1 00:00:00,480 --> 00:00:03,063 (upbeat music) 2 00:00:05,490 --> 00:00:07,080 - This is "Lab Medicine Rounds", 3 00:00:07,080 --> 00:00:09,300 a curated podcast for physicians, 4 00:00:09,300 --> 00:00:11,430 laboratory professionals and students. 5 00:00:11,430 --> 00:00:14,790 I'm your host, Justin Kreuter, the Bow Tie Bandit of blood, 6 00:00:14,790 --> 00:00:17,970 a transfusion medicine pathologist here at Mayo Clinic. 7 00:00:17,970 --> 00:00:20,847 Today, we're rounding with Dr. Ann Moyer, 8 00:00:20,847 --> 00:00:22,770 who is an Associate Professor 9 00:00:22,770 --> 00:00:24,930 of Laboratory Medicine and Pathology, 10 00:00:24,930 --> 00:00:28,200 and Assistant Professor of Pharmacology, 11 00:00:28,200 --> 00:00:30,390 and Associate Program Director 12 00:00:30,390 --> 00:00:33,300 for the Pathology Residency Program. 13 00:00:33,300 --> 00:00:35,940 And Dr. Moyer's joining us today 14 00:00:35,940 --> 00:00:39,960 to talk about residents getting started 15 00:00:39,960 --> 00:00:41,190 in their training programs, 16 00:00:41,190 --> 00:00:44,100 kind of a follow up to a recent podcast we've had. 17 00:00:44,100 --> 00:00:46,980 So, thanks for joining us today, Dr. Moyer. 18 00:00:46,980 --> 00:00:48,630 - Thanks for inviting me to be here. 19 00:00:48,630 --> 00:00:51,137 I'm excited to talk about this topic. 20 00:00:51,137 --> 00:00:51,970 - Yeah, yeah. 21 00:00:51,970 --> 00:00:56,970 So, you've been through your training, both, 22 00:00:57,540 --> 00:01:01,350 you're one of our double doctors, MD, PhD, 23 00:01:01,350 --> 00:01:03,720 and you've gone through a lot of training, 24 00:01:03,720 --> 00:01:04,680 and you've gone through it, 25 00:01:04,680 --> 00:01:06,420 and now you've very much launched 26 00:01:06,420 --> 00:01:10,380 a very successful academic pathology career. 27 00:01:10,380 --> 00:01:13,290 And I think that all of our residents, of course, 28 00:01:13,290 --> 00:01:15,210 are overjoyed for you 29 00:01:15,210 --> 00:01:18,840 to be in this Associate Program Director role 30 00:01:18,840 --> 00:01:20,010 for the residency. 31 00:01:20,010 --> 00:01:21,480 And that's why I think you're bringing 32 00:01:21,480 --> 00:01:23,700 a really neat perspective here. 33 00:01:23,700 --> 00:01:25,650 I'm just setting this up for our students 34 00:01:25,650 --> 00:01:28,540 that are listening to this podcast to understand 35 00:01:28,540 --> 00:01:33,540 that your perspective is authentic in a very meaningful way. 36 00:01:37,260 --> 00:01:39,030 So, let's kick this off. 37 00:01:39,030 --> 00:01:42,270 And so for residents who have recently started, 38 00:01:42,270 --> 00:01:47,270 now that we're recording this the beginning of August, now, 39 00:01:48,840 --> 00:01:51,750 orientation is presumably behind us. 40 00:01:51,750 --> 00:01:54,600 Where should their focus be? 41 00:01:54,600 --> 00:01:57,810 - I think this one's a really hard one for a new resident, 42 00:01:57,810 --> 00:01:59,970 because you're very excited. 43 00:01:59,970 --> 00:02:01,620 You just got into pathology. 44 00:02:01,620 --> 00:02:04,920 Hopefully it was the specialty of your dreams. 45 00:02:04,920 --> 00:02:06,510 And now you kind of feel a little bit 46 00:02:06,510 --> 00:02:08,280 like a kid in a candy store. 47 00:02:08,280 --> 00:02:11,730 There's all this really cool stuff going on around you. 48 00:02:11,730 --> 00:02:15,180 There's opportunities to get involved in research projects. 49 00:02:15,180 --> 00:02:18,240 You can just get in so deep into this area 50 00:02:18,240 --> 00:02:19,890 that you're so excited about. 51 00:02:19,890 --> 00:02:22,740 But I think the biggest thing from my perspective, 52 00:02:22,740 --> 00:02:26,100 that when you start out in residency is even if you know 53 00:02:26,100 --> 00:02:28,590 what specialty area you want to go into, 54 00:02:28,590 --> 00:02:30,090 and you've got these great plans, 55 00:02:30,090 --> 00:02:32,340 and you've got these opportunities of things you can do, 56 00:02:32,340 --> 00:02:34,890 it's good to really just take a step back and realize, 57 00:02:34,890 --> 00:02:36,150 wait a minute, number one, 58 00:02:36,150 --> 00:02:38,730 I've gotta become a really good pathologist. 59 00:02:38,730 --> 00:02:40,530 And how are you going to do that? 60 00:02:40,530 --> 00:02:43,110 I think the most important aspect is to start 61 00:02:43,110 --> 00:02:45,060 with a really strong foundation. 62 00:02:45,060 --> 00:02:46,260 And so for some people, 63 00:02:46,260 --> 00:02:47,970 you might've gotten to have some experience 64 00:02:47,970 --> 00:02:48,990 as a medical student, 65 00:02:48,990 --> 00:02:51,780 and gotten to see some aspects of pathology, 66 00:02:51,780 --> 00:02:53,160 and some people are coming into it 67 00:02:53,160 --> 00:02:54,960 where they know what pathology is, 68 00:02:54,960 --> 00:02:57,510 but they haven't had as much in-depth experience. 69 00:02:57,510 --> 00:02:58,530 And in both cases, 70 00:02:58,530 --> 00:03:01,230 I think making sure that both on the anatomic pathology side 71 00:03:01,230 --> 00:03:03,360 and on the clinical pathology side, 72 00:03:03,360 --> 00:03:04,440 you make sure you really get 73 00:03:04,440 --> 00:03:06,510 again the foundation of the basics. 74 00:03:06,510 --> 00:03:08,070 So, what does that really mean? 75 00:03:08,070 --> 00:03:11,010 Well, so I trained in anatomic and clinical pathology, 76 00:03:11,010 --> 00:03:14,010 but now I practice molecular genetic pathology. 77 00:03:14,010 --> 00:03:16,140 So, I'm through and through a clinical pathologist 78 00:03:16,140 --> 00:03:18,600 who happens to be trained in anatomic pathology, 79 00:03:18,600 --> 00:03:21,120 but even still, for anatomic pathology, 80 00:03:21,120 --> 00:03:23,010 it's really important just to get an understanding 81 00:03:23,010 --> 00:03:25,530 of what normal histology looks like. 82 00:03:25,530 --> 00:03:28,200 It's really hard to have a framework of what's abnormal 83 00:03:28,200 --> 00:03:30,240 if you don't really have a good understanding 84 00:03:30,240 --> 00:03:31,530 of what's normal. 85 00:03:31,530 --> 00:03:33,720 So, having some of those textbooks 86 00:03:33,720 --> 00:03:35,340 that cover a lot of the normal histology, 87 00:03:35,340 --> 00:03:37,290 definitely a great place to start. 88 00:03:37,290 --> 00:03:38,580 And then in addition to that, 89 00:03:38,580 --> 00:03:40,110 I think having some sort of framework 90 00:03:40,110 --> 00:03:41,790 about how to think about the different cases 91 00:03:41,790 --> 00:03:42,900 that you're seeing. 92 00:03:42,900 --> 00:03:44,970 So, starting to understand maybe 93 00:03:44,970 --> 00:03:47,850 how the disease process works or the mechanism, 94 00:03:47,850 --> 00:03:49,200 and making sure you actually understand 95 00:03:49,200 --> 00:03:50,790 the clinical correlation of it too. 96 00:03:50,790 --> 00:03:54,000 So, there is the whole what we call wallpaper matching 97 00:03:54,000 --> 00:03:55,740 that you might be able to get pretty good at, 98 00:03:55,740 --> 00:03:56,730 but that's not going to get you 99 00:03:56,730 --> 00:03:58,650 where you need to go in pathology. 100 00:03:58,650 --> 00:04:00,150 It's really having that full, 101 00:04:00,150 --> 00:04:01,500 big picture understanding. 102 00:04:01,500 --> 00:04:04,230 And I think to get that, you really need the basics. 103 00:04:04,230 --> 00:04:06,690 Now on the CP side of things, as a medical student, 104 00:04:06,690 --> 00:04:08,790 you've probably got some familiarity 105 00:04:08,790 --> 00:04:10,620 with what lab tests you might order, 106 00:04:10,620 --> 00:04:11,880 but maybe this is your first time 107 00:04:11,880 --> 00:04:14,010 to come through a clinical laboratory. 108 00:04:14,010 --> 00:04:15,360 So, I think the biggest place 109 00:04:15,360 --> 00:04:17,070 to start there is getting a foundation 110 00:04:17,070 --> 00:04:19,890 about, well, how does a clinical laboratory work? 111 00:04:19,890 --> 00:04:21,180 What are they all about? 112 00:04:21,180 --> 00:04:23,760 How do the samples flow through the lab? 113 00:04:23,760 --> 00:04:25,680 Who are the people in the lab? 114 00:04:25,680 --> 00:04:27,690 And then in addition to that, 115 00:04:27,690 --> 00:04:29,910 some medical students might have had some opportunities 116 00:04:29,910 --> 00:04:31,830 to work in a research environment, 117 00:04:31,830 --> 00:04:33,930 and starting to get an understanding of, well, 118 00:04:33,930 --> 00:04:34,890 what's really different 119 00:04:34,890 --> 00:04:37,680 between a clinical lab and a research lab. 120 00:04:37,680 --> 00:04:39,870 What are these processes that they have in place 121 00:04:39,870 --> 00:04:40,703 so that they make sure 122 00:04:40,703 --> 00:04:42,630 that they're resulting out quality results 123 00:04:42,630 --> 00:04:43,890 every single time? 124 00:04:43,890 --> 00:04:46,110 I think some of these things can be kind of surprising 125 00:04:46,110 --> 00:04:48,090 for people that are new in pathology. 126 00:04:48,090 --> 00:04:49,320 So, I think being able to, again, 127 00:04:49,320 --> 00:04:50,910 just get that really solid foundation 128 00:04:50,910 --> 00:04:54,300 of how everything should work is really important. 129 00:04:54,300 --> 00:04:55,860 And I guess as I mentioned earlier, 130 00:04:55,860 --> 00:04:57,960 some people might have a subspecialty in mind 131 00:04:57,960 --> 00:04:58,793 when you come in. 132 00:04:58,793 --> 00:05:00,480 I know I already knew that I wanted 133 00:05:00,480 --> 00:05:03,330 to be a molecular genetic pathologist from day one, 134 00:05:03,330 --> 00:05:04,410 but it turns out 135 00:05:04,410 --> 00:05:07,230 I actually thought all of the rotations were pretty fun. 136 00:05:07,230 --> 00:05:08,460 I even liked grossing, 137 00:05:08,460 --> 00:05:10,470 and I didn't think I'd like autopsy, 138 00:05:10,470 --> 00:05:12,840 but it was certainly interesting, too. 139 00:05:12,840 --> 00:05:15,000 So, even if you've got a pretty good idea 140 00:05:15,000 --> 00:05:16,230 of where you're going, 141 00:05:16,230 --> 00:05:19,920 you can learn a lot from every single rotation you go to. 142 00:05:19,920 --> 00:05:22,440 So, I think it's helpful to approach every single rotation 143 00:05:22,440 --> 00:05:25,530 as if maybe this is the thing that I'm actually going to do. 144 00:05:25,530 --> 00:05:26,700 And even if you don't do it, 145 00:05:26,700 --> 00:05:28,890 you can draw on that knowledge in the future. 146 00:05:28,890 --> 00:05:30,510 Or maybe suddenly you'll realize 147 00:05:30,510 --> 00:05:31,980 that you have a passion for something 148 00:05:31,980 --> 00:05:34,350 that you didn't realize that you had a passion for 149 00:05:34,350 --> 00:05:36,000 and you'll change your mind. 150 00:05:36,000 --> 00:05:38,760 And, let's see, I had one other thing in mind, I guess, 151 00:05:38,760 --> 00:05:41,400 for advice for a brand new resident. 152 00:05:41,400 --> 00:05:43,170 So, I think as a medical student, 153 00:05:43,170 --> 00:05:44,940 you get to have a little bit of ownership 154 00:05:44,940 --> 00:05:46,140 over what's going on, 155 00:05:46,140 --> 00:05:48,450 and making sure that this is my patient, 156 00:05:48,450 --> 00:05:49,890 and I'm going to take care of them. 157 00:05:49,890 --> 00:05:50,723 But in addition, 158 00:05:50,723 --> 00:05:53,040 you do a lot of things that are a little bit more shadowing, 159 00:05:53,040 --> 00:05:54,840 or sometimes you are involved, 160 00:05:54,840 --> 00:05:57,900 but not the person that's driving something forward. 161 00:05:57,900 --> 00:06:00,360 So, when you're going through your residency training, 162 00:06:00,360 --> 00:06:03,270 if you can start taking some ownership of that case. 163 00:06:03,270 --> 00:06:04,920 So, you're certainly going to get help. 164 00:06:04,920 --> 00:06:06,090 You're not going to be signing it out 165 00:06:06,090 --> 00:06:07,620 on your own on day one, 166 00:06:07,620 --> 00:06:09,270 but making sure that you know, okay, well, 167 00:06:09,270 --> 00:06:10,710 this is what's going to need to happen. 168 00:06:10,710 --> 00:06:12,900 Maybe I have to move on to another rotation, 169 00:06:12,900 --> 00:06:15,152 but someone's going to follow up 170 00:06:15,152 --> 00:06:16,350 on some immunohistochemical stains, 171 00:06:16,350 --> 00:06:18,960 or something else is going to happen downstream 172 00:06:18,960 --> 00:06:20,550 after what I've been looking at, 173 00:06:20,550 --> 00:06:22,590 taking ownership to follow through on it 174 00:06:22,590 --> 00:06:25,080 and make sure that you understand what happened 175 00:06:25,080 --> 00:06:25,913 for that case, 176 00:06:25,913 --> 00:06:28,140 I think that can be really helpful for people. 177 00:06:28,140 --> 00:06:31,830 And part of that is not being afraid to ask questions, 178 00:06:31,830 --> 00:06:34,290 because sometimes some of these things in pathology, 179 00:06:34,290 --> 00:06:36,150 like the case will probably get signed out, 180 00:06:36,150 --> 00:06:38,820 whether you took ownership of it or not. 181 00:06:38,820 --> 00:06:39,720 But if you can make sure 182 00:06:39,720 --> 00:06:41,580 that you really understand what's going on, 183 00:06:41,580 --> 00:06:44,730 and if you don't, now is really your time to learn. 184 00:06:44,730 --> 00:06:45,563 In the future, 185 00:06:45,563 --> 00:06:48,090 you'll have to be able to practice independently, 186 00:06:48,090 --> 00:06:50,250 but that's not what training is all about. 187 00:06:50,250 --> 00:06:52,830 So, definitely just ask questions, 188 00:06:52,830 --> 00:06:54,960 make sure you understand what's going on with that case. 189 00:06:54,960 --> 00:06:55,800 Pretend it's a case 190 00:06:55,800 --> 00:06:57,510 that you were going to probably have to sign out 191 00:06:57,510 --> 00:06:58,560 at the end of the day. 192 00:06:58,560 --> 00:07:00,750 And I think being fully engaged, 193 00:07:00,750 --> 00:07:02,460 I think that'll help you really get the most 194 00:07:02,460 --> 00:07:03,753 out of your residency. 195 00:07:04,948 --> 00:07:09,360 - I really like how your answer puts us on this focus. 196 00:07:09,360 --> 00:07:11,400 'Cause I totally relate to your idea 197 00:07:11,400 --> 00:07:14,100 of walking into a candy store, 198 00:07:14,100 --> 00:07:16,890 and you're just, like, you're so overwhelmed. 199 00:07:16,890 --> 00:07:20,850 And plus you get a lot of trainees you probably look up to 200 00:07:20,850 --> 00:07:25,230 who are your seniors who have a lot of knowledge, 201 00:07:25,230 --> 00:07:27,240 and that also can get really enticing, 202 00:07:27,240 --> 00:07:30,540 but your return to focus, if I'm hearing you right, 203 00:07:30,540 --> 00:07:34,080 is that foundational information, 204 00:07:34,080 --> 00:07:37,920 which paraphrasing you is this, 205 00:07:37,920 --> 00:07:39,960 what's the framework we're approaching 206 00:07:39,960 --> 00:07:42,870 that anatomic pathology case. 207 00:07:42,870 --> 00:07:43,950 And it's kind of this 208 00:07:43,950 --> 00:07:46,200 to the same extent in clinical pathology, 209 00:07:46,200 --> 00:07:50,432 the framework on how do you approach clinical issues 210 00:07:50,432 --> 00:07:53,460 that come up in the laboratory. 211 00:07:53,460 --> 00:07:56,040 And since this is really a focused on our students, 212 00:07:56,040 --> 00:07:59,640 I think that our physician listeners 213 00:07:59,640 --> 00:08:01,500 can also kind of take this, 214 00:08:01,500 --> 00:08:05,100 and use this same advice you're giving to think about, 215 00:08:05,100 --> 00:08:09,540 okay, when I have a junior resident on service, 216 00:08:09,540 --> 00:08:14,540 how can I focus on being more transparent with my framework, 217 00:08:15,240 --> 00:08:18,060 and how do I approach a case, 218 00:08:18,060 --> 00:08:20,130 as opposed to maybe a more senior resident 219 00:08:20,130 --> 00:08:24,210 that needs a different sort of training focus at the time. 220 00:08:24,210 --> 00:08:26,820 And then also for laboratory professionals, 221 00:08:26,820 --> 00:08:28,620 you might have students rotating in the lab, 222 00:08:28,620 --> 00:08:31,320 and sometimes it might be, what do I do with them? 223 00:08:31,320 --> 00:08:33,270 And you're kind of highlight on contrasting 224 00:08:33,270 --> 00:08:35,250 on a lot of times, people are involved with research, 225 00:08:35,250 --> 00:08:37,860 but how is this different than a research lab? 226 00:08:37,860 --> 00:08:41,490 How does the lab work on the grand scheme? 227 00:08:41,490 --> 00:08:44,790 What does the forest look like? 228 00:08:44,790 --> 00:08:46,890 I think are really key insights. 229 00:08:46,890 --> 00:08:48,990 One thing I wanted to ask you just 230 00:08:48,990 --> 00:08:50,160 to elaborate a little bit, 231 00:08:50,160 --> 00:08:51,570 you talked about ownership, 232 00:08:51,570 --> 00:08:55,890 and I think that's such a neat concept 233 00:08:55,890 --> 00:08:57,630 that I think it's something 234 00:08:57,630 --> 00:09:01,590 that is kind of in the ethers a little bit as a topic, 235 00:09:01,590 --> 00:09:03,810 where a lot of times, like, 236 00:09:03,810 --> 00:09:04,890 I'm not thinking about it 237 00:09:04,890 --> 00:09:07,497 because it's just happening and I feel it. 238 00:09:07,497 --> 00:09:09,540 And it's sometimes maybe 239 00:09:09,540 --> 00:09:14,180 with a learner who is not taking ownership of a case. 240 00:09:14,180 --> 00:09:15,570 In other words, I guess for me, 241 00:09:15,570 --> 00:09:20,570 I feel like then I'm having to step in periodically 242 00:09:20,970 --> 00:09:24,450 and direct what's next step, what's next step. 243 00:09:24,450 --> 00:09:27,840 But I also am sympathetic that maybe for a learner, 244 00:09:27,840 --> 00:09:30,990 that's a little tough to understand and come in. 245 00:09:30,990 --> 00:09:34,500 And how does a first year resident work on 246 00:09:34,500 --> 00:09:37,263 or start developing that taking ownership? 247 00:09:38,100 --> 00:09:39,240 Do you have any advice 248 00:09:39,240 --> 00:09:43,230 for what step one or two might look like 249 00:09:43,230 --> 00:09:47,220 for a new resident that's just trying to get their sea legs. 250 00:09:47,220 --> 00:09:49,050 What does that look like? 251 00:09:49,050 --> 00:09:50,940 - Yeah, I think this is a really good question, 252 00:09:50,940 --> 00:09:53,340 because ownership looks like something very different 253 00:09:53,340 --> 00:09:54,660 when you're a fourth year resident 254 00:09:54,660 --> 00:09:57,660 or a fellow even versus first year resident. 255 00:09:57,660 --> 00:10:00,660 So, I guess my approach would be when I was on call, 256 00:10:00,660 --> 00:10:03,080 let's say as a junior resident, for example, 257 00:10:03,080 --> 00:10:04,740 in clinical pathology, 258 00:10:04,740 --> 00:10:07,140 first, somebody calls you with some question, 259 00:10:07,140 --> 00:10:08,580 and sometimes you're like, 260 00:10:08,580 --> 00:10:11,250 I don't even know what that test actually is. 261 00:10:11,250 --> 00:10:14,220 So, you try to get as much clinical information as you can, 262 00:10:14,220 --> 00:10:16,440 figure out, well, what exactly is their question? 263 00:10:16,440 --> 00:10:17,970 Take down some notes. 264 00:10:17,970 --> 00:10:19,260 And then you tell them, oh yeah, 265 00:10:19,260 --> 00:10:20,700 I'll get back to you on that. 266 00:10:20,700 --> 00:10:22,530 And then as soon as you hang up, well, 267 00:10:22,530 --> 00:10:25,410 you've kind of got two options of roads you can go down. 268 00:10:25,410 --> 00:10:27,090 Number one, you can be like, okay, 269 00:10:27,090 --> 00:10:28,740 who's the consultant or the attending, 270 00:10:28,740 --> 00:10:31,380 if you're not at the Mayo Clinic, who might be on call, 271 00:10:31,380 --> 00:10:33,840 and or might oversee this laboratory, 272 00:10:33,840 --> 00:10:35,610 and you can just pick up the phone and call them 273 00:10:35,610 --> 00:10:38,550 and relay the exact same thing that you just got back, 274 00:10:38,550 --> 00:10:40,500 and get the answer from them. 275 00:10:40,500 --> 00:10:42,480 I don't think that's really ownership. 276 00:10:42,480 --> 00:10:44,280 I would recommend taking the approach 277 00:10:44,280 --> 00:10:46,320 where you take down that information, 278 00:10:46,320 --> 00:10:48,990 and now you spend a little bit of time looking up, 279 00:10:48,990 --> 00:10:50,580 well, what is this test? 280 00:10:50,580 --> 00:10:52,350 What is this test for? 281 00:10:52,350 --> 00:10:53,550 Find out a little bit more 282 00:10:53,550 --> 00:10:55,650 about how it might be used clinically, 283 00:10:55,650 --> 00:10:57,150 and then try to think, well, 284 00:10:57,150 --> 00:10:58,860 how would I answer that question 285 00:10:58,860 --> 00:11:01,530 if I didn't have somebody else I could call. 286 00:11:01,530 --> 00:11:03,600 And then once you've kind of got an idea in your mind 287 00:11:03,600 --> 00:11:06,420 about maybe what you think you might want to say, 288 00:11:06,420 --> 00:11:09,570 then call that consultant or attending, 289 00:11:09,570 --> 00:11:12,030 tell them what the person was asking about, 290 00:11:12,030 --> 00:11:13,560 tell them what you were thinking, 291 00:11:13,560 --> 00:11:16,050 and then ask them for some feedback on that. 292 00:11:16,050 --> 00:11:17,647 And in some cases they might say, 293 00:11:17,647 --> 00:11:20,490 "Oh, good job, you really understood this test." 294 00:11:20,490 --> 00:11:22,590 And you can feel proud and walk away from it. 295 00:11:22,590 --> 00:11:26,250 And other times they might say, "Oh, not even close," 296 00:11:26,250 --> 00:11:27,600 but hopefully it'll be something 297 00:11:27,600 --> 00:11:29,160 that then you can learn from it. 298 00:11:29,160 --> 00:11:30,720 But if you don't go through those steps 299 00:11:30,720 --> 00:11:33,000 of trying to figure it out a little bit on your own, 300 00:11:33,000 --> 00:11:35,610 it's harder to really get something from that education 301 00:11:35,610 --> 00:11:38,700 when it's more passive, someone just telling you the answer. 302 00:11:38,700 --> 00:11:41,880 Now, the only caveat to that, is as a first year, 303 00:11:41,880 --> 00:11:44,070 you could easily go down a rabbit hole 304 00:11:44,070 --> 00:11:47,550 and find thousands of papers to read about this topic. 305 00:11:47,550 --> 00:11:50,040 I don't think you want to go to that extreme either 306 00:11:50,040 --> 00:11:53,190 because that pager's probably gonna start going off again. 307 00:11:53,190 --> 00:11:55,290 So, you really have to find that fine balance 308 00:11:55,290 --> 00:11:57,570 of learning on your own a little bit 309 00:11:57,570 --> 00:11:59,250 so that you've got something intelligent to say 310 00:11:59,250 --> 00:12:00,240 about this test, 311 00:12:00,240 --> 00:12:02,370 and how you're going to ask your question, 312 00:12:02,370 --> 00:12:04,860 and that you've looked into it at least to some extent, 313 00:12:04,860 --> 00:12:08,820 but recognize that, again, especially as a junior trainee, 314 00:12:08,820 --> 00:12:11,880 no one's expecting you to know the exact answer, 315 00:12:11,880 --> 00:12:13,320 and it's okay to be wrong. 316 00:12:13,320 --> 00:12:15,960 So, don't spend three days trying to answer that question, 317 00:12:15,960 --> 00:12:18,510 because the patient that's on the other end, 318 00:12:18,510 --> 00:12:19,470 and that provider, 319 00:12:19,470 --> 00:12:22,692 they probably need an answer sooner than that. 320 00:12:22,692 --> 00:12:23,629 - I love that. 321 00:12:23,629 --> 00:12:27,030 That last part of your answer is really kind of, 322 00:12:27,030 --> 00:12:30,600 for my mind, my ear, this kind of highlights, 323 00:12:30,600 --> 00:12:33,210 maintaining situational awareness. 324 00:12:33,210 --> 00:12:35,651 When is it appropriate to dive in? 325 00:12:35,651 --> 00:12:37,773 When is it not appropriate? 326 00:12:38,610 --> 00:12:40,470 And also your answer, 327 00:12:40,470 --> 00:12:41,640 it really resonates for me, 328 00:12:41,640 --> 00:12:44,400 'cause that's my same process I still follow. 329 00:12:44,400 --> 00:12:48,210 When I get a difficult therapeutic apheresis question, 330 00:12:48,210 --> 00:12:52,740 I know I've got Dr. Winters on speed dial, 331 00:12:52,740 --> 00:12:56,010 but always before I pick up the phone and call him, 332 00:12:56,010 --> 00:12:57,720 I'm always asking, like, okay, 333 00:12:57,720 --> 00:13:00,570 if he was unreachable, or if he doesn't pick this up, 334 00:13:00,570 --> 00:13:02,940 what would I do with this? 335 00:13:02,940 --> 00:13:06,510 Or if he doesn't pick up, what will I do with this? 336 00:13:06,510 --> 00:13:08,880 I think that translates to the anatomic path, too. 337 00:13:08,880 --> 00:13:12,346 If you show up as a resident having previewed a case 338 00:13:12,346 --> 00:13:16,320 with certain recommendations on what you think this is 339 00:13:16,320 --> 00:13:17,520 or what you think this needs, 340 00:13:17,520 --> 00:13:19,680 and follow up for special stains, 341 00:13:19,680 --> 00:13:21,090 I think that is a way. 342 00:13:21,090 --> 00:13:24,120 I think you're really spot on showing how are some ways 343 00:13:24,120 --> 00:13:28,743 that as a junior can show what ownership looks like. 344 00:13:29,853 --> 00:13:31,170 - Yeah, I totally agree with that comment, too, 345 00:13:31,170 --> 00:13:32,610 on anatomic pathology, 346 00:13:32,610 --> 00:13:35,970 very similar thinking about what would the next steps be? 347 00:13:35,970 --> 00:13:40,080 That's definitely a good analogous pathway in that area. 348 00:13:40,080 --> 00:13:41,820 - So, there was once a coaching book, 349 00:13:41,820 --> 00:13:43,890 I get nerdy about this stuff, 350 00:13:43,890 --> 00:13:45,360 there was once a coaching book, 351 00:13:45,360 --> 00:13:47,880 I think it had some piece of advice in there about kind of 352 00:13:47,880 --> 00:13:52,880 like what got you here won't get you there kind of thing. 353 00:13:53,160 --> 00:13:54,630 In other words, 354 00:13:54,630 --> 00:13:56,220 what you did to be successful 355 00:13:56,220 --> 00:14:00,210 in medical school won't necessarily be what you need 356 00:14:00,210 --> 00:14:05,210 to focus on, or the skill set to be successful in residency. 357 00:14:05,250 --> 00:14:08,670 And so, I'm curious, in your leadership role, 358 00:14:08,670 --> 00:14:11,650 and with your experiences so far, 359 00:14:11,650 --> 00:14:13,950 what's a new skill or two 360 00:14:13,950 --> 00:14:17,943 that residents should really kind of focus on developing? 361 00:14:19,080 --> 00:14:20,790 - Yeah, I think that's an interesting one, 362 00:14:20,790 --> 00:14:22,650 because probably a lot of the skills 363 00:14:22,650 --> 00:14:25,560 that did get you here are the things you wanna keep doing. 364 00:14:25,560 --> 00:14:29,310 But definitely I think things transition the further you get 365 00:14:29,310 --> 00:14:31,260 through your training. 366 00:14:31,260 --> 00:14:33,750 Again, since I really like clinical pathology, 367 00:14:33,750 --> 00:14:35,310 we're gonna go down that road, 368 00:14:35,310 --> 00:14:36,143 but you can think about 369 00:14:36,143 --> 00:14:38,520 how it might apply to anatomic pathology, 370 00:14:38,520 --> 00:14:40,470 but as a medical student, you think about, well, 371 00:14:40,470 --> 00:14:42,630 what's the differential diagnosis? 372 00:14:42,630 --> 00:14:43,830 And then you start thinking, well, 373 00:14:43,830 --> 00:14:46,560 what tests might I order to help answer my question 374 00:14:46,560 --> 00:14:48,930 and get to the final diagnosis? 375 00:14:48,930 --> 00:14:50,010 But I think the things 376 00:14:50,010 --> 00:14:52,770 that you don't necessarily really think about 377 00:14:52,770 --> 00:14:54,240 as a medical student are the things 378 00:14:54,240 --> 00:14:56,760 that end up being really important in pathology. 379 00:14:56,760 --> 00:14:58,950 And those would be things like, okay, 380 00:14:58,950 --> 00:15:02,280 well what are the limitations of these tests? 381 00:15:02,280 --> 00:15:03,600 Or are there situations 382 00:15:03,600 --> 00:15:07,350 when maybe I would not want to order this test? 383 00:15:07,350 --> 00:15:10,620 Or what happens when I've got my differential built, 384 00:15:10,620 --> 00:15:13,620 I've ordered my tests, and the results just don't come out 385 00:15:13,620 --> 00:15:16,110 how I expected them to have come out? 386 00:15:16,110 --> 00:15:18,960 So, I think that next level of what's the next step 387 00:15:18,960 --> 00:15:20,460 of what I'm going to do, 388 00:15:20,460 --> 00:15:22,860 or what could be the limitations of these tests 389 00:15:22,860 --> 00:15:24,480 that are making them give me a different result 390 00:15:24,480 --> 00:15:25,620 than I expected. 391 00:15:25,620 --> 00:15:27,450 I think that's kind of the level to build on. 392 00:15:27,450 --> 00:15:29,190 And how do you really get there? 393 00:15:29,190 --> 00:15:30,690 Well, I don't think 394 00:15:30,690 --> 00:15:33,030 you can really get to that level of understanding 395 00:15:33,030 --> 00:15:34,980 until you've got a good understanding 396 00:15:34,980 --> 00:15:37,080 of how the actual tests are working, 397 00:15:37,080 --> 00:15:39,420 and how the disease processes are working. 398 00:15:39,420 --> 00:15:41,910 So, a medical school prepared you pretty well, I think, 399 00:15:41,910 --> 00:15:44,160 for how the disease processes work, 400 00:15:44,160 --> 00:15:46,110 but really a lot of being a resident, 401 00:15:46,110 --> 00:15:47,940 at least on the clinical pathology side, 402 00:15:47,940 --> 00:15:50,100 is understanding how are the tests working, 403 00:15:50,100 --> 00:15:51,330 what are their limitations, 404 00:15:51,330 --> 00:15:53,880 what's the technology that's driving that? 405 00:15:53,880 --> 00:15:54,720 And then if you think about it 406 00:15:54,720 --> 00:15:56,580 on the anatomic pathology side, 407 00:15:56,580 --> 00:15:58,710 I think it's kind of somewhat similar. 408 00:15:58,710 --> 00:16:00,420 So, you have your differential 409 00:16:00,420 --> 00:16:02,010 when you've got this slide in front of you 410 00:16:02,010 --> 00:16:03,930 about what it maybe could be. 411 00:16:03,930 --> 00:16:06,150 And sometimes you can probably get that answer, 412 00:16:06,150 --> 00:16:07,290 looking at the H and E. 413 00:16:07,290 --> 00:16:09,510 And that's probably similar to maybe what you would've seen 414 00:16:09,510 --> 00:16:12,000 in a medical school histology sort of class, 415 00:16:12,000 --> 00:16:13,680 or pathology sort of class, 416 00:16:13,680 --> 00:16:14,917 but then sometimes you're like, 417 00:16:14,917 --> 00:16:17,460 "Hmm, I'm not really sure what this is," 418 00:16:17,460 --> 00:16:19,282 or you might need to order some special stains 419 00:16:19,282 --> 00:16:21,240 to differentiate that. 420 00:16:21,240 --> 00:16:23,760 So, it's really that next level of thinking. 421 00:16:23,760 --> 00:16:26,130 And again, for figuring out what to do 422 00:16:26,130 --> 00:16:28,590 in those more complex situations, 423 00:16:28,590 --> 00:16:29,730 I think you just really have to have 424 00:16:29,730 --> 00:16:31,380 a deeper knowledge base, 425 00:16:31,380 --> 00:16:33,270 and you really can't get there 426 00:16:33,270 --> 00:16:36,420 by just memorizing a lot of factoids about these disorders. 427 00:16:36,420 --> 00:16:38,700 You really have to start fully understanding 428 00:16:38,700 --> 00:16:41,160 that underlying pathophysiology. 429 00:16:41,160 --> 00:16:42,450 So, I think that's probably the thing 430 00:16:42,450 --> 00:16:45,000 that I would focus on the most is 431 00:16:45,000 --> 00:16:47,370 the understanding the whys of medicine, 432 00:16:47,370 --> 00:16:50,100 as opposed to starting to recognize patterns, 433 00:16:50,100 --> 00:16:51,033 and some of the things 434 00:16:51,033 --> 00:16:53,940 that maybe you focused on as a medical student. 435 00:16:53,940 --> 00:16:56,903 So, just getting a little bit deeper in there. 436 00:16:56,903 --> 00:17:00,120 - One of the things I really appreciate about your answer, 437 00:17:00,120 --> 00:17:04,533 Dr. Moyer, is it's something that is possible, 438 00:17:05,880 --> 00:17:09,300 whatever my training environment is, right? 439 00:17:09,300 --> 00:17:13,620 So, you don't have to have crazy things come up, 440 00:17:13,620 --> 00:17:16,170 but you're talking about that next level thinking. 441 00:17:16,170 --> 00:17:18,930 So, I guess if I have a patient case 442 00:17:18,930 --> 00:17:23,160 in front of me thinking about all the permutations 443 00:17:23,160 --> 00:17:25,890 about how this could be off, 444 00:17:25,890 --> 00:17:28,590 and if I did get such a such a result, 445 00:17:28,590 --> 00:17:31,710 or if this wasn't seen here, 446 00:17:31,710 --> 00:17:33,540 if this artifact was introduced, 447 00:17:33,540 --> 00:17:35,160 how would I navigate around this? 448 00:17:35,160 --> 00:17:38,160 It seems like it's something that no matter where you are 449 00:17:38,160 --> 00:17:39,840 in the world and your resources, 450 00:17:39,840 --> 00:17:44,250 it's something that you can do to, 451 00:17:44,250 --> 00:17:46,620 I don't know if that's mentally hardening 452 00:17:46,620 --> 00:17:48,480 or preparing yourself for, 453 00:17:48,480 --> 00:17:52,173 you're the endurance athlete, so. 454 00:17:54,210 --> 00:17:56,490 - Yeah, I think you're right, even, 455 00:17:56,490 --> 00:17:59,447 so a lot of times you'll be lucky, or unlucky, 456 00:17:59,447 --> 00:18:00,930 depending on how you view it, 457 00:18:00,930 --> 00:18:03,360 and you'll get those really tricky cases. 458 00:18:03,360 --> 00:18:04,193 And I do think 459 00:18:04,193 --> 00:18:07,110 that those are sometimes the most educational, 460 00:18:07,110 --> 00:18:08,700 because they're going to take you a while 461 00:18:08,700 --> 00:18:09,810 to sort through them. 462 00:18:09,810 --> 00:18:10,860 And that's when you see 463 00:18:10,860 --> 00:18:13,560 when things didn't follow the textbook. 464 00:18:13,560 --> 00:18:15,720 But even if things are following the textbook, 465 00:18:15,720 --> 00:18:17,400 if you've got time to read about your case 466 00:18:17,400 --> 00:18:18,720 and think about your case, 467 00:18:18,720 --> 00:18:19,710 I think you can start going 468 00:18:19,710 --> 00:18:21,750 through some of those various permutations, too, 469 00:18:21,750 --> 00:18:22,920 to think about, well, 470 00:18:22,920 --> 00:18:25,710 what would happen if this stain did come back negative, 471 00:18:25,710 --> 00:18:26,640 or what would happen 472 00:18:26,640 --> 00:18:28,590 if this laboratory result didn't match 473 00:18:28,590 --> 00:18:29,940 what I thought it should have matched. 474 00:18:29,940 --> 00:18:32,010 So, I think that's a very good point. 475 00:18:32,010 --> 00:18:34,543 - So, shifting gears a little bit. 476 00:18:34,543 --> 00:18:36,750 So, we've been talking so far 477 00:18:36,750 --> 00:18:38,820 about all the things that we can work on, 478 00:18:38,820 --> 00:18:40,980 focus on to be successful. 479 00:18:40,980 --> 00:18:45,483 I'm kind of curious about when learners struggle, 480 00:18:46,380 --> 00:18:48,720 and how can they get help and approach that? 481 00:18:48,720 --> 00:18:51,090 And I imagine that as a new resident, 482 00:18:51,090 --> 00:18:54,330 it's particularly difficult to reach out. 483 00:18:54,330 --> 00:18:56,610 You're probably in a new city, 484 00:18:56,610 --> 00:18:58,493 in a new training environment. 485 00:18:58,493 --> 00:19:03,493 This is very different than what medical school was like 486 00:19:04,020 --> 00:19:06,270 in some important ways. 487 00:19:06,270 --> 00:19:09,030 And, I don't know, quite disorienting. 488 00:19:09,030 --> 00:19:10,470 And so I was wondering if you could kind of share 489 00:19:10,470 --> 00:19:15,047 with the student listeners, what do you recommend, 490 00:19:15,047 --> 00:19:17,310 when you sort of realize, you sort of look around, 491 00:19:17,310 --> 00:19:19,697 you're like, geez, I'm not really being, 492 00:19:19,697 --> 00:19:22,353 I don't think I'm being as successful as I should be. 493 00:19:23,610 --> 00:19:26,490 What should learners do in that situation? 494 00:19:26,490 --> 00:19:30,450 - I think step one is to stop and realize that, 495 00:19:30,450 --> 00:19:32,313 and this is coming from me to you, 496 00:19:33,420 --> 00:19:35,040 you're probably not alone. 497 00:19:35,040 --> 00:19:38,070 Everybody has probably hit a point where you feel like, 498 00:19:38,070 --> 00:19:40,170 oh my gosh, this is really overwhelming. 499 00:19:40,170 --> 00:19:43,260 I don't get this. This is confusing. 500 00:19:43,260 --> 00:19:44,640 And you start worrying about, well, 501 00:19:44,640 --> 00:19:46,530 maybe I'm not cut out for this, 502 00:19:46,530 --> 00:19:47,880 or whatever the case may be. 503 00:19:47,880 --> 00:19:50,730 They're always, everybody hits rough patches, I think, 504 00:19:50,730 --> 00:19:53,910 where you hit concerns or doubts, 505 00:19:53,910 --> 00:19:55,800 or things you really need to work through. 506 00:19:55,800 --> 00:19:58,410 So, I think the number one thing is just know 507 00:19:58,410 --> 00:20:01,770 you are not the only person to have experienced this. 508 00:20:01,770 --> 00:20:04,230 So, then I think that leads to number two. 509 00:20:04,230 --> 00:20:07,200 If you can recognize that, and believe me when I say this, 510 00:20:07,200 --> 00:20:08,460 I've hit periods of time, too, 511 00:20:08,460 --> 00:20:09,293 when there's things 512 00:20:09,293 --> 00:20:11,430 that I just don't really know what to do about them 513 00:20:11,430 --> 00:20:13,140 and feel a little overwhelmed, 514 00:20:13,140 --> 00:20:14,820 but it makes it a little bit easier 515 00:20:14,820 --> 00:20:16,170 to do what I think is important, 516 00:20:16,170 --> 00:20:17,880 which is to reach out to other people. 517 00:20:17,880 --> 00:20:19,650 And if you can recognize that, you know what, 518 00:20:19,650 --> 00:20:21,270 I bet they've hit a hard point 519 00:20:21,270 --> 00:20:23,190 at some point in their life too, 520 00:20:23,190 --> 00:20:25,440 it makes it a little bit easier 521 00:20:25,440 --> 00:20:27,840 to feel like maybe it's okay to ask. 522 00:20:27,840 --> 00:20:30,690 So, I think what I would do is think about, well, 523 00:20:30,690 --> 00:20:32,310 who can I reach out to? 524 00:20:32,310 --> 00:20:34,230 And I think you have a lot of options. 525 00:20:34,230 --> 00:20:37,110 So, if you haven't found a mentor yet, 526 00:20:37,110 --> 00:20:39,420 I would definitely recommend trying to find somebody 527 00:20:39,420 --> 00:20:40,620 that you click with. 528 00:20:40,620 --> 00:20:43,950 They can either be someone that's in an area of pathology 529 00:20:43,950 --> 00:20:46,020 that you would like to go into in the future, 530 00:20:46,020 --> 00:20:47,640 or maybe they have some attributes 531 00:20:47,640 --> 00:20:49,560 that you would like to emulate, 532 00:20:49,560 --> 00:20:52,170 or maybe they just were friendly that first day 533 00:20:52,170 --> 00:20:53,070 when you met them, 534 00:20:53,070 --> 00:20:55,290 and you can chat with them a little bit more. 535 00:20:55,290 --> 00:20:57,381 So, they don't necessarily have to be someone 536 00:20:57,381 --> 00:20:59,880 that's doing the exact career path 537 00:20:59,880 --> 00:21:01,530 that you are planning on doing, 538 00:21:01,530 --> 00:21:04,230 but someone that you feel comfortable talking to. 539 00:21:04,230 --> 00:21:05,550 And the other person 540 00:21:05,550 --> 00:21:08,700 that you could potentially talk to is your program director. 541 00:21:08,700 --> 00:21:12,210 In general, program directors are there to help you out. 542 00:21:12,210 --> 00:21:13,710 That's their goal is they want 543 00:21:13,710 --> 00:21:16,830 to see residents be successful at the end of the day. 544 00:21:16,830 --> 00:21:18,360 And if someone is struggling 545 00:21:18,360 --> 00:21:21,510 and they never tell their program director about it, 546 00:21:21,510 --> 00:21:25,500 they'll have no idea that you're having a hard time. 547 00:21:25,500 --> 00:21:29,610 So, program directors, associate program directors, 548 00:21:29,610 --> 00:21:32,070 rotation directors, they all, like, 549 00:21:32,070 --> 00:21:34,320 we wouldn't be doing this educational thing 550 00:21:34,320 --> 00:21:37,800 if we didn't want what's best for our trainees. 551 00:21:37,800 --> 00:21:41,460 So, if you're feeling a little intimidated by those people, 552 00:21:41,460 --> 00:21:43,050 even though they're totally there for you, 553 00:21:43,050 --> 00:21:44,250 they've got your back, 554 00:21:44,250 --> 00:21:46,890 they're senior residents at most programs also, 555 00:21:46,890 --> 00:21:48,330 perhaps some fellows, 556 00:21:48,330 --> 00:21:50,610 some of those people can help give you some tips, too. 557 00:21:50,610 --> 00:21:52,650 And they've been in that position that you were in, 558 00:21:52,650 --> 00:21:54,480 not really that long ago, like, 559 00:21:54,480 --> 00:21:56,430 especially think about a third year resident. 560 00:21:56,430 --> 00:21:58,260 They probably still remember what it was like 561 00:21:58,260 --> 00:21:59,940 to be a first year resident. 562 00:21:59,940 --> 00:22:00,773 And even for me, 563 00:22:00,773 --> 00:22:03,570 it's been a little while since I was a first year resident, 564 00:22:03,570 --> 00:22:04,920 but I definitely remember being like, 565 00:22:04,920 --> 00:22:07,110 I don't even know what that word is that they just said, 566 00:22:07,110 --> 00:22:08,970 I'm gonna have to go Google that later, 567 00:22:08,970 --> 00:22:11,520 or look at a textbook, or what was that? 568 00:22:11,520 --> 00:22:14,460 So, I think just finding people that you can reach out to 569 00:22:14,460 --> 00:22:17,010 to kind of ask them, well, how did you get through this? 570 00:22:17,010 --> 00:22:19,380 Or what ideas do you have for me? 571 00:22:19,380 --> 00:22:21,330 And if you've got something very specific, 572 00:22:21,330 --> 00:22:24,180 that's a hard thing that you're working through. 573 00:22:24,180 --> 00:22:25,800 There's also at a lot of institutions, 574 00:22:25,800 --> 00:22:28,290 people who are academic success coaches, 575 00:22:28,290 --> 00:22:30,870 and they might have different styles of studying, perhaps, 576 00:22:30,870 --> 00:22:34,110 that you could apply, or different techniques you could use. 577 00:22:34,110 --> 00:22:36,330 And I guess if the other thing to think about, too, 578 00:22:36,330 --> 00:22:39,210 is probably spending some time reflecting 579 00:22:39,210 --> 00:22:41,713 on what exactly is going on. 580 00:22:41,713 --> 00:22:43,230 And this is maybe the first thing 581 00:22:43,230 --> 00:22:46,080 that you would even actually want to do after realizing 582 00:22:46,080 --> 00:22:47,370 that you're probably not the first person 583 00:22:47,370 --> 00:22:48,510 to experience this. 584 00:22:48,510 --> 00:22:50,130 I guess this is the insert 585 00:22:50,130 --> 00:22:53,280 before you talk to the other people, maybe think about, 586 00:22:53,280 --> 00:22:55,620 well, okay, what am I really struggling with? 587 00:22:55,620 --> 00:22:57,150 Am I just feeling a little bit overwhelmed? 588 00:22:57,150 --> 00:22:58,320 Because as a first year, 589 00:22:58,320 --> 00:23:00,030 it's like you're drinking from a fire hose, 590 00:23:00,030 --> 00:23:01,410 and there's so much new stuff. 591 00:23:01,410 --> 00:23:04,860 And I'm actually doing okay, it just feels overwhelming. 592 00:23:04,860 --> 00:23:07,680 In which case, if I keep studying, I'm going to be okay, 593 00:23:07,680 --> 00:23:08,970 I'm gonna get through this. 594 00:23:08,970 --> 00:23:13,560 Or am I truly struggling in one specific area, one rotation? 595 00:23:13,560 --> 00:23:15,960 Am I not spending enough time reading? 596 00:23:15,960 --> 00:23:18,510 Am I reading, but not understanding? 597 00:23:18,510 --> 00:23:19,800 Kind of really feeling out 598 00:23:19,800 --> 00:23:21,810 what exactly you're worried about, 599 00:23:21,810 --> 00:23:23,190 because then when you do talk 600 00:23:23,190 --> 00:23:25,320 to those people who are there to help you 601 00:23:25,320 --> 00:23:26,910 and are going to be sympathetic, 602 00:23:26,910 --> 00:23:28,500 and want what's best for you, 603 00:23:28,500 --> 00:23:29,820 they'll be able to better help you 604 00:23:29,820 --> 00:23:32,520 and direct you to any resources that you might need. 605 00:23:32,520 --> 00:23:34,470 Or sometimes they might just need to be there 606 00:23:34,470 --> 00:23:37,440 to be a supportive, friendly face, 607 00:23:37,440 --> 00:23:39,840 while you explain what's going on. 608 00:23:39,840 --> 00:23:41,550 And maybe you just need some reassurance. 609 00:23:41,550 --> 00:23:43,200 But I think there are a lot of different scenarios 610 00:23:43,200 --> 00:23:45,030 that people run into as a resident. 611 00:23:45,030 --> 00:23:48,120 And sometimes things outside of work life can get in the way 612 00:23:48,120 --> 00:23:49,470 of some things sometimes, too, 613 00:23:49,470 --> 00:23:52,260 because we're all people outside of being doctors. 614 00:23:52,260 --> 00:23:54,870 So, kind of thinking through all of the various permutations 615 00:23:54,870 --> 00:23:57,030 of what might be inhibiting me 616 00:23:57,030 --> 00:23:58,590 from doing as well as I would like to do, 617 00:23:58,590 --> 00:24:00,120 because they're also resources 618 00:24:00,120 --> 00:24:03,300 for all of those other things outside of pathology, too. 619 00:24:03,300 --> 00:24:04,980 But again, no one can really help you 620 00:24:04,980 --> 00:24:06,240 if you don't ask for help, 621 00:24:06,240 --> 00:24:08,700 because it's hard to see from the outside 622 00:24:08,700 --> 00:24:09,750 what someone's going through. 623 00:24:09,750 --> 00:24:11,970 So, never be afraid to reach out 624 00:24:11,970 --> 00:24:13,920 because everybody wants what's best for you 625 00:24:13,920 --> 00:24:15,020 at the end of the day. 626 00:24:15,960 --> 00:24:18,293 - It's an important message. 627 00:24:18,293 --> 00:24:21,840 And I think another thing is what you're answering there, 628 00:24:21,840 --> 00:24:24,330 it really resonates for me in practice 629 00:24:24,330 --> 00:24:28,020 in that I guess I've got a division chair 630 00:24:28,020 --> 00:24:29,790 that I go and have a meeting with. 631 00:24:29,790 --> 00:24:34,233 It might be most similar to having a residency director. 632 00:24:35,550 --> 00:24:37,320 But it's that same process 633 00:24:37,320 --> 00:24:41,220 of I'm reflecting in between these meetings, 634 00:24:41,220 --> 00:24:45,930 and what am I struggling with, what do I need help with? 635 00:24:45,930 --> 00:24:47,760 These are things that are skills 636 00:24:47,760 --> 00:24:50,610 that kind of continue with you going forward 637 00:24:50,610 --> 00:24:52,803 in your professional career. 638 00:24:53,730 --> 00:24:57,300 How do you recommend residents kind of approach 639 00:24:57,300 --> 00:25:01,770 those meetings with their program director? 640 00:25:01,770 --> 00:25:04,260 I mean, sometimes there's meetings called 641 00:25:04,260 --> 00:25:05,310 for a specific reason, 642 00:25:05,310 --> 00:25:08,850 but there's also kind of periodic meetings 643 00:25:08,850 --> 00:25:11,370 that are scheduled. 644 00:25:11,370 --> 00:25:14,250 And I'm kind of curious for your thoughts 645 00:25:14,250 --> 00:25:19,250 on how do residents make the most of those meetings? 646 00:25:19,470 --> 00:25:21,810 - I think it depends on what exactly is going on 647 00:25:21,810 --> 00:25:24,000 at that point in time for the resident. 648 00:25:24,000 --> 00:25:27,300 So, if you are having a difficult time with a rotation 649 00:25:27,300 --> 00:25:30,720 or a situation, or something's going on in life, 650 00:25:30,720 --> 00:25:31,560 and it's something 651 00:25:31,560 --> 00:25:33,720 that maybe you could use some additional resources 652 00:25:33,720 --> 00:25:34,890 or some help with, 653 00:25:34,890 --> 00:25:37,560 definitely come into the meeting feeling ready 654 00:25:37,560 --> 00:25:39,390 to talk about those sorts of things. 655 00:25:39,390 --> 00:25:41,040 It can be hard to talk about it, 656 00:25:41,040 --> 00:25:42,900 but I think that's an important thing, 657 00:25:42,900 --> 00:25:43,733 because that's, again, 658 00:25:43,733 --> 00:25:45,510 how you get the help if you need it. 659 00:25:45,510 --> 00:25:48,210 If it's more that maybe you've got some questions, 660 00:25:48,210 --> 00:25:49,590 you're not really sure 661 00:25:49,590 --> 00:25:52,950 how do I go about applying for a fellowship? 662 00:25:52,950 --> 00:25:54,900 How do I go about figuring out 663 00:25:54,900 --> 00:25:56,940 what I'm going to do during this elective? 664 00:25:56,940 --> 00:26:00,300 How do I start thinking about I don't know what specialty 665 00:26:00,300 --> 00:26:01,980 or subspecialty I want to go into? 666 00:26:01,980 --> 00:26:03,870 How do I figure those sorts of things out? 667 00:26:03,870 --> 00:26:05,910 I think if there are things rolling around in your mind 668 00:26:05,910 --> 00:26:07,200 that are bothering you, 669 00:26:07,200 --> 00:26:09,270 sometimes it's hard to at first put them into words, 670 00:26:09,270 --> 00:26:11,220 but again, by doing some reflection up front 671 00:26:11,220 --> 00:26:12,990 and figuring out what those things are, 672 00:26:12,990 --> 00:26:15,540 if you can come to your mentor or your program director 673 00:26:15,540 --> 00:26:17,520 with more specific questions, 674 00:26:17,520 --> 00:26:20,130 it's definitely a little bit easier to guide someone, 675 00:26:20,130 --> 00:26:22,080 but if you're having a hard time putting it into words 676 00:26:22,080 --> 00:26:23,070 and there are things that are, 677 00:26:23,070 --> 00:26:24,720 you're still trying to figure out, 678 00:26:24,720 --> 00:26:27,180 even just going in and talking to your mentor 679 00:26:27,180 --> 00:26:29,610 or your program director with an open mind, 680 00:26:29,610 --> 00:26:32,410 sometimes they'll know what questions to ask you 681 00:26:33,810 --> 00:26:36,390 to be able to help sort out those sorts of things. 682 00:26:36,390 --> 00:26:39,300 So, I think being very much willing to talk, 683 00:26:39,300 --> 00:26:41,640 being open with the person that you're working with 684 00:26:41,640 --> 00:26:43,080 that's there to help you, 685 00:26:43,080 --> 00:26:46,650 and being able to have some specific questions ready to go, 686 00:26:46,650 --> 00:26:49,560 if you've already got specific questions, can be helpful. 687 00:26:49,560 --> 00:26:50,850 But then beyond that, 688 00:26:50,850 --> 00:26:53,190 if you're meeting with a mentor, for example, 689 00:26:53,190 --> 00:26:55,230 I think some of the things that you could be thinking about 690 00:26:55,230 --> 00:26:56,310 if you're not really sure, well, 691 00:26:56,310 --> 00:26:57,960 what am I gonna talk about with this mentor? 692 00:26:57,960 --> 00:26:59,430 I've got this lined up. 693 00:26:59,430 --> 00:27:01,590 Well, some of the things that I think are really important, 694 00:27:01,590 --> 00:27:04,230 especially as a junior resident is thinking through, well, 695 00:27:04,230 --> 00:27:06,270 what are my short term goals? 696 00:27:06,270 --> 00:27:09,330 Do I just wanna get through step three, for example, 697 00:27:09,330 --> 00:27:10,920 and how am I going to do that? 698 00:27:10,920 --> 00:27:12,570 And you can ask your mentor questions 699 00:27:12,570 --> 00:27:15,360 about maybe how you could be preparing for that, 700 00:27:15,360 --> 00:27:18,540 or when a good time is to do that during the year. 701 00:27:18,540 --> 00:27:20,250 But then as a junior resident, 702 00:27:20,250 --> 00:27:21,660 you probably want to start thinking 703 00:27:21,660 --> 00:27:23,760 about some of those long term goals, too. 704 00:27:23,760 --> 00:27:25,860 You don't have to know the answer right away 705 00:27:25,860 --> 00:27:28,950 about what area of pathology, or what type of practice, 706 00:27:28,950 --> 00:27:30,690 or anything you want to go into, 707 00:27:30,690 --> 00:27:32,340 but start exploring, well, okay, 708 00:27:32,340 --> 00:27:34,065 these are the things that I really like. 709 00:27:34,065 --> 00:27:36,360 These are the things that maybe aren't my favorite. 710 00:27:36,360 --> 00:27:37,800 And if you start to get a sense 711 00:27:37,800 --> 00:27:39,630 of what direction you're headed, then again, 712 00:27:39,630 --> 00:27:42,630 that mentor or program director can start steering you 713 00:27:42,630 --> 00:27:45,180 towards maybe other people, and doing some networking, 714 00:27:45,180 --> 00:27:46,230 and people that they think, oh, 715 00:27:46,230 --> 00:27:48,360 you should probably talk to this person, 716 00:27:48,360 --> 00:27:49,980 because they can give you a better picture 717 00:27:49,980 --> 00:27:52,350 about what that subspecialty looks like. 718 00:27:52,350 --> 00:27:53,700 Or you could talk to this person 719 00:27:53,700 --> 00:27:55,440 because they might have a good insight 720 00:27:55,440 --> 00:27:57,240 of what it feels like to work in industry, 721 00:27:57,240 --> 00:27:58,740 because I don't know that, 722 00:27:58,740 --> 00:28:01,350 I work in an academic setting, for example. 723 00:28:01,350 --> 00:28:02,183 So, I think coming in 724 00:28:02,183 --> 00:28:04,590 with some of those specific questions can be helpful, 725 00:28:04,590 --> 00:28:06,780 but really just being open minded, 726 00:28:06,780 --> 00:28:08,250 because sometimes you'll come in, 727 00:28:08,250 --> 00:28:10,050 and you might have some questions, 728 00:28:10,050 --> 00:28:13,140 and then your mentor might start asking you some questions. 729 00:28:13,140 --> 00:28:16,620 And sometimes I think you know subconsciously 730 00:28:16,620 --> 00:28:18,060 what you want to do, 731 00:28:18,060 --> 00:28:19,830 or what the best path forward is, 732 00:28:19,830 --> 00:28:22,080 but your brain is telling you something else. 733 00:28:22,080 --> 00:28:23,670 And if they're asking you the right questions, 734 00:28:23,670 --> 00:28:24,990 sometimes you realize 735 00:28:24,990 --> 00:28:26,640 that the advice you're getting isn't quite 736 00:28:26,640 --> 00:28:28,080 what you expected. 737 00:28:28,080 --> 00:28:29,370 And if you're open to it, 738 00:28:29,370 --> 00:28:31,800 you might ultimately get to a better solution 739 00:28:31,800 --> 00:28:33,690 than you were originally thinking about. 740 00:28:33,690 --> 00:28:36,600 So, I think just being open to share with your mentor 741 00:28:36,600 --> 00:28:38,670 and open to their feedback makes 742 00:28:38,670 --> 00:28:40,140 for a really good partnership. 743 00:28:40,140 --> 00:28:41,730 I guess the other thing I didn't really mention 744 00:28:41,730 --> 00:28:42,563 at the beginning, though, 745 00:28:42,563 --> 00:28:44,700 is sometimes just having some goals. 746 00:28:44,700 --> 00:28:47,730 If you've got a formal mentor, for example, figuring out, 747 00:28:47,730 --> 00:28:49,200 well, what are the things, like, 748 00:28:49,200 --> 00:28:51,720 what's the goal of this mentoring relationship 749 00:28:51,720 --> 00:28:53,370 that can really help steer things, too? 750 00:28:53,370 --> 00:28:55,860 'Cause you'll probably keep meeting with them long term. 751 00:28:55,860 --> 00:28:57,210 And so maybe one time 752 00:28:57,210 --> 00:28:59,520 that you meet with them can lead into the next. 753 00:28:59,520 --> 00:29:01,650 But I think there's a lot of different things 754 00:29:01,650 --> 00:29:02,483 that can be gleaned 755 00:29:02,483 --> 00:29:05,220 from meeting with them during these meetings. 756 00:29:05,220 --> 00:29:08,220 So, just being prepared and ready to talk. 757 00:29:08,220 --> 00:29:11,433 And usually it's a pretty fun and pleasant experience. 758 00:29:12,570 --> 00:29:14,490 - Wise words, deliberate words. 759 00:29:14,490 --> 00:29:16,320 We've been rounding with Dr. Moyer. 760 00:29:16,320 --> 00:29:18,900 Thanks for talking with us about 761 00:29:18,900 --> 00:29:21,480 how can resident learners 762 00:29:21,480 --> 00:29:24,693 really have success after orientation. 763 00:29:26,550 --> 00:29:29,220 And to all of our listeners, thank you for joining us today. 764 00:29:29,220 --> 00:29:30,930 We invite you to share your thoughts 765 00:29:30,930 --> 00:29:32,760 and suggestions via email. 766 00:29:32,760 --> 00:29:37,230 Please direct any suggestions to mcleducation@mayo.edu, 767 00:29:37,230 --> 00:29:38,670 and reference this podcast. 768 00:29:38,670 --> 00:29:40,980 If you've enjoyed "Lab Medicine Rounds" podcast, 769 00:29:40,980 --> 00:29:42,240 please subscribe. 770 00:29:42,240 --> 00:29:43,830 And until our next rounds together, 771 00:29:43,830 --> 00:29:47,700 we can encourage you to continue to connect lab medicine 772 00:29:47,700 --> 00:29:51,620 in the clinical practice through insightful conversations. 773 00:29:51,620 --> 00:29:54,203 (upbeat music)