1 00:00:00,301 --> 00:00:02,718 (soft music) 2 00:00:05,550 --> 00:00:07,050 - This is Lab Medicine Rounds, 3 00:00:07,050 --> 00:00:08,880 a curated podcast for physicians, 4 00:00:08,880 --> 00:00:11,130 laboratory professionals and students. 5 00:00:11,130 --> 00:00:11,999 I'm your host, 6 00:00:11,999 --> 00:00:12,832 Justin Justin Kreuter, 7 00:00:12,832 --> 00:00:15,240 the Bow Tie Bandit of Blood Transfusion Medicine 8 00:00:15,240 --> 00:00:17,520 pathologist at Mayo Clinic. 9 00:00:17,520 --> 00:00:20,790 Today we're rounding with Dr. Isabella Holmes, 10 00:00:20,790 --> 00:00:24,150 a first year pathology resident at Michigan State, 11 00:00:24,150 --> 00:00:27,810 to discuss her residency trading experience so far. 12 00:00:27,810 --> 00:00:30,660 Thanks for joining us today, Dr. Holmes. 13 00:00:30,660 --> 00:00:33,540 - Thank you so much for having me Dr. Kreuter. 14 00:00:33,540 --> 00:00:35,910 - So, this actually ties back 15 00:00:35,910 --> 00:00:37,800 a little bit to an earlier podcast 16 00:00:37,800 --> 00:00:40,977 that we had, which was really talking about , 17 00:00:42,090 --> 00:00:47,090 how is this initial introduction to pathology going, 18 00:00:47,310 --> 00:00:51,183 advice for those that are coming into the field. 19 00:00:52,284 --> 00:00:55,077 And we wanted to do kind of this follow up and you know, 20 00:00:55,077 --> 00:00:59,430 now that you have this first year almost behind you, 21 00:00:59,430 --> 00:01:00,730 we're recording this 22 00:01:01,862 --> 00:01:04,503 on May 31st, 2023. 23 00:01:05,460 --> 00:01:06,610 Maybe let's kick off 24 00:01:07,458 --> 00:01:10,050 and let's start by telling our audience your story 25 00:01:10,050 --> 00:01:13,950 and maybe why you decided to become a pathologist. 26 00:01:13,950 --> 00:01:16,350 - Yeah, so I feel like my story is, 27 00:01:16,350 --> 00:01:18,060 everyone's journey to pathology 28 00:01:18,060 --> 00:01:19,050 is a little bit different, 29 00:01:19,050 --> 00:01:21,600 but it's kind of all the same in that pathology 30 00:01:21,600 --> 00:01:23,070 sort of found us. 31 00:01:23,070 --> 00:01:25,683 And so I feel like my story echoes that. 32 00:01:26,853 --> 00:01:28,620 So I grew up in Arizona. 33 00:01:28,620 --> 00:01:31,740 I went to Northern Arizona University for undergrad 34 00:01:31,740 --> 00:01:33,210 and then I went to Lake Erie College 35 00:01:33,210 --> 00:01:36,663 of Osteopathic Medicine in Florida for medical school. 36 00:01:38,049 --> 00:01:39,870 And when I was in medical school, 37 00:01:39,870 --> 00:01:42,660 I found myself a lot of the time asking 38 00:01:42,660 --> 00:01:44,820 a lot of super detailed questions. 39 00:01:44,820 --> 00:01:47,137 And most of the time I would get a response of, 40 00:01:47,137 --> 00:01:48,150 "Oh well that doesn't matter. 41 00:01:48,150 --> 00:01:49,320 We don't care about that." 42 00:01:49,320 --> 00:01:50,153 And so then I'd be like, 43 00:01:50,153 --> 00:01:51,720 oh, okay, well, 44 00:01:51,720 --> 00:01:54,318 I was kind of hoping for a little bit more 45 00:01:54,318 --> 00:01:55,151 and I noticed that I was asking 46 00:01:55,151 --> 00:01:57,990 a lot of my questions based off of pathophysiology. 47 00:01:57,990 --> 00:02:00,183 So I was like venting to a friend one day and I was like, 48 00:02:00,183 --> 00:02:02,400 "I don't know what I'm gonna do. 49 00:02:02,400 --> 00:02:04,140 I really just enjoy reading Robbins 50 00:02:04,140 --> 00:02:06,270 and then I just wanna read Robbins all day." 51 00:02:06,270 --> 00:02:07,103 And she was like, 52 00:02:07,103 --> 00:02:09,480 "Wow, well you should be a pathologist then." 53 00:02:09,480 --> 00:02:10,313 And then I was like, 54 00:02:10,313 --> 00:02:11,910 "That's actually a really good idea. 55 00:02:11,910 --> 00:02:14,097 I think I will be a pathologist." 56 00:02:15,234 --> 00:02:17,280 And it kind of made sense that I ended up in pathology 57 00:02:17,280 --> 00:02:20,977 because between med school and college, 58 00:02:20,977 --> 00:02:23,970 I was a faculty laboratory instructor in chemistry labs. 59 00:02:23,970 --> 00:02:26,883 So I taught organic chemistry and general chemistry labs. 60 00:02:27,866 --> 00:02:29,340 So when I left that job I didn't think 61 00:02:29,340 --> 00:02:31,560 I would ever be going back to the lab. 62 00:02:31,560 --> 00:02:33,390 And I was kind of disappointed, 63 00:02:33,390 --> 00:02:36,750 even though med school was still my dream and everything, 64 00:02:36,750 --> 00:02:40,590 but that's how far like pathology wasn't even a career 65 00:02:40,590 --> 00:02:41,763 I had in mind. 66 00:02:42,694 --> 00:02:44,844 So I'm really glad that pathology found me. 67 00:02:45,817 --> 00:02:47,510 And you know, as soon as I set up 68 00:02:47,510 --> 00:02:51,450 a rotation in pathology, I knew within like the first, 69 00:02:51,450 --> 00:02:52,980 I don't know, it's like love at first sight. 70 00:02:52,980 --> 00:02:55,560 It's like as soon as I walked into that lab I was like yep, 71 00:02:55,560 --> 00:02:57,063 this is definitely for me. 72 00:02:58,343 --> 00:02:59,910 So I never looked back. 73 00:02:59,910 --> 00:03:02,550 I'd like to thank my friend Katarina Kosheri. 74 00:03:02,550 --> 00:03:05,493 She's the one who told me to do pathology. 75 00:03:07,350 --> 00:03:11,760 - I know, friends help friends find pathology. 76 00:03:11,760 --> 00:03:14,760 - They see things in you that you don't see yourself, right? 77 00:03:15,780 --> 00:03:17,520 - Yeah, yeah, so true. 78 00:03:17,520 --> 00:03:20,070 So maybe can you then with that kind of tell us 79 00:03:20,070 --> 00:03:21,660 kind of maybe the what, 80 00:03:21,660 --> 00:03:26,660 like what has this first year sort of been for you in terms 81 00:03:26,989 --> 00:03:29,139 of what's that rotation look like and then, 82 00:03:30,630 --> 00:03:33,093 how has has that experience been? 83 00:03:34,710 --> 00:03:38,460 - So I feel like the first word that comes to mind is fast. 84 00:03:38,460 --> 00:03:41,260 I feel like this year has gone by so fast 85 00:03:43,032 --> 00:03:44,220 and I really can't even believe 86 00:03:44,220 --> 00:03:47,283 that I'm about to be a second year pathology resident. 87 00:03:48,488 --> 00:03:49,321 I kind of, 88 00:03:49,321 --> 00:03:51,960 I feel like a lot of first year pathology residents feel 89 00:03:51,960 --> 00:03:53,670 this way that I kind of feel 90 00:03:53,670 --> 00:03:55,770 like I'm not ready to be a second year. 91 00:03:55,770 --> 00:03:59,640 It's like everything went by in such a blur and you know, 92 00:03:59,640 --> 00:04:01,890 in pathology a lot of the time. 93 00:04:01,890 --> 00:04:04,320 I mean we all have varying experiences of what we get 94 00:04:04,320 --> 00:04:07,140 exposed to in med school, so it's kind of like, 95 00:04:07,140 --> 00:04:10,140 I feel like I still have my training wheels on and I'm not 96 00:04:10,140 --> 00:04:12,690 really sure what I'm gonna be able to let those go. 97 00:04:13,620 --> 00:04:18,360 And thankfully my program is like so nice and so supportive 98 00:04:18,360 --> 00:04:21,360 and so they're like totally okay with us, 99 00:04:21,360 --> 00:04:25,113 walking us through the field of pathology step-by-step. 100 00:04:26,141 --> 00:04:28,080 And I'm kind of, I don't know, 101 00:04:28,080 --> 00:04:31,050 I feel like our rotations too, they're only two weeks long. 102 00:04:31,050 --> 00:04:33,900 So you're there for the first week and you're like, 103 00:04:33,900 --> 00:04:34,950 what's happening? 104 00:04:34,950 --> 00:04:36,240 Where do I show up? 105 00:04:36,240 --> 00:04:38,100 And then by the second week you sort of start to know 106 00:04:38,100 --> 00:04:40,080 what's going on and then it is time 107 00:04:40,080 --> 00:04:42,243 to start a different rotation again. 108 00:04:43,507 --> 00:04:44,757 So it's been a whirlwind, 109 00:04:45,746 --> 00:04:46,770 but I feel like I have gotten 110 00:04:46,770 --> 00:04:48,600 a little bit better at certain things. 111 00:04:48,600 --> 00:04:50,940 So I feel like that's progress. 112 00:04:50,940 --> 00:04:51,783 But yeah. 113 00:04:53,220 --> 00:04:54,960 - As you talk about this experience 114 00:04:54,960 --> 00:04:57,450 of going through these rotations, 115 00:04:57,450 --> 00:05:01,200 that's one of the things that I've also kind of reflected on 116 00:05:01,200 --> 00:05:06,200 for learners and how you're really doing this kind 117 00:05:06,759 --> 00:05:08,310 of rapid sequencing through these 118 00:05:08,310 --> 00:05:10,860 different facets of pathology. 119 00:05:10,860 --> 00:05:14,040 Given that it's like really an apprenticeship, right? 120 00:05:14,040 --> 00:05:15,780 It's a cognitive apprenticeship 121 00:05:15,780 --> 00:05:18,273 you're learning as well as skills. 122 00:05:20,460 --> 00:05:23,130 Do you have any advice for listeners 123 00:05:23,130 --> 00:05:26,670 who might be going into pathology residency 124 00:05:26,670 --> 00:05:30,660 as far as how they can set themselves up 125 00:05:30,660 --> 00:05:33,063 for a success during that and I guess, 126 00:05:34,836 --> 00:05:38,280 try to start to take a little bit of ownership for things? 127 00:05:38,280 --> 00:05:42,363 I know that's kind of a classic challenge, but. 128 00:05:43,230 --> 00:05:44,063 - Yeah, so, 129 00:05:44,063 --> 00:05:47,384 and I was kind of thinking about this question a lot 130 00:05:47,384 --> 00:05:49,045 'cause I was thinking about 131 00:05:49,045 --> 00:05:50,820 what I've actually done myself and then, 132 00:05:50,820 --> 00:05:53,310 what I feel like general advice is. 133 00:05:53,310 --> 00:05:55,800 So there's kinda like two different answers there. 134 00:05:55,800 --> 00:05:59,880 For me, what has helped me take ownership of my cases, 135 00:05:59,880 --> 00:06:02,880 and this is kind of, I don't know if other people do this, 136 00:06:02,880 --> 00:06:04,230 but when I'm reading through 137 00:06:04,230 --> 00:06:06,450 the clinical history of the patient, 138 00:06:06,450 --> 00:06:09,810 sometimes if I'm looking at slides I'll look at it blind 139 00:06:09,810 --> 00:06:11,610 and then I'll go through the history. 140 00:06:11,610 --> 00:06:14,040 But a lot of the time I start off with the history the most. 141 00:06:14,040 --> 00:06:17,010 I spend like 20 minutes digging through the chart 142 00:06:17,010 --> 00:06:18,840 and what really helps me connect 143 00:06:18,840 --> 00:06:20,310 with the patients 'cause even though 144 00:06:20,310 --> 00:06:23,790 you're not there face-to-face is I actually read the social 145 00:06:23,790 --> 00:06:27,060 work notes because those kind of give me 146 00:06:27,060 --> 00:06:30,330 like a good idea of like a picture 147 00:06:30,330 --> 00:06:32,460 of that human that's 148 00:06:32,460 --> 00:06:36,333 on the slide or that I'm calling for over the phone. 149 00:06:37,974 --> 00:06:39,690 And I haven't really heard that a lot, 150 00:06:39,690 --> 00:06:43,920 but for me that's what really makes me motivated to, 151 00:06:43,920 --> 00:06:45,630 not only get them, 152 00:06:45,630 --> 00:06:47,040 help get the correct answer, 153 00:06:47,040 --> 00:06:50,250 but also to see the case all the way through. 154 00:06:50,250 --> 00:06:53,310 And I've noticed that the patients that I do 155 00:06:53,310 --> 00:06:56,250 look into their personal history a little bit more, 156 00:06:56,250 --> 00:06:58,875 I actually remember them and I write them down 157 00:06:58,875 --> 00:07:01,230 in my notebook and I actually follow up 158 00:07:01,230 --> 00:07:04,290 on them later because you get that little bit 159 00:07:04,290 --> 00:07:08,163 of personal touch that sometimes is lacking in pathology. 160 00:07:09,420 --> 00:07:11,400 And so that's what I like to do. 161 00:07:11,400 --> 00:07:14,190 I know that like other people take ownership in cases, 162 00:07:14,190 --> 00:07:15,693 the general advice is, 163 00:07:17,040 --> 00:07:19,800 you need to learn from these cases 'cause they're 164 00:07:19,800 --> 00:07:22,740 pertinent to future cases in your board. 165 00:07:22,740 --> 00:07:24,150 So this is a good, 166 00:07:24,150 --> 00:07:26,673 it's always like, this is a good example for this. 167 00:07:27,516 --> 00:07:29,340 And so I know that's how some people take ownership too. 168 00:07:29,340 --> 00:07:30,450 So I've kind of, 169 00:07:30,450 --> 00:07:32,007 I do like a little bit of mix of both, 170 00:07:32,007 --> 00:07:35,290 but for me it's really like the personal history 171 00:07:36,238 --> 00:07:38,133 that keeps me invested in the case. 172 00:07:39,150 --> 00:07:40,500 - This really resonates with me. 173 00:07:40,500 --> 00:07:43,120 I was just at a noon conference 174 00:07:44,254 --> 00:07:46,260 where somebody was presenting a case 175 00:07:46,260 --> 00:07:47,370 of something where, 176 00:07:47,370 --> 00:07:51,930 there's only been 20 describes in the world literature, 177 00:07:51,930 --> 00:07:53,043 but there were, 178 00:07:54,397 --> 00:07:58,800 it was a great example for several different things 179 00:07:58,800 --> 00:08:00,450 in the transfusion medicine world. 180 00:08:00,450 --> 00:08:01,560 And it was like, okay, 181 00:08:01,560 --> 00:08:03,510 even though this is this very rare case, 182 00:08:03,510 --> 00:08:04,343 there are these, 183 00:08:04,343 --> 00:08:08,970 this is a great examples for X, Y, and Z. 184 00:08:08,970 --> 00:08:12,137 I tend to get the most out of that by kind of, 185 00:08:12,137 --> 00:08:14,910 I know for me at the end of the day 186 00:08:14,910 --> 00:08:16,380 kind of reflecting back. 187 00:08:16,380 --> 00:08:20,040 I usually just take about 15 minutes before going home 188 00:08:20,040 --> 00:08:22,743 and just kind of jot down notes on, 189 00:08:23,640 --> 00:08:26,500 what did we learn or discuss today 190 00:08:27,571 --> 00:08:29,086 and is there something where I was like, geez, 191 00:08:29,086 --> 00:08:33,420 I bet I need to read a little bit more on that. 192 00:08:33,420 --> 00:08:34,960 What's your process look like 193 00:08:36,009 --> 00:08:37,830 for kind of capturing the learning? 194 00:08:37,830 --> 00:08:39,330 - Yeah, I do the same thing. 195 00:08:39,330 --> 00:08:41,670 I have a notebook, 196 00:08:41,670 --> 00:08:44,400 just a standard composition notebook that I, 197 00:08:44,400 --> 00:08:45,810 it's basically attached to me 198 00:08:45,810 --> 00:08:48,270 with every rotation and I try 199 00:08:48,270 --> 00:08:49,890 to remember it as much as I can. 200 00:08:49,890 --> 00:08:53,220 Sometimes I forget it but I usually bring it down to sign 201 00:08:53,220 --> 00:08:56,640 out and every time I hear a word or something I'll just like 202 00:08:56,640 --> 00:08:59,220 jot it down really quick and then look it up as soon 203 00:08:59,220 --> 00:09:01,830 as I get the chance back at my desk. 204 00:09:01,830 --> 00:09:06,330 I try to not leave the day without having at least looked up 205 00:09:06,330 --> 00:09:08,670 everything in the notebook because I feel like 206 00:09:08,670 --> 00:09:10,740 in the beginning I got into the mindset 207 00:09:10,740 --> 00:09:11,940 of oh I'll write it down 208 00:09:11,940 --> 00:09:14,040 and I'll look it up later. 209 00:09:14,040 --> 00:09:18,180 Later never comes, it's like today or never. 210 00:09:18,180 --> 00:09:19,980 And so I feel like I've really learned 211 00:09:19,980 --> 00:09:24,299 to seize the day in pathology residency, 212 00:09:24,299 --> 00:09:26,879 but that's what I do and it's been working a lot better 213 00:09:26,879 --> 00:09:29,220 actually committing to that. 214 00:09:29,220 --> 00:09:31,689 And also not like worrying so much about writing down every 215 00:09:31,689 --> 00:09:34,353 single thing that the attending is saying, 216 00:09:35,417 --> 00:09:38,250 because I'm also very much an auditory learner. 217 00:09:38,250 --> 00:09:40,710 So if I'm too busy writing things down, 218 00:09:40,710 --> 00:09:43,051 I'm not gonna actually learn from that person who's trying 219 00:09:43,051 --> 00:09:44,883 to teach me in that moment. 220 00:09:45,739 --> 00:09:46,860 So you don't need to copy everything, 221 00:09:46,860 --> 00:09:51,240 just write down a couple of like key like memory joggers. 222 00:09:51,240 --> 00:09:52,492 Yeah. 223 00:09:52,492 --> 00:09:54,133 - Yeah, I can see that. 224 00:09:54,133 --> 00:09:56,433 I also wanna applaud and highlight, right, 225 00:09:57,388 --> 00:09:58,221 that this skill 226 00:09:59,592 --> 00:10:01,530 that you just articulated right of you, 227 00:10:01,530 --> 00:10:03,810 you started one thing and that was, 228 00:10:03,810 --> 00:10:07,503 you're gonna jot things down that you need to look up, 229 00:10:08,868 --> 00:10:12,598 but then you discovered or recognized for yourself 230 00:10:12,598 --> 00:10:14,161 that you weren't following, 231 00:10:14,161 --> 00:10:18,150 you're writing this stuff down but not capitalizing on it 232 00:10:18,150 --> 00:10:20,040 the way I think you intended. 233 00:10:20,040 --> 00:10:21,570 How did you catch yourself? 234 00:10:21,570 --> 00:10:24,120 Because that's something that all of us, 235 00:10:24,120 --> 00:10:27,030 I continue to work on catching myself. 236 00:10:27,030 --> 00:10:28,030 How did you do that? 237 00:10:29,654 --> 00:10:31,353 - That's a good question. 238 00:10:36,240 --> 00:10:37,073 I don't know. 239 00:10:37,073 --> 00:10:38,100 I feel like it was just, 240 00:10:38,100 --> 00:10:42,630 when you're doing something for so long and you're not, 241 00:10:42,630 --> 00:10:45,660 I guess for me maybe it goes back to like exercise 242 00:10:45,660 --> 00:10:47,740 and like staying committed to something 243 00:10:48,850 --> 00:10:50,040 and I feel like I have 244 00:10:50,040 --> 00:10:54,840 learned what it means to show up for myself in terms of like 245 00:10:54,840 --> 00:10:58,200 exercise and eating right and sleeping well. 246 00:10:58,200 --> 00:11:00,480 And so when I started to notice like, okay, 247 00:11:00,480 --> 00:11:04,620 well I keep not doing this and that list and that notebook 248 00:11:04,620 --> 00:11:07,500 just kept getting longer and then at a certain point you get 249 00:11:07,500 --> 00:11:09,870 anxious because you're like, well now you know, 250 00:11:09,870 --> 00:11:11,820 it's like giant laundry pile, 251 00:11:11,820 --> 00:11:14,310 it becomes too much to tackle. 252 00:11:14,310 --> 00:11:15,330 And so then I'm like, okay, 253 00:11:15,330 --> 00:11:17,940 well obviously what I'm doing isn't working. 254 00:11:17,940 --> 00:11:20,250 And this did take me a couple, like a few months, 255 00:11:20,250 --> 00:11:22,710 probably like three or four months to be totally honest, 256 00:11:22,710 --> 00:11:23,610 to figure it out. 257 00:11:23,610 --> 00:11:27,241 So it's not like I recognized it right away. 258 00:11:27,241 --> 00:11:29,011 - Good, you're a human like the rest of us. 259 00:11:29,011 --> 00:11:30,515 - Yeah, yeah. 260 00:11:30,515 --> 00:11:33,360 But I think it comes back to like exercise and just being 261 00:11:33,360 --> 00:11:35,250 healthy and like learning. 262 00:11:35,250 --> 00:11:36,810 Like that's how I learned 263 00:11:36,810 --> 00:11:39,270 how to show up for myself if that makes sense. 264 00:11:39,270 --> 00:11:44,248 And so I knew that like education wise and academically, 265 00:11:44,248 --> 00:11:48,510 I was not doing what I needed to do for success for me. 266 00:11:48,510 --> 00:11:50,550 - So this reminds me another podcast 267 00:11:50,550 --> 00:11:52,410 that we did earlier about no 268 00:11:52,410 --> 00:11:54,810 excuses where we had somebody, 269 00:11:54,810 --> 00:11:58,920 they were also tying it into kind of that physical exercise 270 00:11:58,920 --> 00:12:02,673 and how does that translate into their clinical practice. 271 00:12:03,750 --> 00:12:05,280 One of the things I'm curious about, 272 00:12:05,280 --> 00:12:06,990 we're kind of been talking about how you 273 00:12:06,990 --> 00:12:09,270 and yourself have been developing, 274 00:12:09,270 --> 00:12:13,620 navigating residency, wonderful words of wisdom 275 00:12:13,620 --> 00:12:15,600 for our listeners, especially those 276 00:12:15,600 --> 00:12:16,800 that are going into the field. 277 00:12:16,800 --> 00:12:17,633 But I think 278 00:12:18,724 --> 00:12:20,400 for us that are educators to reflect 279 00:12:20,400 --> 00:12:23,130 on how we're setting our students up for success, 280 00:12:23,130 --> 00:12:25,113 helping 'em make that transition, 281 00:12:26,010 --> 00:12:30,430 what does that look like as far as that that culture, 282 00:12:32,421 --> 00:12:34,023 that interprofessionalism of, 283 00:12:35,705 --> 00:12:38,913 you're a physician now in Michigan and there's other, 284 00:12:40,260 --> 00:12:42,150 and there's residents who are surgeons, 285 00:12:42,150 --> 00:12:44,760 residents who are internal medicine. 286 00:12:44,760 --> 00:12:48,540 I imagine you're interacting with them professionally, 287 00:12:48,540 --> 00:12:51,900 but how is that kind of going or how is that working? 288 00:12:51,900 --> 00:12:55,920 Is it working the way you imagined it would work, 289 00:12:55,920 --> 00:12:57,540 those kind of connections? 290 00:12:57,540 --> 00:12:59,193 Is that happening by, 291 00:13:00,660 --> 00:13:01,493 I don't know. 292 00:13:02,580 --> 00:13:03,950 Is there kind of a, 293 00:13:04,830 --> 00:13:06,363 what's that community like? 294 00:13:08,321 --> 00:13:11,880 - So I think it's really fun actually and I think, 295 00:13:11,880 --> 00:13:13,140 I don't know at Michigan I feel, 296 00:13:13,140 --> 00:13:14,760 I'm sure it's like this in a lot of places, 297 00:13:14,760 --> 00:13:16,660 but everyone is just so nice 298 00:13:18,663 --> 00:13:19,496 and I do it, 299 00:13:19,496 --> 00:13:20,910 we connect the most I feel like, 300 00:13:20,910 --> 00:13:22,350 well, cause I'm a first year anyway, 301 00:13:22,350 --> 00:13:25,240 on autopsy and micro 302 00:13:26,074 --> 00:13:26,970 and then on transfusion. 303 00:13:26,970 --> 00:13:28,950 I feel like that's when I am doing that 304 00:13:28,950 --> 00:13:31,440 interprofessional house officer 305 00:13:31,440 --> 00:13:34,680 to other house officer type of communication. 306 00:13:34,680 --> 00:13:36,750 And since I'm on autopsy right now, 307 00:13:36,750 --> 00:13:40,260 I feel like that is like the easiest thing to speak about. 308 00:13:40,260 --> 00:13:41,640 Basically we had a case 309 00:13:41,640 --> 00:13:43,990 where we've had some unexpected findings 310 00:13:46,091 --> 00:13:47,700 and I usually page the clinician 311 00:13:47,700 --> 00:13:49,440 in the morning to ask, 312 00:13:49,440 --> 00:13:51,603 hey, like is there any specific questions? 313 00:13:53,144 --> 00:13:55,050 And the house officer called me and he just, 314 00:13:55,050 --> 00:13:58,680 it was just like a very relaxed conversation. 315 00:13:58,680 --> 00:14:03,609 It kind of felt like in med school when I'm just talking 316 00:14:03,609 --> 00:14:06,063 to my fellow med students, just like very casual, 317 00:14:07,332 --> 00:14:09,570 giving the information that we need to know and you're not 318 00:14:09,570 --> 00:14:13,920 worried about sounding silly or saying the wrong thing 319 00:14:13,920 --> 00:14:15,870 just because it's just like that. 320 00:14:15,870 --> 00:14:17,820 I don't know that open vibe. 321 00:14:17,820 --> 00:14:20,310 And so I feel like we had a really good discussion that 322 00:14:20,310 --> 00:14:23,070 morning and then later he actually called me 323 00:14:23,070 --> 00:14:24,150 and texted me again. 324 00:14:24,150 --> 00:14:26,850 He was like, "Hey, I'm just really curious about that case." 325 00:14:26,850 --> 00:14:28,260 And for me like I was like, 326 00:14:28,260 --> 00:14:30,420 this is awesome because like someone's interested 327 00:14:30,420 --> 00:14:32,490 in autopsy, like that's great, 328 00:14:32,490 --> 00:14:34,020 'cause I feel like, 329 00:14:34,020 --> 00:14:36,150 sometimes you don't get like that participation 330 00:14:36,150 --> 00:14:37,830 as much as you would want. 331 00:14:37,830 --> 00:14:39,960 So then it felt like my work was really, 332 00:14:39,960 --> 00:14:41,520 really valued then. 333 00:14:41,520 --> 00:14:44,580 And so then I called him back and we had a great discussion 334 00:14:44,580 --> 00:14:46,620 and that's just happened like recently. 335 00:14:46,620 --> 00:14:49,012 So that's why it's fresh in my mind. 336 00:14:49,012 --> 00:14:49,845 But I don't know, 337 00:14:49,845 --> 00:14:52,560 I feel like it's very casual here and a lot of people 338 00:14:52,560 --> 00:14:54,210 go by first name basis, 339 00:14:54,210 --> 00:14:56,760 which I think also kind of helps when, 340 00:14:56,760 --> 00:14:58,500 he answers the phone, he's like, "Hey, it's Chris." 341 00:14:58,500 --> 00:15:00,894 And I'm like, "Hey, it's Izzy, what's up?" 342 00:15:00,894 --> 00:15:01,800 And I don't know. 343 00:15:01,800 --> 00:15:05,790 So that's how it's been as the house officer communication. 344 00:15:05,790 --> 00:15:10,790 As far as the attending to house officer relationship, 345 00:15:10,857 --> 00:15:13,320 I feel like, I don't know, they do a good, 346 00:15:13,320 --> 00:15:15,540 I'm a very anxious and nervous person. 347 00:15:15,540 --> 00:15:18,360 So when I don't know something I feel like a lot of pressure 348 00:15:18,360 --> 00:15:20,100 to answer a certain way. 349 00:15:20,100 --> 00:15:23,040 But I feel like Michigan has done a really good job 350 00:15:23,040 --> 00:15:25,230 at like calming me down 351 00:15:25,230 --> 00:15:27,630 and not making me as nervous to the point 352 00:15:27,630 --> 00:15:32,520 where I feel pretty comfortable majorly messing up 353 00:15:32,520 --> 00:15:35,970 and saying silly things in front of most of my attendings. 354 00:15:35,970 --> 00:15:39,600 Which I feel like is a really good and kind of necessary 355 00:15:39,600 --> 00:15:41,880 comfortable learning environment 356 00:15:41,880 --> 00:15:43,440 because especially for someone like me, 357 00:15:43,440 --> 00:15:45,990 like I'll just not say anything if I'm nervous, 358 00:15:45,990 --> 00:15:48,333 I'll just be quiet the entire time, so. 359 00:15:49,260 --> 00:15:51,750 - Absolutely, actually if I can underline that 360 00:15:51,750 --> 00:15:53,592 for the listeners, 361 00:15:53,592 --> 00:15:58,592 I think that is a profound realization and one that I 362 00:15:58,740 --> 00:16:01,113 recognize myself all too late. 363 00:16:02,049 --> 00:16:04,410 There was a lot of quiet just in, 364 00:16:04,410 --> 00:16:06,840 during trading and it really 365 00:16:06,840 --> 00:16:09,681 wasn't until I was more senior where I was like, 366 00:16:09,681 --> 00:16:13,830 this is the time that I need to make mistakes. 367 00:16:13,830 --> 00:16:15,663 And then by making mistakes, 368 00:16:17,137 --> 00:16:20,940 my attendings understand how to correct me 369 00:16:20,940 --> 00:16:24,723 and coach me to do better going forward. 370 00:16:25,971 --> 00:16:27,120 And that escaped me for a while. 371 00:16:27,120 --> 00:16:30,453 So kudos for appreciating that. 372 00:16:31,487 --> 00:16:33,000 And do you have any kind of advice for people? 373 00:16:33,000 --> 00:16:34,320 'Cause I imagine, 374 00:16:34,320 --> 00:16:36,600 you've seen others kind of struggle with this 375 00:16:36,600 --> 00:16:41,600 and how do you help them to realize to speak up 376 00:16:41,610 --> 00:16:45,093 and making mistakes is okay when you're training? 377 00:16:46,290 --> 00:16:49,200 - Yeah, so let's see, how should I word this? 378 00:16:49,200 --> 00:16:52,530 I feel like I have gotten to a point now for the most part. 379 00:16:52,530 --> 00:16:56,370 I'm like 70% there where I'm basically shameless 380 00:16:56,370 --> 00:16:58,653 at this point because it's like, 381 00:17:00,810 --> 00:17:03,610 it's a good way to think of it or a good metaphor 382 00:17:04,925 --> 00:17:06,330 is you know how you're studying for a test 383 00:17:06,330 --> 00:17:09,430 and you don't necessarily understand a topic 384 00:17:10,455 --> 00:17:11,288 and so you're kind of like, 385 00:17:11,288 --> 00:17:13,440 ah, I just don't wanna deal with that topic right now. 386 00:17:13,440 --> 00:17:16,110 I'll focus on this other stuff and take the test. 387 00:17:16,110 --> 00:17:20,310 And then that topic that you avoided is all over the test 388 00:17:20,310 --> 00:17:22,890 and then you're kind of just like, that's embarrassing. 389 00:17:22,890 --> 00:17:25,200 I should have just like asked and then I would've gotten 390 00:17:25,200 --> 00:17:27,300 a good grade or something like that. 391 00:17:27,300 --> 00:17:30,460 I kind of take that approach to residency now 392 00:17:31,362 --> 00:17:34,380 because I have noticed that when I try 393 00:17:34,380 --> 00:17:35,820 to avoid something that I don't 394 00:17:35,820 --> 00:17:39,000 understand because it's either conceptually 395 00:17:39,000 --> 00:17:41,490 very difficult or it's something 396 00:17:41,490 --> 00:17:42,750 that I should feel like I should 397 00:17:42,750 --> 00:17:44,313 already know by now. 398 00:17:45,210 --> 00:17:47,370 And so it's kind of like that embarrassment, 399 00:17:47,370 --> 00:17:49,140 I'm just afraid of being like, wait, 400 00:17:49,140 --> 00:17:51,030 can you explain this to me? 401 00:17:51,030 --> 00:17:54,000 It's really just hurting myself because the further I get 402 00:17:54,000 --> 00:17:58,710 into residency it's gonna just affect me more and more 403 00:17:58,710 --> 00:17:59,820 and then at a certain point 404 00:17:59,820 --> 00:18:01,373 it's gonna be even harder to come 405 00:18:01,373 --> 00:18:03,243 and ask for help. 406 00:18:04,277 --> 00:18:05,430 So I just have been like, okay, wait, 407 00:18:05,430 --> 00:18:06,900 I'm sorry, I don't know anything. 408 00:18:06,900 --> 00:18:09,270 Can you please explain this to me? 409 00:18:09,270 --> 00:18:11,070 And I feel like taking that approach 410 00:18:12,783 --> 00:18:14,700 of kind of subtly humbling myself, 411 00:18:14,700 --> 00:18:17,430 which I feel like I came into this process pretty humble, 412 00:18:17,430 --> 00:18:22,430 but man I have been humbled a lot more since then. 413 00:18:22,740 --> 00:18:24,300 I feel like, I don't know, 414 00:18:24,300 --> 00:18:26,640 I don't really think anyone is like, 415 00:18:26,640 --> 00:18:29,050 don't think that people are judging you 416 00:18:30,420 --> 00:18:32,850 because we all started in different spots 417 00:18:32,850 --> 00:18:34,410 and I know that some more senior 418 00:18:34,410 --> 00:18:35,583 attendings may have, 419 00:18:37,290 --> 00:18:41,762 their beginning residency days are long behind them. 420 00:18:41,762 --> 00:18:42,595 But I don't know, 421 00:18:42,595 --> 00:18:45,490 for me talking to the fellows also really helps because 422 00:18:46,470 --> 00:18:48,510 they're in some subspecialty training, 423 00:18:48,510 --> 00:18:50,160 but they're pretty close to you 424 00:18:50,160 --> 00:18:52,620 as far as where they were at in residency. 425 00:18:52,620 --> 00:18:53,790 And especially at Michigan. 426 00:18:53,790 --> 00:18:55,290 We have a lot of our fellows, 427 00:18:55,290 --> 00:18:58,923 like most residency programs that also did residency here. 428 00:18:59,924 --> 00:19:02,160 So when you know I'm talking to this heen path fellow 429 00:19:02,160 --> 00:19:04,410 that I think is a total genius 430 00:19:04,410 --> 00:19:06,510 and I'm like, oh this is awful, 431 00:19:06,510 --> 00:19:07,353 I suck. 432 00:19:08,460 --> 00:19:09,307 And he's all like, 433 00:19:09,307 --> 00:19:10,650 "Oh, when I was a resident, 434 00:19:10,650 --> 00:19:12,540 I didn't even know this until my third year. 435 00:19:12,540 --> 00:19:13,860 So like, you're way ahead." 436 00:19:13,860 --> 00:19:17,370 And then I'm like, "Okay, okay." 437 00:19:17,370 --> 00:19:18,840 You know? 438 00:19:18,840 --> 00:19:22,200 So I don't know, I guess just be open and shameless. 439 00:19:22,200 --> 00:19:23,370 I don't know if that's good advice, 440 00:19:23,370 --> 00:19:24,780 but that's what I'm doing. 441 00:19:24,780 --> 00:19:25,800 - Right on. 442 00:19:25,800 --> 00:19:27,270 As we're kinda hitting on advice, 443 00:19:27,270 --> 00:19:28,103 I'm kind of curious, 444 00:19:28,103 --> 00:19:30,737 what do you think for you has been kind 445 00:19:30,737 --> 00:19:33,540 of the biggest surprise of residency training? 446 00:19:33,540 --> 00:19:35,133 I kind of got an eye for, 447 00:19:36,150 --> 00:19:37,740 something that you didn't expect, 448 00:19:37,740 --> 00:19:38,700 but wow, this, 449 00:19:38,700 --> 00:19:40,743 this was really a surprise this year. 450 00:19:42,210 --> 00:19:46,094 - I think that the biggest surprise for me actually is 451 00:19:46,094 --> 00:19:47,340 and I feel like this shouldn't be a surprise, 452 00:19:47,340 --> 00:19:50,220 this should be kind of, I guess expected, 453 00:19:50,220 --> 00:19:55,220 but is just how supportive the attendings are with us. 454 00:19:56,010 --> 00:19:59,160 I mean they really value, 455 00:19:59,160 --> 00:20:01,020 like they actually care 456 00:20:01,020 --> 00:20:04,230 whether or not I'm understanding a concept. 457 00:20:04,230 --> 00:20:06,960 It's not just like a nine to five job, 458 00:20:06,960 --> 00:20:10,260 they're just getting it done and leaving for the day. 459 00:20:10,260 --> 00:20:12,240 They actually care and get, 460 00:20:12,240 --> 00:20:14,850 are gratified from me learning something. 461 00:20:14,850 --> 00:20:18,570 And so to me that makes me feel like just so good 462 00:20:18,570 --> 00:20:22,560 and just like so cared for I guess. 463 00:20:22,560 --> 00:20:23,393 So I'm just, 464 00:20:23,393 --> 00:20:26,223 I'm surprised at how cared for I feel. 465 00:20:27,933 --> 00:20:29,980 Like in my program I could tell them 466 00:20:31,410 --> 00:20:33,210 that I'm having the worst day of my life 467 00:20:33,210 --> 00:20:35,048 and they would be like, okay, yeah. 468 00:20:35,048 --> 00:20:39,000 How can we support you and like what do you need from us 469 00:20:39,000 --> 00:20:40,260 to like help you? 470 00:20:40,260 --> 00:20:42,330 And they're not judgmental about it. 471 00:20:42,330 --> 00:20:44,490 They, I don't know, it's like, 472 00:20:44,490 --> 00:20:47,010 it's kind of like we're all like friends which isn't like, 473 00:20:47,010 --> 00:20:50,160 I know there's like a hierarchy and like a respect thing, 474 00:20:50,160 --> 00:20:52,980 but it really doesn't feel like that a lot of the time. 475 00:20:52,980 --> 00:20:56,280 So it's pretty cool. I just got married for example, right? 476 00:20:56,280 --> 00:20:59,190 And so I had all these attendings emailing me 477 00:20:59,190 --> 00:21:01,200 like being how was the wedding? 478 00:21:01,200 --> 00:21:02,520 We wanna see pictures. 479 00:21:02,520 --> 00:21:04,140 And it's just like, I don't know, 480 00:21:04,140 --> 00:21:07,260 that sense of community is just like not something 481 00:21:07,260 --> 00:21:08,730 I was expecting to find. 482 00:21:08,730 --> 00:21:10,080 So it's great. 483 00:21:10,080 --> 00:21:13,629 - Yeah, just to highlight that for the listeners. 484 00:21:13,629 --> 00:21:16,150 I mean I think in any program you go to 485 00:21:17,070 --> 00:21:19,350 there's obviously gonna be a spectrum, 486 00:21:19,350 --> 00:21:24,210 but I think overall faculty are very dedicated to training, 487 00:21:24,210 --> 00:21:25,260 to the residents 488 00:21:25,260 --> 00:21:27,960 and I think being upfront and communicating, 489 00:21:27,960 --> 00:21:30,327 that helps us not only with learning stuff, 490 00:21:30,327 --> 00:21:34,263 but helps to support us each other during challenging times. 491 00:21:35,400 --> 00:21:37,830 I wonder if I could kind of ask you to look into the future 492 00:21:37,830 --> 00:21:41,070 now as we close out this particular episode. 493 00:21:41,070 --> 00:21:45,390 And so, I hope we can grab you again in the future, 494 00:21:45,390 --> 00:21:49,080 Dr. Holmes, and do another check-in. 495 00:21:49,080 --> 00:21:51,450 So you're headed into your second year 496 00:21:51,450 --> 00:21:54,065 of residency training. 497 00:21:54,065 --> 00:21:56,640 I'm kind of curious of kind of what do you think 498 00:21:56,640 --> 00:22:00,333 is gonna be your biggest challenge for the year ahead? 499 00:22:02,831 --> 00:22:04,973 How are you thinking about being successful? 500 00:22:06,240 --> 00:22:07,950 What kind of tactic approach are you kind of thinking about 501 00:22:07,950 --> 00:22:09,123 for that challenge? 502 00:22:11,490 --> 00:22:15,070 - I feel like my biggest challenge going into second year 503 00:22:16,677 --> 00:22:18,330 is not really, I guess it, I don't know, 504 00:22:18,330 --> 00:22:20,013 I would say it's a challenge but, 505 00:22:21,607 --> 00:22:24,543 so my husband is technically living in New York right now, 506 00:22:25,511 --> 00:22:28,350 so when I come home I don't have anything else 507 00:22:28,350 --> 00:22:31,080 to do besides go work out, 508 00:22:31,080 --> 00:22:34,740 work on research, do things for residency, 509 00:22:34,740 --> 00:22:38,008 whether that be studying, presentation, whatever. 510 00:22:38,008 --> 00:22:39,660 So I think it's gonna be challenging for me 511 00:22:39,660 --> 00:22:41,370 'cause he's moving here in a couple of weeks, 512 00:22:41,370 --> 00:22:45,120 which is awesome, 'cause long distance is not fun. 513 00:22:45,120 --> 00:22:47,700 But when I get home I feel like I'm gonna 514 00:22:47,700 --> 00:22:49,923 really want to just be home. 515 00:22:51,223 --> 00:22:53,970 And so a lot of the time I'm in this habit of coming home 516 00:22:53,970 --> 00:22:56,430 and doing my work at home because I like to hang out 517 00:22:56,430 --> 00:22:58,906 with my cats and stuff like that. 518 00:22:58,906 --> 00:23:01,440 So I'm gonna have a lot of like work life balance 519 00:23:01,440 --> 00:23:05,523 adjustments that I'm not really sure how to navigate yet. 520 00:23:06,458 --> 00:23:08,250 But I'm hoping that I'll just navigate it 521 00:23:08,250 --> 00:23:09,720 the same way I did in med school. 522 00:23:09,720 --> 00:23:13,080 But residency is a lot more time commitment than med school, 523 00:23:13,080 --> 00:23:14,555 I feel like. 524 00:23:14,555 --> 00:23:16,710 I feel in med school you have a lot more autonomy 525 00:23:16,710 --> 00:23:19,773 of your free time versus in residencies. 526 00:23:21,001 --> 00:23:22,470 So that's I feel like my biggest challenge. 527 00:23:22,470 --> 00:23:24,000 And then, sorry, there was a follow up question, 528 00:23:24,000 --> 00:23:25,290 I don't remember. 529 00:23:25,290 --> 00:23:27,630 - Well and I was curious about does that, 530 00:23:27,630 --> 00:23:30,600 do you think it's fair to say that because I agree with you, 531 00:23:30,600 --> 00:23:33,330 like it seems like each stage of training there, 532 00:23:33,330 --> 00:23:34,530 there's potentially, 533 00:23:34,530 --> 00:23:38,460 I mean there's more of a demand on our time but also, 534 00:23:38,460 --> 00:23:42,090 'cause you've been successful with the previous step, 535 00:23:42,090 --> 00:23:45,530 it's kind of an incremental and survivable is that kind, 536 00:23:45,530 --> 00:23:47,955 do you think that's fair to say? 537 00:23:47,955 --> 00:23:49,020 I don't want to be sending 538 00:23:51,450 --> 00:23:53,940 inappropriate sunshines and rainbows, but you know, 539 00:23:53,940 --> 00:23:56,430 I think also to say that, you know, 540 00:23:56,430 --> 00:24:01,012 if you find that you struggle with something, 541 00:24:01,012 --> 00:24:02,670 I think it sounds like speaking up 542 00:24:02,670 --> 00:24:04,290 and talking to colleagues, 543 00:24:04,290 --> 00:24:07,800 it sounds like you have an awesome support network 544 00:24:07,800 --> 00:24:09,270 there in your residency. 545 00:24:09,270 --> 00:24:12,090 And I think, for any residency somebody goes to, 546 00:24:12,090 --> 00:24:14,460 I'd say that same piece of advice and I don't know, 547 00:24:14,460 --> 00:24:17,550 does that seem to resonate with you? 548 00:24:17,550 --> 00:24:20,190 - Definitely, and what I've noticed from talking 549 00:24:20,190 --> 00:24:23,980 to my colleagues about my struggles that I've been having, 550 00:24:23,980 --> 00:24:27,480 99% of the time you're not the only person 551 00:24:27,480 --> 00:24:29,850 that's currently experiencing that. 552 00:24:29,850 --> 00:24:32,250 I feel like I can always find like one to two other people 553 00:24:32,250 --> 00:24:35,550 that are also experiencing the same emotion that I am about, 554 00:24:35,550 --> 00:24:37,350 whatever it is that's going on. 555 00:24:37,350 --> 00:24:38,940 So you're never alone. 556 00:24:38,940 --> 00:24:40,230 And then also, 557 00:24:40,230 --> 00:24:42,813 talking to your more senior residents, 558 00:24:44,098 --> 00:24:44,940 they really, I don't know my, 559 00:24:44,940 --> 00:24:48,030 the senior residents here I feel like are very chill 560 00:24:48,030 --> 00:24:50,970 and really like bring you back down to the ground. 561 00:24:50,970 --> 00:24:54,723 So I feel like that support has also been helpful. 562 00:24:56,220 --> 00:24:57,330 Yeah. 563 00:24:57,330 --> 00:25:00,630 And as far as your a whole adaptability thing and sunshine 564 00:25:00,630 --> 00:25:04,080 and rainbows and stuff, I totally, I do agree with you. 565 00:25:04,080 --> 00:25:06,030 I do think that, 566 00:25:06,030 --> 00:25:08,751 every time that you've made it through something that you 567 00:25:08,751 --> 00:25:11,700 didn't think you were gonna get through, 568 00:25:11,700 --> 00:25:13,710 and not to sound so dramatic, 569 00:25:13,710 --> 00:25:15,360 and you still made it through, 570 00:25:15,360 --> 00:25:16,560 I mean that, you, 571 00:25:16,560 --> 00:25:19,770 it's not like that experience just happened and you survived 572 00:25:19,770 --> 00:25:24,180 and you left like you learned and grew from that experience 573 00:25:24,180 --> 00:25:26,850 to become the person that you are now. 574 00:25:26,850 --> 00:25:27,683 So I feel like, 575 00:25:27,683 --> 00:25:28,516 especially for me, 576 00:25:28,516 --> 00:25:31,440 like looking back and thinking about who the person I was 577 00:25:31,440 --> 00:25:34,413 like 10 years ago when I was in college, 578 00:25:36,360 --> 00:25:39,180 I couldn't even imagine like the stuff that I'm doing today, 579 00:25:39,180 --> 00:25:42,657 I would've never imagined that I was capable of doing these 580 00:25:42,657 --> 00:25:44,730 things and you know, 581 00:25:44,730 --> 00:25:46,980 being at such a great pathology program. 582 00:25:46,980 --> 00:25:51,210 I mean, I remember like I just wanted a job 583 00:25:51,210 --> 00:25:52,590 at one point in my life 584 00:25:52,590 --> 00:25:56,520 and I was like a maid for a long time and so, 585 00:25:56,520 --> 00:25:58,980 you just never know what's gonna happen and you know, 586 00:25:58,980 --> 00:26:03,750 I feel like you do get stronger and that's not to like harp 587 00:26:03,750 --> 00:26:05,940 on the whole resilience term, 588 00:26:05,940 --> 00:26:08,310 'cause I know that's kind of a hot topic, 589 00:26:08,310 --> 00:26:12,600 but you do get stronger and you do build a strong foundation 590 00:26:12,600 --> 00:26:17,600 of how to get through problems and you get faster at, 591 00:26:18,450 --> 00:26:20,250 getting solutions to those problems, 592 00:26:20,250 --> 00:26:21,573 if that makes any sense. 593 00:26:22,800 --> 00:26:25,470 - We've been rounding with Dr. Holmes talking about her 594 00:26:25,470 --> 00:26:27,810 residency training experience. 595 00:26:27,810 --> 00:26:29,610 Thank you for taking the time to share 596 00:26:29,610 --> 00:26:31,680 your words of wisdom with us. 597 00:26:31,680 --> 00:26:33,690 - Thank you so much for having me. 598 00:26:33,690 --> 00:26:35,130 Hope you have a great day. 599 00:26:35,130 --> 00:26:36,900 - It's all of our listeners, 600 00:26:36,900 --> 00:26:38,820 thank you for joining us today. 601 00:26:38,820 --> 00:26:40,530 We invite you to share your thoughts 602 00:26:40,530 --> 00:26:42,090 and suggestions via email. 603 00:26:42,090 --> 00:26:46,920 Please direct any suggestions to mcleducation@mayo.edu. 604 00:26:46,920 --> 00:26:48,870 If you've enjoyed Lab Medicine Rounds podcast, 605 00:26:48,870 --> 00:26:50,460 please follow or subscribe. 606 00:26:50,460 --> 00:26:52,140 Until our next rounds together, 607 00:26:52,140 --> 00:26:55,320 we encourage you to continue to connect lab medicine 608 00:26:55,320 --> 00:26:58,983 and the clinical practice through insightful conversations. 609 00:27:00,345 --> 00:27:02,762 (soft music)