Reflections on Residency

(upbeat 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. And today we're very lucky, because again, we're rounding with Dr. Isabella Holmes, a PGY-3 resident and assistant co-chief pathology resident at the University of Michigan, to talk about her reflections on residency.

Thanks for joining us today, Dr. Holmes. - Thanks for having me, I'm excited to be back. - Well, yeah, this is wonderful. I think we did our first podcast, I think when you had just matched into pathology, talking about where your thoughts and the like, and then we've kind of revisited how did first year go? And this is just continuing a fun tradition of looking back and seeing this evolution. I really appreciate kinda exploring this with you. - Definitely, me too.

- So I guess the natural question is, so what has this past year of residency been like for you? - This past year has been so exciting. I feel like so much has happened in such a condensed

amount of time. First of all, my husband moved to Michigan at the end of the summer, which was great. And so he started working as a hospitalist at Henry Ford. And so now we don't have that long distance anymore, which is fabulous. And then I went to three conferences this year. I went to CAP, AABB, and then the Cytopathology Conference, where I presented posters at two out of those three conferences.

And then, I don't know, I really feel like I kind of got a lot more comfortable as a resident and just in that role of what a resident is like at Michigan the past year. Oh, and then another great thing that I've been working towards this year that has taken a lot of stress off of my plate is getting a few publications done, and as well as I also accepted a Fellowship recently.

So putting together the fellowship application was quite the project because it is not like the ERAS System at all, where you can submit it all in one neat little packet. It's every program wants different things at different times. But it was relatively painless and I was successful, so that's great. (Isabella laughs) - I love how you mentioned, you know, it sounds like you're really kinda hit your stride of going to a number of conferences and you said that you've really kinda settled in

as like, you're comfortable in this role as resident. I wonder if, can you unpack that a little bit for the listeners? - Yeah, let me think. I guess what it comes down to really is you're less afraid to ask questions. You know what's expected of you, and when I mess up, I know exactly what went wrong or where I took like a misstep, if that makes sense. And then also you kind of have a little bit more of a sense of comradery among your co-residents.

And now a lot of the fellows at Michigan have also trained as residents at Michigan. So then now I also know most of the fellows too. So it's just like a really comfortable like learning environment at this point. And then I've already established a lot of relationships with attendings and the PA. So I don't know, it just all kinda makes it a little bit easier once you feel like everyone really knows you and you are 100% yourself at this point in training.

And so, you know, it's no more of those like nervous jitters of, you know, "Oh, are these people gonna like me," or you know, "Can I be myself?" And at this point I totally am. And so that's kind of really a freeing experience for me. So that's kind of how I would describe being more comfortable. But now I'm kinda transitioning into this new role of assistant co-chief and then eventually co-chief. And that's been kind of an adjustment as well.

So it's kinda like, as soon as you get comfortable it's like, well, now it's time to be a little bit more uncomfortable to get some growth. - You're leveling up. (Justin laughs) - Yeah. (Isabella laughs) So don't know how that's gonna go yet. I'm only like a month or so into the actual position, but I have a really good team and we have good support.

So I think it'll go okay. (Isabella laughs) - You know, I hearing you talk about taking on this new and added responsibility of assistant co-chief, recently, I was mentoring one of our residents, who was kind of trying to decide if, you know, does, is he interested in taking on that role

or should he focus on his research? And you know, it was a really interesting discussion. What was that like for you? Was this an easy decision to kind of go on, to take the, to want to take on this role? Like, is this like, leadership skills or management skills or something that you're seeking to develop or was this kind of a more difficult decision for you? - I thought about this decision a lot, because I know that it is a ton of work and you are not compensated financially for it at all.

So that's not why people do this role. I went back and forth on it a lot, to be honest, because initially when I first started residency, the thought of becoming chief sounded terrifying, because I was just trying to get through the day of being a resident and not screwing up too badly.

But then as like time went on, I had a few people, there were fellows, co-residents and then previous chiefs that had told me, hey, I think your personality would be really good for this job so you should really consider it. And so then after enough people say that to you, you know, you kind of think, well maybe they're not just trying to make me feel better about myself, maybe they're just like actually honest and they think that I would do good in this role.

So then I started thinking about it more seriously. And also once I kind of narrowed down what I wanted to do with my career, that also helped because obviously as you know, I wanna, I'm going into transfusion medicine, and I kind of pictured what my like career would look like and I feel that my career is gonna be in academic medicine and I wanna be, my dream is to maybe one day be a fellowship director for a transfusion medicine program somewhere, I don't know where.

And so I feel like to do that kind of job and to be successful in that job to get leadership experience now, and I have had leadership experience in the past, but nothing quite like this. I feel like this is a very serious, valuable role that you really can't drop the ball and you have to stay on it and you have to be fair, and all while maintaining your residency education, which is quite the challenge. So I think that this role will help me be prepared for that.

So given all of that, that's when I finally decided okay, I think that this is the right decision for me even though it will be a lot of work. - Yeah, I could not agree with you more. And if I can tie together two things that you've said so far into a question, I was, you know, wondering,

you know, when you're talking about earlier about when you first started being afraid to ask questions, right? That kind of hurts my medical educator heart a little bit. I, you know, want people to want to ask questions. And then also you're a very deliberate person, obviously is talking about making this decision. For our audience of folks who might be going and following in your footsteps. You know, how do you kind of identify how you are doing, and what you should focus on?

- So I was thinking about this and I feel like there are two aspects of it. There are, you know, how am I doing educational wise and then also how am I doing professional wise and just with the day-to-day logistics of the service. So those are like the kind of two categories. For me, I think educational wise, I do need some improvement. Recently, we take the RISE, which is the Resident In Service Examination every year.

And we just took it this past March and I did not do as well as I wanted to do at all, but I am only a second year at that time. so what I'm doing to, you know, move forward from that is I want to start being more deliberate about my studying. I've taken the approach in the past where I write things down, I look them up, I read on Expert Path, do some casual reading, like while I'm on service.

But I think I need to start applying that knowledge to questions more so, 'cause that's how I've always succeeded with tests in the past. And so that's what I'm trying to do now is more so watching videos and doing questions and applying the information.

So we'll see how that helps me next year, because for the University of Michigan for our third year, they typically want us to score within a certain range, and then if not, then they kind of put you on a study plan, which isn't terrible, but I just, for me, I just wanna meet that mark so I know I can do it and then just move forward, you know?

But, and then as far as the logistics day-to-day measurement of success, the way I view that is for me personally, when I'm grossing a specimen and I type up a gross or I dictate a gross, if I don't get any questions about my gross, that means that it was really clear, right? Or if I don't have to go back to the bucket for something that I missed, that means that I know the cancer templates and I know what is needed to stage this X, Y, Z, whatever I'm grossing at the time.

So to me, I feel like getting less questions about clarity and having to go back on things that I should have known, like correct number of lymph nodes, things like that, that's how I've measured my success, and that has gone a lot better over the past year or so. - Right. And so, you're getting this feedback, and you're getting it from like, you just mentioned, through here through the RISE exam, for on the educational side.

And I really appreciate how you divide these two up, 'cause I think a lot of us in residency and fellowship programs are thinking about, what are the professional or service commitments versus the educational learning value, and trying to always kind of find that right balance between the two. So I like that you're kind of paying attention to those too. I'm curious, like for those who are listening to this podcast who, you know, have been, you know, learners and now are faculty members.

Do you have advice for, you know, what the rest of us faculty members, is there one thing that, you know, we could really focus on to become better mentors, to kind of be that assist for you to kind of continue to progress along both education and professional lines? - Yeah, so I would say that, and I don't know if this would be the most popular answer, but for me personally, what really helps me is when someone is respectfully direct.

And that's what I have learned that I really need to progress and to succeed in my training, because I feel that everyone we work with at University of Michigan is very nice, very approachable and very genuine. But not everyone tells you, 'cause sometimes people tell you what you want to hear and not necessarily what you need to hear.

And I think because it's challenging to convey that information without, you know, potentially hurting someone's feelings or it coming off the wrong way, because being respectfully direct I feel is a true talent and an art form, and I even struggle with that personally. I don't know, I'm working on it.

But I think that the advice that I've gotten from the mentors that I really value at Michigan have been the ones that have told me, you know, you should really do this because of this. And it may have not been what I wanted to hear at the time, but it was the most valuable advice that anyone could have told me.

- With the faculty, do you feel that in your trying to develop this ability, this skill, right, of being respectfully direct, that's one of the aspects you mentioned on wanting to focus on. Is that something that... What's the best piece of advice that you've gotten for how to do that well? - I don't know. I haven't really gotten advice for how to do that well yet, to be honest. I think it is kind of like, a learned practice. I see how other people do it well, and I try to emulate that.

But it hasn't really been, I haven't really gotten any specific advice for it yet.

But I feel like I will be getting into that as I transition into this co-chief and assistant co-chief role, because at some points, I'm going to have to be direct with my co-residents and also faculty members of whatever our goals or objectives are. - I think I'm gonna put a pin in that. 'Cause I'm kind of curious at next year, when we do our next installment of this series, to kind of explore that.

Because I feel like to some extent, like feedback, and perhaps appropriately so are usually quite private conversations. And, you know, maybe it's not as visible to those, like unless it's happening to us, maybe not as visible. So that's an interesting one.

As far as our student listeners, our residents that are listening here, and as you're going into and starting your third year of residency, what are you focusing on this new academic year, now that you're getting settled, you're hitting your stride, you got your fellowship mapped out. Where's your attention? - So my attention first and foremost right now is towards my education.

And so what I'm going to do is, the fourth years have like a condensed study plan of how they study during their like, dedicated elective time for boards. And so what I decided to do is to take that plan and stretch it out amongst all my rotations. So not in like a six week thing, but really stretch it out so if you have to do, you know, a hundred cytopathology questions, then you have two weeks to do that on, you know,

I guess that's like a 10 day rotation if you're only counting business days. So that's what I've been doing now. I'm not meeting those goals a hundred percent because I think that's impossible. So my goal is to just meet at least 60 to 70% of that material in that two week block, all rotations are all two weeks long, so that's kind of what I'm doing, and I'm hoping that that will be, that'll be a lot more studying than what I have been doing.

So I think it'll really show in my RISE score hopefully. The second thing that's most important to me this coming year is transitioning into that assistant co-chief role. And that's with basically managing all of the meetings and all of the things and emails that we have to do on a daily basis to keep the program afloat and going smoothly for all the other residents. And so that's gonna be my second main focus.

- You know, so maybe I should kind of close out this podcast and ask you, now that we're talking, we've been talking a lot of the actual work of being a resident. What if we flip it around the other way and think about, you know, are you, have you kind of figured out or hit a better stride as far as how to maintain like, a balance,

and like, to continue to work on your personal wellbeing? Has that kind of evolved in parallel? - Yeah, and I think it's actually been a lot easier than I thought it was going to be, 'cause I wasn't sure how it would be with, you know, my husband actually physically being here, 'cause I just wanna only spend time with him, and then just rush home, you know.

But I've been still working out, you know, three to four times a week, that's like my number one personal priority, 'cause if I'm not working out, I'm useless. And then also, like when he, thankfully is, thankfully, and unfortunately a night shift doctor. So when he's on shift, I don't really see him that much. But when he's not on shift, I really prioritize those weekends that I have off with him when he's also off.

So what that usually looks like for me is when I put in call request, I put that I don't wanna be on call the days that he's off, especially on weekends. And then thankfully our chief accommodates those pretty well usually. And so I just really prioritize the time that I do have at home. And then when he's on shift, then I just am on all business and getting a lot of stuff done, so. - Oh, right on.

We've been rounding with Dr. Isabella Holmes, talking about her reflections of residency, and this has really been an awesome series to continue. Thank you so much Dr. Holmes, for letting us continue this conversation. - Thank you. It was nice to be here again. - To all of our listeners, thank you for joining us today. We invite you to share your thoughts and suggestions via 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. (upbeat music)