuter.
- So, this actually ties back
a little bit to an earlier podcast
that we had, which was
really talking about ,
how is this initial
introduction to pathology going,
advice for those that are
coming into the field.
And we wanted to do kind of
this follow up and you know,
now that you have this first
year almost behind you,
we're recording this
on May 31st, 2023.
Maybe let's kick off
and let's start by telling
our audience your story
and maybe why you decided
to become a pathologist.
- Yeah, so I feel like my story is,
everyone's journey to pathology
is a little bit different,
but it's kind of all the
same in that pathology
sort of found us.
And so I feel like my story echoes that.
So I grew up in Arizona.
I went to Northern Arizona
University for undergrad
and then I went to Lake Erie College
of Osteopathic Medicine in
Florida for medical school.
And when I was in medical school,
I found myself a lot of the time asking
a lot of super detailed questions.
And most of the time I
would get a response of,
"Oh well that doesn't matter.
We don't care about that."
And so then I'd be like,
oh, okay, well,
I was kind of hoping for a little bit more
and I noticed that I was asking
a lot of my questions based
off of pathophysiology.
So I was like venting to a
friend one day and I was like,
"I don't know what I'm gonna do.
I really just enjoy reading Robbins
and then I just wanna
read Robbins all day."
And she was like,
"Wow, well you should
be a pathologist then."
And then I was like,
"That's actually a really good idea.
I think I will be a pathologist."
And it kind of made sense
that I ended up in pathology
because between med school and college,
I was a faculty laboratory
instructor in chemistry labs.
So I taught organic chemistry
and general chemistry labs.
So when I left that job I didn't think
I would ever be going back to the lab.
And I was kind of disappointed,
even though med school was
still my dream and everything,
but that's how far like
pathology wasn't even a career
I had in mind.
So I'm really glad that
pathology found me.
And you know, as soon as I set up
a rotation in pathology, I
knew within like the first,
I don't know, it's like
love at first sight.
It's like as soon as I walked
into that lab I was like yep,
this is definitely for me.
So I never looked back.
I'd like to thank my
friend Katarina Kosheri.
She's the one who told me to do pathology.
- I know, friends help
friends find pathology.
- They see things in you that
you don't see yourself, right?
- Yeah, yeah, so true.
So maybe can you then
with that kind of tell us
kind of maybe the what,
like what has this first year
sort of been for you in terms
of what's that rotation
look like and then,
how has has that experience been?
- So I feel like the first word
that comes to mind is fast.
I feel like this year has gone by so fast
and I really can't even believe
that I'm about to be a second
year pathology resident.
I kind of,
I feel like a lot of first
year pathology residents feel
this way that I kind of feel
like I'm not ready to be a second year.
It's like everything went by
in such a blur and you know,
in pathology a lot of the time.
I mean we all have varying
experiences of what we get
exposed to in med school,
so it's kind of like,
I feel like I still have my
training wheels on and I'm not
really sure what I'm gonna
be able to let those go.
And thankfully my program is
like so nice and so supportive
and so they're like totally okay with us,
walking us through the field
of pathology step-by-step.
And I'm kind of, I don't know,
I feel like our rotations too,
they're only two weeks long.
So you're there for the
first week and you're like,
what's happening?
Where do I show up?
And then by the second week
you sort of start to know
what's going on and then it is time
to start a different rotation again.
So it's been a whirlwind,
but I feel like I have gotten
a little bit better at certain things.
So I feel like that's progress.
But yeah.
- As you talk about this experience
of going through these rotations,
that's one of the things that
I've also kind of reflected on
for learners and how you're
really doing this kind
of rapid sequencing through these
different facets of pathology.
Given that it's like really
an apprenticeship, right?
It's a cognitive apprenticeship
you're learning as well as skills.
Do you have any advice for listeners
who might be going into
pathology residency
as far as how they can set themselves up
for a success during that and I guess,
try to start to take a little
bit of ownership for things?
I know that's kind of a
classic challenge, but.
- Yeah, so,
and I was kind of thinking
about this question a lot
'cause I was thinking about
what I've actually done myself and then,
what I feel like general advice is.
So there's kinda like two
different answers there.
For me, what has helped me
take ownership of my cases,
and this is kind of, I don't
know if other people do this,
but when I'm reading through
the clinical history of the patient,
sometimes if I'm looking at
slides I'll look at it blind
and then I'll go through the history.
But a lot of the time I start
off with the history the most.
I spend like 20 minutes
digging through the chart
and what really helps me connect
with the patients 'cause even though
you're not there face-to-face
is I actually read the social
work notes because those kind of give me
like a good idea of like a picture
of that human that's
on the slide or that I'm
calling for over the phone.
And I haven't really heard that a lot,
but for me that's what
really makes me motivated to,
not only get them,
help get the correct answer,
but also to see the case
all the way through.
And I've noticed that
the patients that I do
look into their personal
history a little bit more,
I actually remember them
and I write them down
in my notebook and I actually follow up
on them later because
you get that little bit
of personal touch that sometimes
is lacking in pathology.
And so that's what I like to do.
I know that like other people
take ownership in cases,
the general advice is,
you need to learn from
these cases 'cause they're
pertinent to future cases in your board.
So this is a good,
it's always like, this is
a good example for this.
And so I know that's how some
people take ownership too.
So I've kind of,
I do like a little bit of mix of both,
but for me it's really
like the personal history
that keeps me invested in the case.
- This really resonates with me.
I was just at a noon conference
where somebody was presenting a case
of something where,
there's only been 20 describes
in the world literature,
but there were,
it was a great example for
several different things
in the transfusion medicine world.
And it was like, okay,
even though this is this very rare case,
there are these,
this is a great examples for X, Y, and Z.
I tend to get the most
out of that by kind of,
I know for me at the end of the day
kind of reflecting back.
I usually just take about
15 minutes before going home
and just kind of jot down notes on,
what did we learn or discuss today
and is there something
where I was like, geez,
I bet I need to read a
little bit more on that.
What's your process look like
for kind of capturing the learning?
- Yeah, I do the same thing.
I have a notebook,
just a standard composition
notebook that I,
it's basically attached to me
with every rotation and I try
to remember it as much as I can.
Sometimes I forget it but I
usually bring it down to sign
out and every time I hear a
word or something I'll just like
jot it down really quick
and then look it up as soon
as I get the chance back at my desk.
I try to not leave the day
without having at least looked up
everything in the notebook
because I feel like
in the beginning I got into the mindset
of oh I'll write it down
and I'll look it up later.
Later never comes, it's
like today or never.
And so I feel like I've really learned
to seize the day in pathology residency,
but that's what I do and it's
been working a lot better
actually committing to that.
And also not like worrying so
much about writing down every
single thing that the attending is saying,
because I'm also very
much an auditory learner.
So if I'm too busy writing things down,
I'm not gonna actually learn
from that person who's trying
to teach me in that moment.
So you don't need to copy everything,
just write down a couple of
like key like memory joggers.
Yeah.
- Yeah, I can see that.
I also wanna applaud and highlight, right,
that this skill
that you just articulated right of you,
you started one thing and that was,
you're gonna jot things down
that you need to look up,
but then you discovered
or recognized for yourself
that you weren't following,
you're writing this stuff down
but not capitalizing on it
the way I think you intended.
How did you catch yourself?
Because that's something that all of us,
I continue to work on catching myself.
How did you do that?
- That's a good question.
I don't know.
I feel like it was just,
when you're doing something
for so long and you're not,
I guess for me maybe it
goes back to like exercise
and like staying committed to something
and I feel like I have
learned what it means to show
up for myself in terms of like
exercise and eating
right and sleeping well.
And so when I started
to notice like, okay,
well I keep not doing this and
that list and that notebook
just kept getting longer and
then at a certain point you get
anxious because you're
like, well now you know,
it's like giant laundry pile,
it becomes too much to tackle.
And so then I'm like, okay,
well obviously what I'm
doing isn't working.
And this did take me a
couple, like a few months,
probably like three or four
months to be totally honest,
to figure it out.
So it's not like I
recognized it right away.
- Good, you're a human
like the rest of us.
- Yeah, yeah.
But I think it comes back to
like exercise and just being
healthy and like learning.
Like that's how I learned
how to show up for myself
if that makes sense.
And so I knew that like
education wise and academically,
I was not doing what I needed
to do for success for me.
- So this reminds me another podcast
that we did earlier about no
excuses where we had somebody,
they were also tying it into
kind of that physical exercise
and how does that translate
into their clinical practice.
One of the things I'm curious about,
we're kind of been talking about how you
and yourself have been developing,
navigating residency,
wonderful words of wisdom
for our listeners, especially those
that are going into the field.
But I think
for us that are educators to reflect
on how we're setting our
students up for success,
helping 'em make that transition,
what does that look like as
far as that that culture,
that interprofessionalism of,
you're a physician now in
Michigan and there's other,
and there's residents who are surgeons,
residents who are internal medicine.
I imagine you're interacting
with them professionally,
but how is that kind of
going or how is that working?
Is it working the way you
imagined it would work,
those kind of connections?
Is that happening by,
I don't know.
Is there kind of a,
what's that community like?
- So I think it's really
fun actually and I think,
I don't know at Michigan I feel,
I'm sure it's like this
in a lot of places,
but everyone is just so nice
and I do it,
we connect the most I feel like,
well, cause I'm a first year anyway,
on autopsy and micro
and then on transfusion.
I feel like that's when I am doing that
interprofessional house officer
to other house officer
type of communication.
And since I'm on autopsy right now,
I feel like that is like the
easiest thing to speak about.
Basically we had a case
where we've had some unexpected findings
and I usually page the clinician
in the morning to ask,
hey, like is there any specific questions?
And the house officer
called me and he just,
it was just like a very
relaxed conversation.
It kind of felt like in med
school when I'm just talking
to my fellow med students,
just like very casual,
giving the information that
we need to know and you're not
worried about sounding silly
or saying the wrong thing
just because it's just like that.
I don't know that open vibe.
And so I feel like we had a
really good discussion that
morning and then later
he actually called me
and texted me again.
He was like, "Hey, I'm just
really curious about that case."
And for me like I was like,
this is awesome because
like someone's interested
in autopsy, like that's great,
'cause I feel like,
sometimes you don't get
like that participation
as much as you would want.
So then it felt like my work was really,
really valued then.
And so then I called him back
and we had a great discussion
and that's just happened like recently.
So that's why it's fresh in my mind.
But I don't know,
I feel like it's very casual
here and a lot of people
go by first name basis,
which I think also kind of helps when,
he answers the phone, he's
like, "Hey, it's Chris."
And I'm like, "Hey, it's Izzy, what's up?"
And I don't know.
So that's how it's been as the
house officer communication.
As far as the attending to
house officer relationship,
I feel like, I don't know, they do a good,
I'm a very anxious and nervous person.
So when I don't know something
I feel like a lot of pressure
to answer a certain way.
But I feel like Michigan
has done a really good job
at like calming me down
and not making me as nervous to the point
where I feel pretty
comfortable majorly messing up
and saying silly things in
front of most of my attendings.
Which I feel like is a really
good and kind of necessary
comfortable learning environment
because especially for someone like me,
like I'll just not say
anything if I'm nervous,
I'll just be quiet the entire time, so.
- Absolutely, actually
if I can underline that
for the listeners,
I think that is a profound
realization and one that I
recognize myself all too late.
There was a lot of quiet just in,
during trading and it really
wasn't until I was more
senior where I was like,
this is the time that I
need to make mistakes.
And then by making mistakes,
my attendings understand how to correct me
and coach me to do better going forward.
And that escaped me for a while.
So kudos for appreciating that.
And do you have any kind
of advice for people?
'Cause I imagine,
you've seen others kind
of struggle with this
and how do you help them
to realize to speak up
and making mistakes is
okay when you're training?
- Yeah, so let's see,
how should I word this?
I feel like I have gotten to
a point now for the most part.
I'm like 70% there where
I'm basically shameless
at this point because it's like,
it's a good way to think
of it or a good metaphor
is you know how you're studying for a test
and you don't necessarily
understand a topic
and so you're kind of like,
ah, I just don't wanna deal
with that topic right now.
I'll focus on this other
stuff and take the test.
And then that topic that you
avoided is all over the test
and then you're kind of just
like, that's embarrassing.
I should have just like asked
and then I would've gotten
a good grade or something like that.
I kind of take that
approach to residency now
because I have noticed that when I try
to avoid something that I don't
understand because it's
either conceptually
very difficult or it's something
that I should feel like I should
already know by now.
And so it's kind of
like that embarrassment,
I'm just afraid of being like, wait,
can you explain this to me?
It's really just hurting myself
because the further I get
into residency it's gonna
just affect me more and more
and then at a certain point
it's gonna be even harder to come
and ask for help.
So I just have been like, okay, wait,
I'm sorry, I don't know anything.
Can you please explain this to me?
And I feel like taking that approach
of kind of subtly humbling myself,
which I feel like I came into
this process pretty humble,
but man I have been humbled
a lot more since then.
I feel like, I don't know,
I don't really think anyone is like,
don't think that people are judging you
because we all started in different spots
and I know that some more senior
attendings may have,
their beginning residency
days are long behind them.
But I don't know,
for me talking to the fellows
also really helps because
they're in some subspecialty training,
but they're pretty close to you
as far as where they were at in residency.
And especially at Michigan.
We have a lot of our fellows,
like most residency programs
that also did residency here.
So when you know I'm talking
to this heen path fellow
that I think is a total genius
and I'm like, oh this is awful,
I suck.
And he's all like,
"Oh, when I was a resident,
I didn't even know this
until my third year.
So like, you're way ahead."
And then I'm like, "Okay, okay."
You know?
So I don't know, I guess
just be open and shameless.
I don't know if that's good advice,
but that's what I'm doing.
- Right on.
As we're kinda hitting on advice,
I'm kind of curious,
what do you think for you has been kind
of the biggest surprise
of residency training?
I kind of got an eye for,
something that you didn't expect,
but wow, this,
this was really a surprise this year.
- I think that the biggest
surprise for me actually is
and I feel like this
shouldn't be a surprise,
this should be kind of, I guess expected,
but is just how supportive
the attendings are with us.
I mean they really value,
like they actually care
whether or not I'm
understanding a concept.
It's not just like a nine to five job,
they're just getting it done
and leaving for the day.
They actually care and get,
are gratified from me learning something.
And so to me that makes
me feel like just so good
and just like so cared for I guess.
So I'm just,
I'm surprised at how cared for I feel.
Like in my program I could tell them
that I'm having the worst day of my life
and they would be like, okay, yeah.
How can we support you and
like what do you need from us
to like help you?
And they're not judgmental about it.
They, I don't know, it's like,
it's kind of like we're all
like friends which isn't like,
I know there's like a hierarchy
and like a respect thing,
but it really doesn't feel
like that a lot of the time.
So it's pretty cool. I just
got married for example, right?
And so I had all these
attendings emailing me
like being how was the wedding?
We wanna see pictures.
And it's just like, I don't know,
that sense of community
is just like not something
I was expecting to find.
So it's great.
- Yeah, just to highlight
that for the listeners.
I mean I think in any program you go to
there's obviously gonna be a spectrum,
but I think overall faculty
are very dedicated to training,
to the residents
and I think being upfront
and communicating,
that helps us not only
with learning stuff,
but helps to support us each
other during challenging times.
I wonder if I could kind of
ask you to look into the future
now as we close out
this particular episode.
And so, I hope we can grab
you again in the future,
Dr. Holmes, and do another check-in.
So you're headed into your second year
of residency training.
I'm kind of curious of
kind of what do you think
is gonna be your biggest
challenge for the year ahead?
How are you thinking
about being successful?
What kind of tactic approach
are you kind of thinking about
for that challenge?
- I feel like my biggest
challenge going into second year
is not really, I guess it, I don't know,
I would say it's a challenge but,
so my husband is technically
living in New York right now,
so when I come home I
don't have anything else
to do besides go work out,
work on research, do things for residency,
whether that be studying,
presentation, whatever.
So I think it's gonna
be challenging for me
'cause he's moving here
in a couple of weeks,
which is awesome, 'cause
long distance is not fun.
But when I get home I feel like I'm gonna
really want to just be home.
And so a lot of the time I'm
in this habit of coming home
and doing my work at home
because I like to hang out
with my cats and stuff like that.
So I'm gonna have a lot
of like work life balance
adjustments that I'm not really
sure how to navigate yet.
But I'm hoping that I'll just navigate it
the same way I did in med school.
But residency is a lot more
time commitment than med school,
I feel like.
I feel in med school you
have a lot more autonomy
of your free time versus in residencies.
So that's I feel like
my biggest challenge.
And then, sorry, there
was a follow up question,
I don't remember.
- Well and I was curious about does that,
do you think it's fair to say
that because I agree with you,
like it seems like each
stage of training there,
there's potentially,
I mean there's more of a
demand on our time but also,
'cause you've been successful
with the previous step,
it's kind of an incremental
and survivable is that kind,
do you think that's fair to say?
I don't want to be sending
inappropriate sunshines
and rainbows, but you know,
I think also to say that, you know,
if you find that you
struggle with something,
I think it sounds like speaking up
and talking to colleagues,
it sounds like you have
an awesome support network
there in your residency.
And I think, for any
residency somebody goes to,
I'd say that same piece of
advice and I don't know,
does that seem to resonate with you?
- Definitely, and what
I've noticed from talking
to my colleagues about my
struggles that I've been having,
99% of the time you're not the only person
that's currently experiencing that.
I feel like I can always find
like one to two other people
that are also experiencing the
same emotion that I am about,
whatever it is that's going on.
So you're never alone.
And then also,
talking to your more senior residents,
they really, I don't know my,
the senior residents here
I feel like are very chill
and really like bring you
back down to the ground.
So I feel like that support
has also been helpful.
Yeah.
And as far as your a whole
adaptability thing and sunshine
and rainbows and stuff, I
totally, I do agree with you.
I do think that,
every time that you've made
it through something that you
didn't think you were gonna get through,
and not to sound so dramatic,
and you still made it through,
I mean that, you,
it's not like that experience
just happened and you survived
and you left like you learned
and grew from that experience
to become the person that you are now.
So I feel like,
especially for me,
like looking back and thinking
about who the person I was
like 10 years ago when I was in college,
I couldn't even imagine like
the stuff that I'm doing today,
I would've never imagined that
I was capable of doing these
things and you know,
being at such a great pathology program.
I mean, I remember like
I just wanted a job
at one point in my life
and I was like a maid
for a long time and so,
you just never know what's
gonna happen and you know,
I feel like you do get stronger
and that's not to like harp
on the whole resilience term,
'cause I know that's kind of a hot topic,
but you do get stronger and you
do build a strong foundation
of how to get through problems
and you get faster at,
getting solutions to those problems,
if that makes any sense.
- We've been rounding with
Dr. Holmes talking about her
residency training experience.
Thank you for taking the time to share
your words of wisdom with us.
- Thank you so much for having me.
Hope you have a great day.
- It's all of our listeners,
thank you for joining us today.
We invite you to share your thoughts
and suggestions via email.
Please direct any suggestions
to mcleducation@mayo.edu.
If you've enjoyed Lab
Medicine Rounds podcast,
please follow or subscribe.
Until our next rounds together,
we encourage you to continue
to connect lab medicine
and the clinical practice
through insightful conversations.
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