(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 [email protected]. 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)