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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.
(bright staccato music)
- This is "Lab Medicine
Rounds," a curated podcast
for physicians, laboratory
professionals, and students.
I'm your host, Justin Kreuter,
a transfusion medicine pathologist
and Assistant Professor
of Laboratory Medicine
and Pathology at Mayo Clinic.
Today we're rounding with two
transfusion medicine fellows
that we have here at Mayo Clinic,
Dr. Nidhi Kataria and Dr.
Thane Kubik, to dive in
to talk about how to optimize
that residency experience.
Thanks for joining us today.
- Thanks for having us.
- Thank you for having us.
- Absolutely.
So I really am always
impressed by you guys
how you, throughout this academic year,
you see residents come through
and rotate through transfusion medicine,
which can be a very
challenging environment.
And I'm kind of curious, you know,
what information perspective
do you think is important
for residents to understand
about where to put their focus,
their energy during residency training?
- Sounds good. That's a great question.
So we know pathology residency is, like,
a demanding journey in itself.
And like anything else, basics come first.
So getting your basics right,
getting your fundamentals right
is the first thing to start on.
So when you're in a pathology residency,
what your fundamentals
are, you need to know
how to grasp specimens properly.
You need to preview cases.
Preview cases, as many cases as possible.
That's what my seniors used to tell me
and that's what I feel
like helped me a lot,
both in terms of practicing
pathology and even for the both.
So those are the basic skills
that you need to acquire
and even for the clinical, like,
need to understand the
different diagnostic entities
or like, how do we come for
the patient care decisions.
If you don't have your fundamentals right,
you would not be able to
get to the proper decision.
That is the first and foremost thing
to start your residency with.
And that just doesn't
end in the beginning.
Like, you have to keep
this practice going.
(Nidhi laughing)
(Thane humming)
Another thing I feel
like, which is important
along with doing your hard work,
to that is doing your
learning, is research,
which is another important aspect
of pathology residency training.
Whether it is just for, like,
your own CV and your own interests,
but you also need
research to build your CV
for fellowship applications,
to get a job in the future.
So you need some kind of
research, and how do you do that?
Like, you get into residency,
you may have some experience,
but, like, when I got into residency,
I didn't have experience with research.
I had to ask my seniors.
I went to my program director.
I did a residency training in India too,
and I went to my program
director and I was like,
I wanna get involved in research projects,
but I don't know where to start from.
And I was like plain and straight.
- Wow. You give me so much.
Let me put a pin in the research topic.
Let me circle back to
that in a little bit.
I really wanna kind of
dive into, you know,
your highlight of kind of the
fundamentals and the basics.
And one thing I'm curious
about is, you know,
how to approach this with,
you know, learners, you know,
junior residents that are,
you know, just coming on
or just coming on to clinical
pathology rotations now.
I imagine that for anatomic pathology,
maybe that's an easier thing
to define or put your finger on
because you could think
of like, okay, histology,
I need to really have a good
understanding of histology
and be able to identify my cell types,
be able to identify the architecture.
But I could see maybe
that being a struggle
in the clinical pathology world
where maybe the fundamentals
is like, clinical medicine,
(Justin laughing)
which can almost get beyond
what I can get my arms around.
Do you guys have thoughts on, like,
what does the fundamentals
in clinical pathology
rotation look like?
- Yeah, I mean, that's
a really good question.
Like you said, it's quite a bit different
and quite a bit more nebulous.
And I find that one thing that we were
gonna mention before was talking about
sort of the hidden
curriculum a little bit,
which is maybe not, like,
these are the sets of entities
that you have to look at and learn.
I feel like on the clinical
side of clinical pathology,
it lends itself more to a bit
of this hidden curriculum.
So things that aren't, you
know, gonna be in a syllabus,
but it's sort of like the
teamwork sort of things.
You know, especially
in clinical pathology,
you're interacting quite a bit more
with allied health professionals as well.
So it's really important
to find good mentors,
good role models to kind of see
how they approach challenging calls
and really to help have them guide you
in sort of that, like, apprentice
and learner sort of relationship,
so that they can really help highlight
what are the more important things
to kind of key you in on as well.
Because otherwise, you're quite right,
you know, it's like,
this is all of academic
or clinical medicine, you know, go for it.
Learn what you need to know, so.
I found from my personal standpoint,
finding those mentors to
kind of watch their practice,
kind of see what things they key in on,
that's really been helpful to me as well.
- Yeah, I really like that,
'cause that does sound like
something I can get my
hands around, right?
Thinking back to where I
was as a junior resident.
And then what do you say about
kind of the frequency of, like,
is it kind of like at least once a day
when you're coming on a new service
that you're kind of
checking in with mentors
and asking about, you know, how am I doing
and this is where my
thoughts are on x, y, or z?
- I don't think there's
a defined frequency.
Like, based on what, say like
if I'm on call for a
day, hot seat for a day,
as many times I'm getting, like, some kind
of difficult calls which
I'm not confident with,
I would approach my
consultant or my mentor
and see like, this is how I
am thinking about this topic.
What are you thinking about this?
- I like that, right?
So highlighting for our audience, right,
whenever the uncertainty, you're like,
oh, this is new territory for me.
Or I guess maybe to your point
is like maybe it's a new iteration,
like you've handled similar calls before
but this one's just a
little bit different,
that might be a nice time
to check in with faculty.
You know, you guys have both,
oh sorry, were you gonna add?
- Yeah, I was just gonna add one thing.
So checking daily is helpful
but I find that, like, having some sort
of reflective practice in
residency is important too.
Listen, journaling isn't for everybody,
but having some way of
kind of keeping tabs
maybe over the course of a week
to kind of figure out maybe
where you've struggled,
and then having that, you
know, like 10, 15-minute redux
that's set away from busy
service work to sit down
with the faculty mentor would
be really helpful as well.
And then you could try to
think about some themes
or kind of general ways to approach things
so it's not just one
call, one itty bitty fire
to put out kind of at
a time sort of thing.
- You know, diving in that Dr. Kubik,
do you think there's, you
know, you mentioned that,
you know, journaling isn't for everybody.
Certainly that's the way that
me and my younger daughter
are connecting these days
is doing a little bit
of this bullet journaling type of thing.
You know, what are some of
the diversity of practices
that you've seen maybe different
types of residents do that,
you know, still is this
kind of reflective practice?
- Yeah, I think, so here on a
busy service that we've had,
I find that with a couple of
trainees that have come through
or I should say learners,
I would just sort of flip
through their on-call kind of
notebook throughout the week
when thing sort of die down and
say, "Let's go through this.
Was there any other call
that you kind of wanted
to chat about that didn't quite
go as well as you wanted to,
or that you feel like you
didn't quite answer well?
Let's chat about that now."
So I find that's kind of one
way to do it, have a record
of something and then go
back to it and revisit it.
'Cause it's really hard to pull, you know,
examples straight out of the air.
- Just to add to it.
Like, something what I try to do is like,
I would try to self-reflect,
I think this is something you taught me,
on what I have done in that
week and have I achieved, like,
the things that I were trying to achieve.
So it's easy, like, if I'm
practicing transfusion right now,
transfusion is a vast word,
and it's easy to get lost in
the sea of clinical service.
And then are you learning new things?
Are you achieving your
targets as well on the side?
That's important to realize that.
So reflecting back on this
past week, what you have done
and then setting up goals
for the next week so that,
along with your busy schedule,
you can fit those goals in.
That helps a lot.
- Yeah, that's really interesting.
That sparks in my mind, I
think you're highlighting.
Dr. Kataria this issue of, you
know, every training program
is going to inherently
have maybe blind spots
or things you may not
necessarily be exposed to
or may be exposed to a lot of, right.
But by having this thoughtful
practice that you described,
you can catch that or have that look
into what's in your blind spot.
And so then have a targeted approach for
how are you gonna work on that.
You know, sitting down
with a mentor, for example,
and having a conversation about, geez,
I haven't seen in cases like this,
but what are your, you know,
how should I approach that?
You know, one thing, next
question I have for you,
and again, this is at the
end of your academic year,
so you've seen a number
of trainees come through,
both junior residents as
well as senior residents.
I'm curious, having worked
with several of them,
are there a few common
challenges that you've seen
that they kind of might run into
when they're on transfusion medicine
with the idea that the
listeners can kind of be
kind of heads up about this and
anticipate these challenges?
- Definitely.
Like, I think as a
resident, both as a fellow,
like, there are a lot of challenges,
especially that there are gaps
in medical school and pathology residency.
Pathology, like residency, basic skills
like histology, grossing, and
then transfusion medicine.
They're not taught in the medical school.
So once you actually start your residency,
it becomes challenging.
It becomes simply overwhelming.
And I remember when I started my residency
and like, as physicians
we target for excellence.
I started feeling overwhelmed.
I wanted to know everything on day one
or on my first month.
And it was just putting
a lot of pressure on me,
and that I had to talk to my seniors
and like, bring the self-realization
that I cannot learn
everything in on day one
and it's gonna be a journey
and we are lifelong learners.
(Nidhi laughing)
- So I get you're saying
that pathology trainees
may be partially selected
for perfectionism
(Justin and Nidhi laughing)
as a character trait.
(Justin and Nidhi laughing)
Are there ways that you've
kind of, when you recognize,
wow, this person has got, you know,
and it's nice to follow
protocols and the like,
but where maybe the perfectionism
is getting in the way of
moving forward in practice.
How do you help that person
overcome that barrier?
- Yep. So I think just a sense
of graduated responsibility.
People that will tell you
that, but first of all,
self-realization of that
is extremely important.
Be compassionate to yourself.
(Thane humming)
Don't be too hard.
We as physicians would
show compassion to others,
but we often forget self-compassion,
and that is a skill to learn.
And then just realizing
that this is a journey
and this is not, like, one-day
task or one-month task,
and everyone is in the same boat with you
and we are here to learn.
Like, celebrate every day.
Like, I learned this new entity today,
I learned this new thing today.
So achieve, enjoy those victories.
- What are some of the ways
that you guys have seen,
like, you're talking about this, you know,
I think you said that we're
compassionate to each other
and that that was a skill to be developed.
What does that skill look like?
- That's a really good question.
I think part of that is something
that you can model off of
just good, like, general
professionalism I would say.
So we all kind of work.
Pathology doesn't exist on an island.
We work with a lot of allied
health professionals too,
whether they're pathology
assistants in the grossing room,
you know, our clinical teams
that were phoning a lot
about, you know, additional platelet units
and transfusion medicine, et cetera.
But just always sort of being humble
and really that you're
trying to work the best
and do the best possible job
for the patients that
you're looking after.
And recognizing that
you're gonna make mistakes,
but if you approach it with humility
and an inquisitive attitude
sometimes by saying,
"Hey, I don't really know
how to approach this,
but can you help me out?
Can you point me in the right direction?"
I feel that outward professionalism
and compassion can then
be sort of mirrored
and then imprinted on
yourself a little bit too.
- Yeah, I like that.
I see that quite a bit and that does,
I think, come across as a skill,
something we all can
develop and get better at.
And I'm sure you probably
have seen various mentors
kind of approach that in different ways.
Maybe if I flip the equation
around to the other side/
So we've been talking about maybe
where are some challenges
that you guys have seen
and talking about
perfectionism, talking about
how we can realize it's a
journey, breaking apart.
You guys have been talking about
a lot of really powerful ideas.
When you think about people
that, maybe senior residents,
that have come through that are just
knocking it out of the park, right?
What are they doing that maybe
some of the others of us need to learn?
What are the really
successful residents doing
as a matter of habit that's
helping them be so successful?
- [Nidhi] Okay.
- You can go first and
then I'll add. Yeah.
- Be consistent.
As we have been saying,
like, it's a journey.
So like, be disciplined and be consistent.
There are no shortcuts to success.
If you are doing something every day,
by the end of three or four
years, you would have acquired
that cumulative knowledge
and that would really help.
And then also know, like,
what you are supposed to do.
Like, if you don't know,
you may be just lost in this vast sea.
So talk to your mentors,
talk to your seniors.
And if you are in a certain
rotation, I try to make sure,
like, I would sit with
the rotation director
and understand what the objectives are,
what would be the best resources
to go for that rotation
so that by the end of that I should
at least achieve those objectives
and maybe even have, like, more
knowledge about that topic.
And then also one more thing, like,
having a proper system to do things.
We see so many residents
coming on transfusion service
and often we see that, like,
if you don't have a proper
system to follow up on things,
your follow-up list
will never be complete.
- And especially, like-
- You're in trouble.
- Coming from the busy clinical service,
like, things will get lost to follow up
and there would be trouble.
So having a proper system in a place helps
and prioritize your tasks.
- If I can hop in there really quick
and say like, riffing off that,
oftentimes newly accepted
fellows will ask me about, like,
what do I need to do to
prepare to start fellowship?
You know, which, transfusion
book do I need to be reading?
And I always just recommend, you know,
we'll deal with that stuff, but you know,
the biggest thing to work
on is what is your system
for capturing the to-do list
and working through that.
I think that that structure brings
what you're talking about,
about consistency and this idea
that you can be relied
upon to follow through.
So strong.
Dr. Kubik, what are your
thoughts about, you know,
what those highly-performing
residents are doing
that rest of us can learn from?
- Yeah.
So I think, you know, there's
a big change that happens,
you know, in the early years of residency,
and then sort of as things transition
towards your senior years of residency,
at least it should, I think.
And I think that this is
part of the hidden curriculum
and where people who really
start to understand this
can really start to do an amazing job.
And what that is, is
really you should kind of
look at the final years of your residency
as a transition to practice, I would say.
By that point you should be focusing
not just on the entities anymore
and like, learning the skills,
and how to chat with clinical teams,
but really starting to look
at how different pathologists,
transfusion docs,
whoever, how they practice
and how you're gonna emulate
the way that they practice,
you know, into your own unique
kind of flavor of practice going forward.
So the residents that do really well,
they'll sort of kind of
be pick and choosy about,
you know, okay, from this attending,
I'm gonna take this skill or
this presentation technique
or this way of approaching
this particular problem,
and then develop their own style.
And I feel like nobody
tells you that you have
to develop your own style
kind of along the way,
but ultimately it's gonna be you
making the calls at the end of the day.
There'll always be backup to
some sort of extent, you know,
whether it's through
quality assurance rounds
or knocking on your
colleague's door or whatever.
But at the end of the day,
you should be an independent practicing
pathologist, transfusion doc, whatever.
And you have to use that time kind of
in your senior resident
years to kind of develop
what your own style is
and your level of comfort.
- I love the way you put
that 'cause I see that
as really kind of somebody developing
a sophisticated medical practice, right?
It's not just, you know,
can I diagnose this?
But you're starting to recognize
the nuances and the differences
that is this thing we call
clinical judgment, right?
And like how are we appreciating
how different mentors
are applying this and
having a sophisticated way
of taking from some, leaving from others,
and building who we are
as individual clinicians.
I really like that. Now let's rotate back.
I put a pin in research because I know
that's always a challenge and you know,
for our audience that are
just starting residency,
I hope that this has been a
really key thing to appreciate
and helpful as you kind of frame
how to approach the beginning phases,
or if you're a listener
that is already in practice,
you know, when you
mentor maybe new trainees
or if you have new faculty that
are just finishing training,
this is helpful as well.
But now let's go back
to this research idea.
Dr. Kataria, you were
saying that, you know,
research was a novel way
of, a new way of thinking
that you hadn't really
been exposed to before.
And certainly in all of our
ACGME accredited programs,
research is an expectation of that.
Do you have thoughts on
how students can kind of
maybe more successfully launch into that?
- Sure.
So again, like, I think
mentorship comes a big way
in research because once you transition
from med school to
residency, you may have no
to limited experience of research.
So having the right
mentor who can guide you
in the right path is important.
And then seeking out, like,
I think for me it was like
I figured out what I'm interested in
and then I try to focus
my research on that.
Having said that though, it
is not like you will just,
you may get another opportunities too,
in which you may be putting less effort
but maybe getting more out of it.
And I think it is important to recognize
those opportunities and grab onto those.
And sometimes those opportunities
just come out of nowhere.
For me, like, during Covid
time we had a book club
where we were reading WHO HemePath
and then some of the seniors said,
hey, do you guys wanna come up with like,
a book for writing, like,
summary of WHO kind?
And that was a small thought.
And with that small thought, like now
we first published, like, our first book,
which was Ace My Path,
Neoplastic HemePath,
and then now there's a
series of that books.
So it can come like, you
should not miss an opportunity
where you see it, it may require
extra time and dedication
and that is something you'll have
to work out in your schedule.
- I like that.
You know, I think that being open,
that being curious,
that kind of resonates.
It's kind of a rolling thread
that regular podcast
listeners will pick up on.
Something you mentioned there was
about the idea of the right mentor.
And I'm curious to hear from both of you
'cause you're really in the thick of it.
How do you identify that right mentor?
- Yeah, so kind of
speaking from experience,
I find that, you know, if
you're kind of new to research
or even if you've done
research projects in the past,
it's really hard to
kind of get the sense of
who the right mentor is
maybe with one meeting.
Or even if it is the right mentor,
it might not be the right project, right?
So I think it's important to
kind of cast a wide net first.
You know, maybe not, as hard as it is
'cause we tend to be yes people,
maybe just say, you know,
I'll get back to you on that
and kind of play the field
a little bit, get a sense
because A, the right mentor is important,
but also the right project.
Unfortunately because
residency is so time bound,
you need to find projects
that are gonna achieve
some sort of liftoff.
And you know, you don't
have time for a magnum opus
or a thesis kind of in
your residency position,
unless you choose to go
on in their, you know,
clinician science training programs,
you know, you could do
your PhD, et cetera.
But the advice I would
give is talk broadly
and then find smaller
projects to start with
and then you can always
take on more later on.
But find ones that, you know,
have a good success of achieving liftoff.
- Dr. Kataria, do you have
additional thoughts on that?
- Yeah, sure.
Just like, echoing on
that, like, small projects.
I think it's important to have some.
I try to have something
on my CV every year
so that it at least keeps me, like,
saying that I'm doing
something every year,
whether it's a poster or a case report,
like, you are making
some kind of progress.
That is important.
And so going back to your
question of right mentor,
early on it was more like
you don't really have an idea,
and you just see what
opportunities you are coming for,
and like, as Thane said, like,
you have hard time saying no.
But now I just try to reflect upon, like,
what are the fields I am interested in?
And then mentors, like,
I'll do maybe a small project with someone
and then see how our bonding was,
and like, did I get to learn something.
And if I get that feeling,
then I'll do a big project
with that person and then
just build on that bond.
- That's awesome.
We've been rounding with
Doctors Kataria and Dr. Kubik
for optimizing the residency
experience, that's optimizing
the residency experience.
(Thane and Nidhi laughing)
So thanks so much for joining us today.
- Thanks for having us.
- Thank you so much.
- This was fun.
- It was a privilege. Yeah.
- And to all our listeners,
thank you for joining us today.
We invite you to share your
thoughts and suggestions
by email to mcleducation@mayo.edu.
If you've enjoyed this
podcast, please subscribe.
And until our next rounds together,
we encourage you to continue
to connect lab medicine
and the clinical practice through
educational conversations.
(bright music)