WEBVTT 00:00:10.990 --> 00:00:13.070 Hello, anesthesia enthusiasts, and welcome to 00:00:13.070 --> 00:00:15.630 this month's episode of Style Points. Today, 00:00:15.750 --> 00:00:17.870 we've got an episode geared towards one of my 00:00:17.870 --> 00:00:20.809 favorite groups of people, medical students applying 00:00:20.809 --> 00:00:24.850 to residency in anesthesiology. Even if you aren't 00:00:24.850 --> 00:00:27.129 a medical student, though, I'm hoping that this 00:00:27.129 --> 00:00:29.350 episode provides you with an inside look at what 00:00:29.350 --> 00:00:32.189 it takes to become an anesthesiologist. Before 00:00:32.189 --> 00:00:34.509 I invite my fellow associate program director, 00:00:34.729 --> 00:00:37.929 Dr. Dustin Satoris, on the podcast, I'm going 00:00:37.929 --> 00:00:40.109 to turn it over to Nate, who will be introducing 00:00:40.109 --> 00:00:43.109 this month's RSI, which of course stands for 00:00:43.109 --> 00:00:46.429 Resident Selected Information. Thank you, John. 00:00:46.750 --> 00:00:49.649 Delivering our RSI is CA1 resident Anne Burgess. 00:00:49.909 --> 00:00:52.409 Anne was a college burn ball champion, which 00:00:52.409 --> 00:00:54.189 she described as an incredibly dangerous game 00:00:54.189 --> 00:00:56.750 of hockey without ice skates. If a burn ball 00:00:56.750 --> 00:00:59.049 trauma victim rolls into your ED tonight needing 00:00:59.049 --> 00:01:01.469 ventilatory support, you're in luck because Anne 00:01:01.469 --> 00:01:03.810 is going to teach us about ventilators. Welcome, 00:01:03.909 --> 00:01:06.859 Anne. The learning curve for new trainees is 00:01:06.859 --> 00:01:09.280 steep in the operating room as well as the intensive 00:01:09.280 --> 00:01:11.739 care unit, especially when throwing around terms 00:01:11.739 --> 00:01:16.640 like BCAC, SIMV, SBT, RISB. What do they all 00:01:16.640 --> 00:01:19.579 mean? How do I use them? Learning how to navigate 00:01:19.579 --> 00:01:21.840 the modes of mechanical ventilation can often 00:01:21.840 --> 00:01:24.959 feel overwhelming. So let's get into it. The 00:01:24.959 --> 00:01:27.299 goal of mechanical ventilation, in very simplified 00:01:27.299 --> 00:01:30.040 terms, is to provide oxygenation and ventilation. 00:01:30.760 --> 00:01:32.939 Patients may require mechanical ventilation for 00:01:32.939 --> 00:01:35.310 a whole host of reasons. from routine general 00:01:35.310 --> 00:01:37.810 anesthesia in the operating room to dire respiratory 00:01:37.810 --> 00:01:40.870 failure in the ICU. Regardless of the reason 00:01:40.870 --> 00:01:43.349 for requiring mechanical ventilation, the basics 00:01:43.349 --> 00:01:45.870 of vent management forms an important backbone 00:01:45.870 --> 00:01:49.450 of our practice in anesthesia. Some of the variables 00:01:49.450 --> 00:01:51.829 that we can manipulate when programming and adjusting 00:01:51.829 --> 00:01:55.430 the ventilator include the FiO2, positive end 00:01:55.430 --> 00:01:57.890 -expiratory pressure, otherwise known as PEEP, 00:01:58.049 --> 00:02:01.370 respiratory rate, and tidal volume or inspiratory 00:02:01.370 --> 00:02:03.469 pressure, depending on the ventilatory mode. 00:02:04.150 --> 00:02:06.829 FiO2 and PEEP will generally be adjusted to achieve 00:02:06.829 --> 00:02:09.849 oxygenation goals. Respiratory rate and tidal 00:02:09.849 --> 00:02:12.449 volume comprise minute ventilation and will therefore 00:02:12.449 --> 00:02:14.969 be adjusted to meet various ventilation goals. 00:02:15.909 --> 00:02:18.250 There are a couple of main themes within ventilator 00:02:18.250 --> 00:02:21.210 modes. We tend to use either volume or pressure 00:02:21.210 --> 00:02:24.349 as an independent variable, meaning you can decide 00:02:24.349 --> 00:02:26.310 to set either the volume or the pressure you 00:02:26.310 --> 00:02:28.310 want delivered, and the ventilator will figure 00:02:28.310 --> 00:02:31.030 out where to set the other one. At the same time, 00:02:31.050 --> 00:02:32.729 there are modes that account for patient effort, 00:02:33.050 --> 00:02:35.370 and those that do not. Volume -controlled ventilation 00:02:35.370 --> 00:02:37.849 delivers a set tidal volume with each breath. 00:02:38.090 --> 00:02:40.870 This is great for ensuring consistent tidal volumes 00:02:40.870 --> 00:02:42.810 and therefore a consistent minute ventilation. 00:02:43.430 --> 00:02:45.870 However, the mean airway pressure is generally 00:02:45.870 --> 00:02:48.210 lower than it is with pressure -controlled ventilation, 00:02:48.569 --> 00:02:50.889 which can lead to less effective oxygenation. 00:02:51.969 --> 00:02:54.610 Pressure -controlled ventilation delivers a breath 00:02:54.610 --> 00:02:57.250 until a set pressure is reached. This helps limit 00:02:57.250 --> 00:02:59.550 barotrauma, but tidal volumes can vary, leading 00:02:59.550 --> 00:03:02.479 to an inconsistent minute ventilation. However, 00:03:02.840 --> 00:03:04.939 mean airway pressures are higher in this mode, 00:03:05.039 --> 00:03:07.060 resulting in increased alveolar recruitment, 00:03:07.300 --> 00:03:10.319 therefore increased oxygenation. Note that both 00:03:10.319 --> 00:03:12.460 of these modes have control in the name. This 00:03:12.460 --> 00:03:14.419 means that the ventilator has full control of 00:03:14.419 --> 00:03:16.460 the patient's breathing. If the patient tries 00:03:16.460 --> 00:03:18.460 to take a breath on their own, the ventilator 00:03:18.460 --> 00:03:21.300 will not allow it. This is great for fully sedated 00:03:21.300 --> 00:03:23.900 patients or paralyzed patients, but this can 00:03:23.900 --> 00:03:26.479 lead to coughing, bucking, more formally known 00:03:26.479 --> 00:03:29.319 as ventilator dyssynchrony, if the patient tries 00:03:29.319 --> 00:03:30.979 to take a breath of their own while in these 00:03:30.979 --> 00:03:33.939 modes. In contrast, pressure support ventilation 00:03:33.939 --> 00:03:36.919 is entirely patient -triggered. Each breath is 00:03:36.919 --> 00:03:39.300 supported with a preset driving pressure. This 00:03:39.300 --> 00:03:41.719 is a great mode for ventilator weaning, but can 00:03:41.719 --> 00:03:44.020 also be dangerous if a patient stops initiating 00:03:44.020 --> 00:03:46.740 their own breaths. Assist control is more of 00:03:46.740 --> 00:03:49.259 a hybrid mode. Every breath is supported, whether 00:03:49.259 --> 00:03:52.159 initiated by the ventilator or the patient. This 00:03:52.159 --> 00:03:54.479 mode can be tacked onto volume control and is 00:03:54.479 --> 00:03:57.159 very common in ICUs as it will deliver a set 00:03:57.159 --> 00:03:59.099 volume when the patient's initiated a breath. 00:03:59.639 --> 00:04:01.860 but also have a backup minimum respiratory rate 00:04:01.860 --> 00:04:04.479 if the patient is not breathing at a rate greater 00:04:04.479 --> 00:04:06.939 than what is programmed on the vent. Synchronized 00:04:06.939 --> 00:04:10.460 intermittent mandatory ventilation, SIMV, also 00:04:10.460 --> 00:04:12.840 combines mandatory breaths with spontaneous breathing. 00:04:13.120 --> 00:04:16.300 It will deliver a fixed volume when the patient 00:04:16.300 --> 00:04:18.680 does not initiate a breath, but in contrast to 00:04:18.680 --> 00:04:20.959 assist control, it will only provide pressure 00:04:20.959 --> 00:04:23.800 support to patient -triggered breaths. Choosing 00:04:23.800 --> 00:04:25.779 the right mode depends entirely on the patient's 00:04:25.779 --> 00:04:28.000 lung mechanics, mental status, and underlying 00:04:28.000 --> 00:04:31.079 pathology. Other variables, like type of procedure 00:04:31.079 --> 00:04:33.879 or patient positioning, may also contribute towards 00:04:33.879 --> 00:04:36.399 choosing one mode over the other. So when do 00:04:36.399 --> 00:04:38.180 we know that it's time to stop mechanical ventilation 00:04:38.180 --> 00:04:40.500 and extubate? We look at a couple different areas 00:04:40.500 --> 00:04:42.579 when considering extubation, especially in the 00:04:42.579 --> 00:04:45.500 ICU, including lung mechanics, mental status, 00:04:45.660 --> 00:04:48.319 and the patient's overall clinical picture. A 00:04:48.319 --> 00:04:51.319 spontaneous breathing trial, or SBT, is the clinical 00:04:51.319 --> 00:04:53.600 test that is used to assess a patient's readiness 00:04:53.600 --> 00:04:57.060 for extubation in the ICU. In order to perform 00:04:57.060 --> 00:04:59.740 an SBT, Patients will typically need to be on 00:04:59.740 --> 00:05:02.740 minimal ventilatory settings. This varies from 00:05:02.740 --> 00:05:05.680 institution to institution, but tends to be an 00:05:05.680 --> 00:05:10.439 FI below 30 or 40 and a PEEP of 5 to 8. The SPT 00:05:10.439 --> 00:05:12.600 is typically performed by the respiratory therapist, 00:05:12.920 --> 00:05:14.939 and they will place the patient on pressure support 00:05:14.939 --> 00:05:18.399 for at least 30 minutes. The SPT can be stopped 00:05:18.399 --> 00:05:21.259 earlier if the patient isn't doing well. We then 00:05:21.259 --> 00:05:23.279 look at a few factors to decide whether the patient 00:05:23.279 --> 00:05:26.019 can be extubated. Typically, we will assess the 00:05:26.019 --> 00:05:28.740 patient's ability to maintain oxygenation by 00:05:28.740 --> 00:05:31.819 looking at the SpO2 or formal blood gas. In order 00:05:31.819 --> 00:05:34.040 to assess the patient's ventilation, we will 00:05:34.040 --> 00:05:37.920 calculate their RSBI or RISBI. The RISBI is the 00:05:37.920 --> 00:05:40.139 Rapid Shallow Breathing Index and is calculated 00:05:40.139 --> 00:05:42.480 by dividing their respiratory rate by the tidal 00:05:42.480 --> 00:05:45.920 volume. If a patient is breathing fast and shallow, 00:05:46.339 --> 00:05:49.240 their RISBI will be higher. This tells you that 00:05:49.240 --> 00:05:51.600 the patient may not be quite ready to be extubated. 00:05:52.120 --> 00:05:55.839 We typically use a threshold of 105 as our upper 00:05:55.839 --> 00:05:59.180 limit of an extubatable RISB, although some recent 00:05:59.180 --> 00:06:01.399 evidence may suggest that the trend in RISB may 00:06:01.399 --> 00:06:03.699 be more indicative of success than one standalone 00:06:03.699 --> 00:06:07.019 value. It isn't a perfect measure, but does provide 00:06:07.019 --> 00:06:09.519 some objective information about a patient's 00:06:09.519 --> 00:06:12.060 chance of success post -extubation. Ultimately, 00:06:12.199 --> 00:06:14.160 the decision to extubate does not rely solely 00:06:14.160 --> 00:06:17.339 on the SBT in your RISB. Patients must also be 00:06:17.339 --> 00:06:20.379 awake, following commands, clearing their secretions, 00:06:20.379 --> 00:06:23.519 and be able to protect their own airway. Pristine 00:06:23.519 --> 00:06:25.560 lung mechanics on its own does not guarantee 00:06:25.560 --> 00:06:27.120 that they are safe to be without a protected 00:06:27.120 --> 00:06:29.839 airway. Hopefully this helps give you a foundation 00:06:29.839 --> 00:06:32.459 for discussing these patients and demystifies 00:06:32.459 --> 00:06:35.399 the black box that is a ventilator. Happy venting 00:06:35.399 --> 00:06:45.990 and SBT -ing! And we are actually both associate 00:06:45.990 --> 00:06:48.069 program directors here at the University of Cincinnati 00:06:48.069 --> 00:06:50.930 as well. We're here to talk about applying for 00:06:50.930 --> 00:06:53.490 anesthesiology residency. But first, Dustin's 00:06:53.490 --> 00:06:55.449 going to give us some of his pro tips about how 00:06:55.449 --> 00:06:58.050 to remove a ring from your finger in the perioperative 00:06:58.050 --> 00:07:00.889 period. Dustin? All right. Well, thank you for 00:07:00.889 --> 00:07:04.589 having me. So that's a little bit of a story 00:07:04.589 --> 00:07:07.360 based on what happened when I was running. the 00:07:07.360 --> 00:07:10.100 board the other day for the hospital that we 00:07:10.100 --> 00:07:12.779 work at. And all of a sudden, my hand started 00:07:12.779 --> 00:07:19.639 swelling. And what started out as a casual idea 00:07:19.639 --> 00:07:23.019 to potentially remove my wedding ring that I've 00:07:23.019 --> 00:07:26.839 had on for 16 years turned into a relatively 00:07:26.839 --> 00:07:29.420 emergent situation as my finger began to swell 00:07:29.420 --> 00:07:32.819 pretty rapidly. But, you know, thanks to... John 00:07:32.819 --> 00:07:36.000 Crow and a few other of my helpful associates, 00:07:36.379 --> 00:07:40.040 we were able to use an emergency ring cutter. 00:07:40.240 --> 00:07:43.779 And then ultimately, we used, I think, four or 00:07:43.779 --> 00:07:45.800 five different emergency ring cutters. Yes, that's 00:07:45.800 --> 00:07:49.500 right. And then to my dismay, a very large bolt 00:07:49.500 --> 00:07:53.360 cutter to finish the job. But all is well. I 00:07:53.360 --> 00:07:55.759 live to fight another day and do not have to 00:07:55.759 --> 00:07:58.600 apply for disability. So that's good. Thank goodness. 00:07:58.939 --> 00:08:02.029 I did think that. we were going to have to prep 00:08:02.029 --> 00:08:04.350 one of the ORs for you at one point in time. 00:08:05.009 --> 00:08:07.649 I remember the, you know, I initially wanted 00:08:07.649 --> 00:08:10.350 to save it, and we tried the little trick where 00:08:10.350 --> 00:08:13.069 you put the... The floss wrap. Yeah, the floss 00:08:13.069 --> 00:08:16.589 wrap around. And I think you only get really 00:08:16.589 --> 00:08:20.189 one shot at that because it's pretty aggressive, 00:08:20.230 --> 00:08:23.569 and it starts to, the swelling cascade a lot 00:08:23.569 --> 00:08:26.970 more. So when that didn't work, it was, the writing 00:08:26.970 --> 00:08:29.009 was on the wall. We have a lot of people that 00:08:29.009 --> 00:08:30.970 are pretty good at removing rings. In fact, we 00:08:30.970 --> 00:08:33.070 have to do that to prevent burn injuries to people's 00:08:33.070 --> 00:08:35.710 fingers in the perioperative period. That's why 00:08:35.710 --> 00:08:37.509 we have people take off all their jewelry. But 00:08:37.509 --> 00:08:40.289 despite all of our expertise, this one was a 00:08:40.289 --> 00:08:43.970 particularly challenging one, I feel like. Yes, 00:08:43.970 --> 00:08:47.570 but again, you know. I can still see on your 00:08:47.570 --> 00:08:49.990 finger where. Oh, there's no escaping. There's 00:08:49.990 --> 00:08:52.789 no escaping the fact that I've been married for 00:08:52.789 --> 00:08:57.049 so long. Happily, I must say. But yes, the swelling 00:08:57.049 --> 00:09:00.669 is still there, but it's healing slowly but surely. 00:09:01.210 --> 00:09:04.230 Well, I'm glad. Well, what we're actually here 00:09:04.230 --> 00:09:07.250 to talk about today is applying for anesthesiology 00:09:07.250 --> 00:09:10.370 residency. Dustin, how long have you been an 00:09:10.370 --> 00:09:12.970 associate program director? So I've been an associate 00:09:12.970 --> 00:09:18.009 program director since 2017. And then even before 00:09:18.009 --> 00:09:23.490 that, I was involved with the process as a chief 00:09:23.490 --> 00:09:28.289 resident. the year before that or a couple of 00:09:28.289 --> 00:09:31.330 years before that, actually. And then and then 00:09:31.330 --> 00:09:33.789 again, like probably many of the people listening, 00:09:33.909 --> 00:09:37.009 I was involved on the other side as an applicant. 00:09:37.129 --> 00:09:41.009 So, you know, that's something we always we all 00:09:41.009 --> 00:09:44.509 share. So we all have hopefully you're not so 00:09:44.509 --> 00:09:47.549 far removed that you don't remember what it's 00:09:47.549 --> 00:09:51.629 like. And I think that provides. you know, a 00:09:51.629 --> 00:09:55.629 lot of structure to hopefully provide a lot of 00:09:55.629 --> 00:09:57.850 structure to the talk today. Do you think that 00:09:57.850 --> 00:10:00.870 it's easier or harder than it was when you were 00:10:00.870 --> 00:10:07.210 applying for residency? It's harder. And I think 00:10:07.210 --> 00:10:09.250 it's gotten a little more competitive, for sure. 00:10:10.049 --> 00:10:15.210 I think there is definitely a larger eye on anesthesia 00:10:15.210 --> 00:10:19.950 as as a great specialty. And a great career that 00:10:19.950 --> 00:10:26.350 people have tapped into. And I think like everybody 00:10:26.350 --> 00:10:29.149 else, you look at the applicants, if you're privy 00:10:29.149 --> 00:10:31.909 to them and you say, well, man, I don't know 00:10:31.909 --> 00:10:35.009 if I would have been able to match at this point 00:10:35.009 --> 00:10:38.269 in time if I was going up against all these wonderful 00:10:38.269 --> 00:10:41.690 applicants. Yeah, it's really kind of humbling 00:10:41.690 --> 00:10:43.389 when you're going through all of these different 00:10:43.389 --> 00:10:46.690 applications that are dramatically better than. 00:10:47.210 --> 00:10:49.590 At least mine was probably not yours, but they're 00:10:49.590 --> 00:10:52.330 definitely a lot better than mine. And thinking 00:10:52.330 --> 00:10:54.929 to yourself, wow, it's really kind of a privilege 00:10:54.929 --> 00:10:59.129 to get to pick out the people who we get to interview 00:10:59.129 --> 00:11:03.549 and who we get to ultimately match to our program. 00:11:03.850 --> 00:11:07.110 Right. Absolutely. And I think the big kind of 00:11:07.110 --> 00:11:09.230 overarching thing to remember as a medical student 00:11:09.230 --> 00:11:12.389 or anybody involved really is that, you know, 00:11:12.389 --> 00:11:16.059 by and large. Everyone's already made it to medical 00:11:16.059 --> 00:11:18.559 school. They've already had success in medical 00:11:18.559 --> 00:11:21.919 school. When you're applying to residency, you've 00:11:21.919 --> 00:11:24.379 already realized such great successes in your 00:11:24.379 --> 00:11:29.940 life that it's just inherent to the process that 00:11:29.940 --> 00:11:33.700 you're going to be presented with a ton of wonderful 00:11:33.700 --> 00:11:37.340 people who've done wonderful things. And that's 00:11:37.340 --> 00:11:40.120 ultimately a great thing for the specialty because 00:11:40.120 --> 00:11:43.919 we're all going to be colleagues someday. So 00:11:43.919 --> 00:11:46.919 let's put yourself in the shoes of a medical 00:11:46.919 --> 00:11:49.860 student who's maybe a second or third year medical 00:11:49.860 --> 00:11:52.320 student somewhere in there. And they have just 00:11:52.320 --> 00:11:55.139 decided anesthesiology is definitely the thing 00:11:55.139 --> 00:11:57.379 for them. Maybe they spent some time shadowing 00:11:57.379 --> 00:11:59.659 you and they figured out that's who I want to 00:11:59.659 --> 00:12:02.419 be when I grow up. Where do you go from there? 00:12:02.539 --> 00:12:07.539 How do you build a CV? How do you make it so 00:12:07.539 --> 00:12:11.120 that you are? Someone who the program directors 00:12:11.120 --> 00:12:13.299 will look at and say, that's the guy that I wanted 00:12:13.299 --> 00:12:19.980 our program. So finding mentors is really important 00:12:19.980 --> 00:12:22.879 and finding people that that have gone through 00:12:22.879 --> 00:12:26.539 the process that could be students that are that 00:12:26.539 --> 00:12:29.360 are. above you that have just done it it can 00:12:29.360 --> 00:12:31.799 be faculty at your home institution it can be 00:12:31.799 --> 00:12:34.840 people at other institutions but certainly finding 00:12:34.840 --> 00:12:37.700 mentors i think is the first step really asking 00:12:37.700 --> 00:12:41.159 as many questions as possible and getting a really 00:12:41.159 --> 00:12:44.639 good understanding of what the specialty is really 00:12:44.639 --> 00:12:47.740 like not only as a trainee but also as a faculty 00:12:47.740 --> 00:12:50.740 member eventually so that's the step for that's 00:12:50.740 --> 00:12:54.460 the first step and i think from there you really 00:12:54.460 --> 00:12:58.360 want to look at all the different things that 00:12:58.360 --> 00:13:02.519 make your application whole. First off, when 00:13:02.519 --> 00:13:04.580 we're talking about mentors, how do you find 00:13:04.580 --> 00:13:07.320 a good mentor? What kind of person would you 00:13:07.320 --> 00:13:09.059 be looking for? What kind of characteristics? 00:13:09.240 --> 00:13:11.179 Do they have to be an anesthesiologist, do you 00:13:11.179 --> 00:13:14.340 think? I don't think they have to be, but certainly 00:13:14.340 --> 00:13:16.879 that helps because they're going to be keenly 00:13:16.879 --> 00:13:21.000 aware and understanding and understand the specialty. 00:13:22.740 --> 00:13:27.149 It needs to be somebody who you potentially see 00:13:27.149 --> 00:13:32.190 yourself in or who you jive with, somebody who 00:13:32.190 --> 00:13:35.490 you get along with, somebody who you can tell 00:13:35.490 --> 00:13:38.409 maybe has your best interest at heart and is 00:13:38.409 --> 00:13:41.730 not doing it for other reasons. That's the first 00:13:41.730 --> 00:13:44.529 step. And then you're going to have a better 00:13:44.529 --> 00:13:47.750 outcome, I think, if you pick somebody in anesthesiology, 00:13:47.870 --> 00:13:50.549 because that person is going to understand the 00:13:50.549 --> 00:13:54.110 process. Yeah, I've found that to be true as 00:13:54.110 --> 00:13:58.059 well. I've definitely had some My mentees talked 00:13:58.059 --> 00:14:01.820 to me before about other mentors' advice that 00:14:01.820 --> 00:14:03.899 they've given, and I've thought to myself, oh, 00:14:03.960 --> 00:14:07.700 wow, that's actually not correct. And I can tell 00:14:07.700 --> 00:14:09.700 them definitively that it's not correct because 00:14:09.700 --> 00:14:12.340 I'm an associate program director. I'm the one 00:14:12.340 --> 00:14:14.600 who's looking through the applications and can 00:14:14.600 --> 00:14:17.320 help pick things out. That doesn't mean that 00:14:17.320 --> 00:14:19.480 you have to have somebody who's a program director 00:14:19.480 --> 00:14:22.240 as one of your mentors necessarily, but it definitely 00:14:22.240 --> 00:14:24.549 does help to have somebody who's... gone through 00:14:24.549 --> 00:14:26.370 the process themselves i think i agree with you 00:14:26.370 --> 00:14:31.149 yeah we i think uh earlier on we had some people 00:14:31.149 --> 00:14:34.870 here at our home institution who had been advised 00:14:34.870 --> 00:14:37.590 by somebody who wasn't in anesthesia and i think 00:14:37.590 --> 00:14:40.409 fortunately they found some people in our department 00:14:40.409 --> 00:14:43.330 and we were able to kind of give them the correct 00:14:43.330 --> 00:14:46.070 information i remember some of those stories 00:14:46.070 --> 00:14:49.970 distinctly so what makes an anesthesia application 00:14:49.970 --> 00:14:53.409 stand out If we're looking through hundreds or 00:14:53.409 --> 00:14:56.009 even thousands of applications, what's going 00:14:56.009 --> 00:14:58.549 to make someone stand out? The last few years, 00:14:58.570 --> 00:15:01.529 it has been thousands. It has been. Yes. So I 00:15:01.529 --> 00:15:05.330 think what you have to remember is when you're 00:15:05.330 --> 00:15:07.610 presenting an application, just like any other 00:15:07.610 --> 00:15:14.379 marketing professional. you become a marketing 00:15:14.379 --> 00:15:16.779 professional for that small period of time, right? 00:15:17.039 --> 00:15:20.320 And my wife is a creative director, so I know 00:15:20.320 --> 00:15:24.360 this uniquely well. But really what you're doing 00:15:24.360 --> 00:15:27.840 is you are telling a story. Just like somebody 00:15:27.840 --> 00:15:30.200 might be telling a story about a product, you're 00:15:30.200 --> 00:15:34.179 telling the story of your life and your professional 00:15:34.179 --> 00:15:38.480 life. And there are a few key things that you 00:15:38.480 --> 00:15:42.039 have to hit, but really providing a well -rounded... 00:15:42.799 --> 00:15:46.980 story is the key to having your application get 00:15:46.980 --> 00:15:49.539 noticed. So I'll go into some like specifics. 00:15:49.720 --> 00:15:57.059 Please do. First off, academics, you need to 00:15:57.059 --> 00:16:01.799 do well in your classes. And it's important that 00:16:01.799 --> 00:16:07.779 you have kind of handily handled the rigors of 00:16:07.779 --> 00:16:11.919 medical school. Residency doesn't necessarily 00:16:11.919 --> 00:16:15.139 get any easier, nor does being a junior attending. 00:16:15.360 --> 00:16:19.039 So, you know, having that where you confidently 00:16:19.039 --> 00:16:22.440 complete a medical school is a really good thing 00:16:22.440 --> 00:16:27.820 to see. Letters of recommendation. Having good 00:16:27.820 --> 00:16:30.440 letters of recommendation is great. Now, what 00:16:30.440 --> 00:16:32.480 does that mean, right? A good letter of recommendation. 00:16:32.580 --> 00:16:36.320 It means somebody who knows you well, somebody 00:16:36.320 --> 00:16:40.419 who has some insight into your character. and 00:16:40.419 --> 00:16:44.419 potentially has some more than surface -level 00:16:44.419 --> 00:16:47.379 interaction with you, ideally over a long period 00:16:47.379 --> 00:16:50.799 of time. So for some people, that's an anesthesiologist. 00:16:51.080 --> 00:16:55.179 For other people, that's a pediatrician or maybe 00:16:55.179 --> 00:16:57.700 an advisor that you had all through medical school. 00:16:59.320 --> 00:17:08.190 It can be anybody, but it's going to be... best 00:17:08.190 --> 00:17:10.650 if you have at least some letters of recommendation 00:17:10.650 --> 00:17:15.710 from an anesthesiologist. I've read through, 00:17:15.769 --> 00:17:18.490 again, thousands of these letters of recommendation. 00:17:18.910 --> 00:17:22.750 They fall into a few categories that I've seen. 00:17:24.509 --> 00:17:27.630 Would you agree with me that about 85 % to 90 00:17:27.630 --> 00:17:31.049 % of letters of recommendation are almost exactly 00:17:31.049 --> 00:17:34.849 the same? Yeah, they follow a cadence. So they 00:17:34.849 --> 00:17:37.829 follow a little bit of a cadence. And you got 00:17:37.829 --> 00:17:41.109 to think that if you are a faculty member who 00:17:41.109 --> 00:17:44.069 is writing a lot of these, there has to be some 00:17:44.069 --> 00:17:48.109 type of kind of prescribed way of doing it so 00:17:48.109 --> 00:17:50.930 that you hit all the points, hit all the high 00:17:50.930 --> 00:17:53.789 points, the style points, if you will. And then 00:17:53.789 --> 00:18:01.980 you want to make sure that you are. speaking 00:18:01.980 --> 00:18:06.819 the language that is going to resonate with the 00:18:06.819 --> 00:18:09.460 people reading the application. So who would 00:18:09.460 --> 00:18:12.000 be a good example of somebody who could write 00:18:12.000 --> 00:18:15.140 a great letter of recommendation? And maybe what 00:18:15.140 --> 00:18:17.680 are some characteristics of some letter writers 00:18:17.680 --> 00:18:21.059 that you don't think would do as good of a job 00:18:21.059 --> 00:18:24.630 writing a letter of recommendation? That's a 00:18:24.630 --> 00:18:27.450 great question. So I can give you a personal 00:18:27.450 --> 00:18:29.730 anecdote. So I had a letter of recommendation. 00:18:29.970 --> 00:18:32.430 And while you're not, you know, you waive your 00:18:32.430 --> 00:18:34.569 right to see your letters of recommendation. 00:18:35.210 --> 00:18:38.750 But I'm very confident that one of my best letters 00:18:38.750 --> 00:18:42.650 of recommendation was from a pediatrician that 00:18:42.650 --> 00:18:48.910 had a pretty prominent role in the patient safety 00:18:48.910 --> 00:18:54.880 sector at Cincinnati Children's. Now, I had no 00:18:54.880 --> 00:18:56.880 interest in being a pediatrician, and you know 00:18:56.880 --> 00:19:01.240 me very well, and that's not where my aptitudes 00:19:01.240 --> 00:19:05.380 are necessarily. I like being a dad, but I don't 00:19:05.380 --> 00:19:09.799 like being a pediatrician. Me too. Yes. And so 00:19:09.799 --> 00:19:13.279 I'm confident that that was a great letter. I 00:19:13.279 --> 00:19:15.960 had great interactions with this person. We had 00:19:15.960 --> 00:19:19.160 talks outside of just medicine through my two 00:19:19.160 --> 00:19:22.400 months that I was there. And I had him all two 00:19:22.400 --> 00:19:24.619 months. So that's a pretty long period of time 00:19:24.619 --> 00:19:27.480 as a medical student. So I think that that is, 00:19:27.480 --> 00:19:30.700 you know, again, longitudinal interaction with 00:19:30.700 --> 00:19:35.640 something beyond just surface level academic 00:19:35.640 --> 00:19:51.630 interaction, I think is great. some people who 00:19:51.630 --> 00:19:56.670 were newly diagnosed with ALS. And it was quite 00:19:56.670 --> 00:20:00.230 an emotional thing to be there while these people 00:20:00.230 --> 00:20:04.569 were being told that they had this disease process 00:20:04.569 --> 00:20:10.009 that's ultimately terminal. And being there through 00:20:10.009 --> 00:20:13.029 those situations, talking to the patients through 00:20:13.029 --> 00:20:15.109 those situations, and the professor had seen 00:20:15.109 --> 00:20:19.450 me in those kind of critical situations, I think... 00:20:19.769 --> 00:20:22.349 Helped him write a really nice letter for me. 00:20:24.009 --> 00:20:27.130 Absolutely. That's a I mean, very parallel type 00:20:27.130 --> 00:20:30.710 stories. You know, you're going to get letters 00:20:30.710 --> 00:20:33.650 from the chairman of the department oftentimes 00:20:33.650 --> 00:20:36.250 or a program director of your home institution. 00:20:36.490 --> 00:20:38.589 The chairs write all those letters personally 00:20:38.589 --> 00:20:41.569 by hand. I understand. Yes. With papyrus and 00:20:41.569 --> 00:20:45.210 a quill pen. Yes. But no, it's you know, it's 00:20:45.210 --> 00:20:48.509 a kind of. something that sort of has to happen 00:20:48.509 --> 00:20:51.789 and it needs to be there um that does that's 00:20:51.789 --> 00:20:53.450 not to say that some of them aren't personal 00:20:53.450 --> 00:20:55.670 some of them can be very personal that's true 00:20:55.670 --> 00:20:58.869 but you have to you have to imagine how many 00:20:58.869 --> 00:21:04.529 uh those people are writing so um you know you 00:21:04.529 --> 00:21:05.950 still got to go through the motions and get those 00:21:05.950 --> 00:21:09.089 letters if you're applying but um you know finding 00:21:09.089 --> 00:21:12.069 at least one or two letters from somebody who 00:21:12.069 --> 00:21:15.150 knows you really well is really the key Also, 00:21:15.250 --> 00:21:17.529 you definitely need to have some anesthesia letters 00:21:17.529 --> 00:21:20.289 as well. I think it's probably a red flag if 00:21:20.289 --> 00:21:22.630 you don't have any letters from an anesthesiologist. 00:21:22.809 --> 00:21:28.269 100%. 100%. Because that shows that you have 00:21:28.269 --> 00:21:33.569 done some due diligence in actually talking to 00:21:33.569 --> 00:21:37.809 somebody in the field. So let's move to personal 00:21:37.809 --> 00:21:40.789 statements. Yes. This is always a very challenging 00:21:40.789 --> 00:21:44.289 issue with personal statements. One of the things 00:21:44.289 --> 00:21:46.650 that I wanted to offer to whoever is listening 00:21:46.650 --> 00:21:49.150 is I remember writing my personal statement, 00:21:49.309 --> 00:21:51.789 went through a whole bunch of edits. I thought 00:21:51.789 --> 00:21:53.809 that it was great. I submitted it. I got into 00:21:53.809 --> 00:21:58.250 residency. But when I was advising people and 00:21:58.250 --> 00:22:00.130 editing their personal statements years later 00:22:00.130 --> 00:22:03.009 as a program director, I kept coming across some 00:22:03.009 --> 00:22:05.869 of the same themes. This is a little bit too 00:22:05.869 --> 00:22:07.630 cheesy. You're not putting enough of yourself 00:22:07.630 --> 00:22:10.920 into it. And so what I eventually did is i looked 00:22:10.920 --> 00:22:15.200 back at my own personal statement and i i was 00:22:15.200 --> 00:22:18.940 somewhat unsurprised to find that it was just 00:22:18.940 --> 00:22:24.859 as bad as everyone else's oh yes hindsight is 00:22:24.859 --> 00:22:28.880 20 20. and so what i did was i i saved my old 00:22:28.880 --> 00:22:33.980 one i edited my old one uh knowing that it isn't 00:22:33.980 --> 00:22:37.740 for anything now but i made it much much much 00:22:37.740 --> 00:22:40.420 better from perspective of a program director. 00:22:40.579 --> 00:22:44.559 So I have a before and after that I'd be willing 00:22:44.559 --> 00:22:47.059 to share with anybody who is listening to the 00:22:47.059 --> 00:22:50.519 podcast if they want to see the example of what 00:22:50.519 --> 00:22:53.140 a normal personal statement looks like versus 00:22:53.140 --> 00:22:55.019 what I think a pretty decent personal statement 00:22:55.019 --> 00:22:57.299 looks like. So if you're interested in that, 00:22:57.339 --> 00:23:00.059 you can just email me at stylepointspodcast .gmail 00:23:00.059 --> 00:23:04.279 .com. That's very interesting. I remember writing 00:23:04.279 --> 00:23:07.180 mine and thinking it was good at the time. I 00:23:07.180 --> 00:23:08.680 haven't done what you've done and looked back 00:23:08.680 --> 00:23:13.259 at it. I'm sure it's horrid, but it was just 00:23:13.259 --> 00:23:16.400 cheesy. I did take a chance and really not mention 00:23:16.400 --> 00:23:21.940 anesthesia. It was really all about playing soccer, 00:23:22.259 --> 00:23:24.740 which actually does become somewhat of a theme 00:23:24.740 --> 00:23:28.000 where people talk about something that was big 00:23:28.000 --> 00:23:33.620 in their life growing up or whatever. personal 00:23:33.620 --> 00:23:36.680 anecdotes about interactions with medicine, maybe 00:23:36.680 --> 00:23:43.319 from the patient's side, or pivotal cases that 00:23:43.319 --> 00:23:45.960 they experienced that maybe were like a thunderclap 00:23:45.960 --> 00:23:48.660 moment where they decided they wanted to do anesthesia. 00:23:48.720 --> 00:23:52.099 I see that a lot too. Yeah, I've seen a lot of 00:23:52.099 --> 00:23:54.000 different themes and personal statements. People 00:23:54.000 --> 00:23:59.079 will draw out extended metaphors about how anesthesia 00:23:59.079 --> 00:24:01.579 is like sailing a boat or like climbing a mountain. 00:24:02.469 --> 00:24:04.890 I think that's fine. I think that falls within 00:24:04.890 --> 00:24:07.130 the 85 % to 90 % of personal statements that 00:24:07.130 --> 00:24:09.589 are, again, sort of like letters of rec. They 00:24:09.589 --> 00:24:12.670 fall into kind of certain categories, whether 00:24:12.670 --> 00:24:15.410 it's telling a personal medical story about how 00:24:15.410 --> 00:24:18.130 they became interested in anesthesia or in medicine 00:24:18.130 --> 00:24:21.769 in general, which was mine. I had my back surgery 00:24:21.769 --> 00:24:25.349 back when I was 15 or 16, and that was sort of 00:24:25.349 --> 00:24:28.170 what I have come to view as more of a turning 00:24:28.170 --> 00:24:30.369 point in my life that pointed me towards medicine 00:24:30.369 --> 00:24:34.940 and ultimately anesthesia. Or, you know, you 00:24:34.940 --> 00:24:37.720 can draw upon whatever experience in your life 00:24:37.720 --> 00:24:40.519 has brought you to where you are. The one thing 00:24:40.519 --> 00:24:42.740 that I definitely recommend to people in their 00:24:42.740 --> 00:24:46.200 personal statement is read it out loud to yourself. 00:24:46.500 --> 00:24:49.920 And if you think to yourself, I sound really 00:24:49.920 --> 00:24:52.579 cheesy and I don't like how I feel when I'm reading 00:24:52.579 --> 00:24:55.819 it out loud, rewrite it. Try again. Yeah, don't 00:24:55.819 --> 00:24:58.140 be afraid to start over. Yeah, use more natural 00:24:58.140 --> 00:25:01.859 language like... you would actually tell somebody. 00:25:01.980 --> 00:25:04.279 Don't use words in your personal statement that 00:25:04.279 --> 00:25:06.240 you don't use in real life is something that 00:25:06.240 --> 00:25:08.599 I will often tell people. That is very, very 00:25:08.599 --> 00:25:11.880 good advice because ultimately, again, you're 00:25:11.880 --> 00:25:14.579 trying to tell a story and someone needs to be 00:25:14.579 --> 00:25:16.400 able to read your story and needs to be able 00:25:16.400 --> 00:25:21.319 to remain involved and interested in what you're 00:25:21.319 --> 00:25:23.940 saying. One thing that's interesting, I think, 00:25:23.960 --> 00:25:25.579 about personal statements that we should probably 00:25:25.579 --> 00:25:30.049 mention is AI. Oh, yeah, for sure. And chat GPT 00:25:30.049 --> 00:25:35.250 and the like. In the future, I'm sure that this 00:25:35.250 --> 00:25:38.789 is going to become rampant and identifying it 00:25:38.789 --> 00:25:42.630 as going to, I will bet, be much more challenging 00:25:42.630 --> 00:25:45.670 over time, that it's going to be challenging. 00:25:45.809 --> 00:25:48.670 So figuring out a way to write your personal 00:25:48.670 --> 00:25:55.190 statement such that it is absolutely guaranteed 00:25:55.190 --> 00:26:00.329 that you are. writing it yourself and not having 00:26:00.329 --> 00:26:04.089 an AI -based program write it, I think is going 00:26:04.089 --> 00:26:07.190 to be good. The converse is if someone finds 00:26:07.190 --> 00:26:10.470 out that you are writing it with an AI -based 00:26:10.470 --> 00:26:12.670 program, I think that that would be a major red 00:26:12.670 --> 00:26:16.529 flag. I think so too. But I think that what a 00:26:16.529 --> 00:26:19.289 lot of people are using AI for is not necessarily 00:26:19.289 --> 00:26:22.349 writing the entire thing and submitting it as 00:26:22.349 --> 00:26:24.819 is. They're using it... As more of a mentor, 00:26:24.880 --> 00:26:28.319 as a creative editor, somebody who can put things 00:26:28.319 --> 00:26:30.220 in a little bit better language. You know, after 00:26:30.220 --> 00:26:32.799 all, as medical students, we're not really trained 00:26:32.799 --> 00:26:36.119 as creative writers or marketers. We're trained 00:26:36.119 --> 00:26:40.099 as medical students. That's right. So I think 00:26:40.099 --> 00:26:42.420 it's reasonable to use resources at your disposal 00:26:42.420 --> 00:26:45.119 to use AI to help edit things, to help give you 00:26:45.119 --> 00:26:49.359 ideas. But doing the whole thing for you, I think 00:26:49.359 --> 00:26:51.480 it's just going to come across as extremely generic. 00:26:52.599 --> 00:26:56.079 100%. I think the best prescription I have for 00:26:56.079 --> 00:26:59.200 personal statements is just be radically honest, 00:26:59.299 --> 00:27:01.700 not just with who you're writing it to, but with 00:27:01.700 --> 00:27:04.359 yourself. Why are you really interested in it? 00:27:04.440 --> 00:27:06.579 What is driving you? Where are you coming from? 00:27:07.119 --> 00:27:12.440 The best personal statements that I have read 00:27:12.440 --> 00:27:16.460 have just been radically honest. get to the heart 00:27:16.460 --> 00:27:19.420 of why that person wants to do anesthesia. I 00:27:19.420 --> 00:27:21.319 think one other thing we should mention is the 00:27:21.319 --> 00:27:24.680 last paragraph, which has been more frequently 00:27:24.680 --> 00:27:27.559 co -opted than ever. Can you talk about what 00:27:27.559 --> 00:27:29.119 the last paragraph of the personal statement 00:27:29.119 --> 00:27:31.220 should be, whether it should be personalized 00:27:31.220 --> 00:27:32.980 per program? It seems like this is something 00:27:32.980 --> 00:27:36.440 that is being taught, but I'm all for it. The 00:27:36.440 --> 00:27:39.039 last paragraph seems to be some type of tie -in 00:27:39.039 --> 00:27:45.140 where you tie in your experiences to to what 00:27:45.140 --> 00:27:48.700 you want to do in residency and potentially in 00:27:48.700 --> 00:27:54.000 your career. And it also gives you an opportunity 00:27:54.000 --> 00:27:57.180 to personalize it to whoever you're applying 00:27:57.180 --> 00:28:01.420 to. And I see that not infrequently where people 00:28:01.420 --> 00:28:04.460 personalize it. And that's actually a really 00:28:04.460 --> 00:28:06.880 powerful tool that you can have because you're 00:28:06.880 --> 00:28:09.200 like, just, you know, everybody's human. And 00:28:09.200 --> 00:28:12.299 when someone is personalizing it seemingly to 00:28:12.299 --> 00:28:15.420 you, That is something that you gravitate towards. 00:28:15.900 --> 00:28:19.299 That's a very common human emotion is, oh, they 00:28:19.299 --> 00:28:23.299 like me. I like them too. So that's a nice thing. 00:28:25.440 --> 00:28:28.380 Is that what you were getting at? Yeah, I've 00:28:28.380 --> 00:28:31.660 seen a lot of personal statements over time, 00:28:31.779 --> 00:28:35.079 and I've seen a definite trend towards the personalization 00:28:35.079 --> 00:28:37.839 of the last paragraph. You know, with the signaling 00:28:37.839 --> 00:28:42.250 now. there's really only about 15 programs that 00:28:42.250 --> 00:28:47.109 people are applying to very seriously. And with 00:28:47.109 --> 00:28:49.029 those 15 programs, you know, if you're applying 00:28:49.029 --> 00:28:51.069 to 50 programs, I think it's pretty impossible 00:28:51.069 --> 00:28:54.190 to write a personalized personal statement to 00:28:54.190 --> 00:28:58.230 50 programs. And fraught with potential error. 00:28:58.450 --> 00:29:02.490 Yes, with catastrophic error. If you accidentally 00:29:02.490 --> 00:29:07.269 copy and paste the wrong thing, it can be a... 00:29:07.529 --> 00:29:09.910 That's a kill shot. Yeah, that's that's bad news. 00:29:10.910 --> 00:29:14.690 But seeing why the person is interested in your 00:29:14.690 --> 00:29:17.150 program beyond just, oh, your program has a lot 00:29:17.150 --> 00:29:19.049 of liver transplants. And I think that that's 00:29:19.049 --> 00:29:22.150 really great. OK, that's fine. But if they have 00:29:22.150 --> 00:29:25.569 a real reason why they want to come here, for 00:29:25.569 --> 00:29:28.049 example, you know, I really like your program. 00:29:28.349 --> 00:29:32.509 And, you know, my sister lives here in Cincinnati 00:29:32.509 --> 00:29:36.220 and I. grew up just across the river, or I have 00:29:36.220 --> 00:29:39.420 a specific reason why it's not just your program, 00:29:39.480 --> 00:29:41.559 but it's the city, it's the culture, it's everything. 00:29:42.380 --> 00:29:44.539 When you have something more compelling like 00:29:44.539 --> 00:29:48.380 that, I think that can really help you out. I 00:29:48.380 --> 00:29:51.519 agree with that. I think that it's your chance 00:29:51.519 --> 00:29:54.599 of tying it all together. The one last thing 00:29:54.599 --> 00:29:57.160 I'd like to say about personal statements is 00:29:57.160 --> 00:30:03.990 what I ask myself after I read one is, Or not 00:30:03.990 --> 00:30:08.069 what I ask myself, but what I want to hear after 00:30:08.069 --> 00:30:11.670 I read it is, man, I have to meet this guy. I 00:30:11.670 --> 00:30:14.230 have to meet this girl. Absolutely. That's the 00:30:14.230 --> 00:30:18.369 key is I want to meet this person. Like, listen 00:30:18.369 --> 00:30:21.609 to this story. I need to meet this person. And 00:30:21.609 --> 00:30:23.470 that's all you're trying to get across in the 00:30:23.470 --> 00:30:25.150 end of the day. You've got to get to the next 00:30:25.150 --> 00:30:29.930 stage. Yeah, absolutely. So it's not just about 00:30:29.930 --> 00:30:31.430 the personal statement and the letters direct. 00:30:31.490 --> 00:30:35.430 We also have to. Do well in your classes. And 00:30:35.430 --> 00:30:37.589 let's talk about the importance of step scores, 00:30:37.769 --> 00:30:41.549 too. We don't have a step one score anymore to 00:30:41.549 --> 00:30:44.670 look at. That's that's gone away. No. And honestly, 00:30:44.890 --> 00:30:50.289 the objective data that we have when you look 00:30:50.289 --> 00:30:52.910 at dean's letters from medical students or from 00:30:52.910 --> 00:30:56.549 medical schools and everything, a lot of things 00:30:56.549 --> 00:31:00.150 have been going to much more of a pass fail type 00:31:00.150 --> 00:31:03.819 system. there's a lot less objective data. And, 00:31:03.839 --> 00:31:07.359 you know, chiefly step one being away is a good 00:31:07.359 --> 00:31:12.079 example of that. But this makes it pretty onerous 00:31:12.079 --> 00:31:14.980 when you're trying to compare people across different 00:31:14.980 --> 00:31:20.779 institutions. So, you know, I hate to say it, 00:31:20.819 --> 00:31:23.380 but I think that the elimination of step one 00:31:23.380 --> 00:31:29.710 has put a huge burden on students. to do really 00:31:29.710 --> 00:31:31.569 well on step two because that's the only one 00:31:31.569 --> 00:31:35.210 with an objective score attached to it and while 00:31:35.210 --> 00:31:39.589 previously uh you know if you did less than your 00:31:39.589 --> 00:31:42.109 best on step one but everything else in your 00:31:42.109 --> 00:31:45.769 application uh pointed to you being a stellar 00:31:45.769 --> 00:31:48.089 student but you just had a bad day which can 00:31:48.089 --> 00:31:51.509 happen we're all human right um well you had 00:31:51.509 --> 00:31:53.569 a chance to redeem yourself on step two that 00:31:53.569 --> 00:31:57.759 no longer exists right so um I think it's a little 00:31:57.759 --> 00:32:02.400 unfortunate how it's being done now, but it does 00:32:02.400 --> 00:32:09.640 inherently show the importance of kind of really 00:32:09.640 --> 00:32:12.420 studying, playing the game, and doing very, very 00:32:12.420 --> 00:32:15.799 well on step two. What about class rank? What 00:32:15.799 --> 00:32:21.519 do you think? Class rank is more of an objective 00:32:21.519 --> 00:32:24.579 longitudinal. That's another thing to say, actually, 00:32:24.619 --> 00:32:27.779 is that even though you might be pass -fail in 00:32:27.779 --> 00:32:30.799 your classes with what you get on your transcript, 00:32:31.059 --> 00:32:33.799 that doesn't necessarily mean that the school 00:32:33.799 --> 00:32:37.759 itself is not keeping track of people in terms 00:32:37.759 --> 00:32:40.200 of putting them into quartiles or quintiles or 00:32:40.200 --> 00:32:42.940 whatever. I think we do look at that, and I think 00:32:42.940 --> 00:32:45.420 that that's important. It demonstrates kind of 00:32:45.420 --> 00:32:48.519 longitudinal achievement and achievement in other 00:32:48.519 --> 00:32:50.960 disciplines. I really like it when people do 00:32:50.960 --> 00:32:56.609 really well. in subjects that are not anesthesia. 00:32:56.750 --> 00:33:00.589 That means that they're trying their best through 00:33:00.589 --> 00:33:03.950 all facets of their education and really trying 00:33:03.950 --> 00:33:08.809 to kind of suck the marrow from the bone no matter 00:33:08.809 --> 00:33:11.990 where they are. And I think that that's extremely 00:33:11.990 --> 00:33:14.630 important and shows a lot of character. Yeah, 00:33:14.690 --> 00:33:17.369 I agree. It's really nice to see when you can 00:33:17.369 --> 00:33:20.069 see demonstrated across their application and 00:33:20.069 --> 00:33:22.369 all the different facets. This person was trying 00:33:22.369 --> 00:33:25.109 hard no matter what situation they were in, even 00:33:25.109 --> 00:33:29.329 if they were on a rotation that they should have 00:33:29.329 --> 00:33:32.410 no reason to care deeply about. It's just the 00:33:32.410 --> 00:33:34.069 type of person that they are. It's part of the 00:33:34.069 --> 00:33:39.930 story. That's right. So let's talk about one 00:33:39.930 --> 00:33:44.819 other thing in terms of. The application. One 00:33:44.819 --> 00:33:48.220 of the things that I've seen on people's applications 00:33:48.220 --> 00:33:51.180 recently and has gained more importance with 00:33:51.180 --> 00:33:54.259 the elimination of step scores is the research 00:33:54.259 --> 00:33:58.180 aspect of it. How do you do research in anesthesia? 00:33:58.200 --> 00:34:00.759 How do you make that part of your application 00:34:00.759 --> 00:34:06.380 stronger? Is it important? So like most good 00:34:06.380 --> 00:34:10.219 questions and most. stellar answers. It depends. 00:34:10.440 --> 00:34:14.760 But no, I think research is important. It's not 00:34:14.760 --> 00:34:18.239 something that is mandatory. I will say that. 00:34:18.840 --> 00:34:20.940 When you're looking at extracurriculars, and 00:34:20.940 --> 00:34:24.880 research, I think, is included in that. Research 00:34:24.880 --> 00:34:28.420 can be everything from clinical research to bench 00:34:28.420 --> 00:34:32.199 science research to quality improvement projects 00:34:32.199 --> 00:34:35.460 to patient safety research. There's a lot of 00:34:35.460 --> 00:34:38.300 different avenues that you can take that you're 00:34:38.679 --> 00:34:42.619 institution might be involved with that you can 00:34:42.619 --> 00:34:47.480 also get involved with. Certainly, you know, 00:34:47.480 --> 00:34:50.519 checking the box is less important than having 00:34:50.519 --> 00:34:57.440 a tangible position or a tangible experience 00:34:57.440 --> 00:35:01.550 within that body of research. So now I know medical 00:35:01.550 --> 00:35:03.650 students don't have all that much time, right? 00:35:03.969 --> 00:35:06.289 So you don't have all that much time to be involved. 00:35:06.469 --> 00:35:09.110 But with the time that you do have or over a 00:35:09.110 --> 00:35:10.809 longitudinal period of time, I think that that's 00:35:10.809 --> 00:35:14.030 kind of more important. And certainly you'd like 00:35:14.030 --> 00:35:16.449 to get something out of it in terms of a publication, 00:35:16.670 --> 00:35:19.949 whether that be a poster presentation or an abstract 00:35:19.949 --> 00:35:22.610 or something. We certainly look at those things 00:35:22.610 --> 00:35:27.880 and see if people are. involved with and contributing 00:35:27.880 --> 00:35:31.340 to the anesthesia literature and to the academic 00:35:31.340 --> 00:35:36.840 nature of anesthesiology over their short career. 00:35:37.820 --> 00:35:41.199 One of the things that has become more important 00:35:41.199 --> 00:35:44.219 over time is finding ways to separate one medical 00:35:44.219 --> 00:35:48.400 student from another. Now, if your college of 00:35:48.400 --> 00:35:50.760 medicine has decided we're not going to give 00:35:50.760 --> 00:35:53.280 grades to anybody, we're not going to rank anybody, 00:35:53.519 --> 00:35:56.579 we just think that... Everyone is wonderful who 00:35:56.579 --> 00:36:00.199 graduates from here, and that's what we're going 00:36:00.199 --> 00:36:03.900 to put forward. It makes it very hard to tell 00:36:03.900 --> 00:36:05.500 one medical student from another, and it makes 00:36:05.500 --> 00:36:09.320 it very hard for those medical students to show 00:36:09.320 --> 00:36:12.179 that they're the kind of person who is going 00:36:12.179 --> 00:36:16.039 to blossom in residency. So one of the things 00:36:16.039 --> 00:36:21.699 that we look at is how much have you done in 00:36:21.699 --> 00:36:24.829 terms of your publications now? It's become more 00:36:24.829 --> 00:36:26.550 and more important. Do you need to be excellent 00:36:26.550 --> 00:36:29.010 at doing research to be a great anesthesiologist? 00:36:29.130 --> 00:36:37.289 No. But it sort of is a replacement for effort. 00:36:37.889 --> 00:36:41.630 Do you need to know all the stuff on step two 00:36:41.630 --> 00:36:44.489 to be a great anesthesiologist? Also no. But 00:36:44.489 --> 00:36:49.289 it sort of describes how much effort you're willing 00:36:49.289 --> 00:36:51.750 to put into things by studying hard for that 00:36:51.750 --> 00:36:55.039 test. And it describes how much effort that you're 00:36:55.039 --> 00:36:57.980 going to put into things if instead of having 00:36:57.980 --> 00:37:02.920 one case report, you have maybe 10 or you've 00:37:02.920 --> 00:37:05.039 done multiple posters and you've gone to multiple 00:37:05.039 --> 00:37:08.579 conferences. It just shows the amount of effort 00:37:08.579 --> 00:37:10.840 that you're willing to put into things on top 00:37:10.840 --> 00:37:13.059 of getting good grades, getting good step scores, 00:37:13.179 --> 00:37:15.380 everything else. Yeah, I totally agree with that. 00:37:15.420 --> 00:37:17.800 I think that that's a good way of saying it. 00:37:18.349 --> 00:37:20.710 Overall, when you're looking at an application, 00:37:20.969 --> 00:37:23.050 how long does it take you to go over one of these 00:37:23.050 --> 00:37:32.130 applications? It's a trick question because there 00:37:32.130 --> 00:37:36.329 can be things in your application that make me 00:37:36.329 --> 00:37:39.969 look at it for a very short amount of time. Certain 00:37:39.969 --> 00:37:42.170 potential red flags, which we can get into later, 00:37:42.329 --> 00:37:44.610 actually. Let's do red flags now. You want to? 00:37:44.690 --> 00:37:48.960 Yeah. Okay. All right. So some red flags would 00:37:48.960 --> 00:37:53.579 be, you know, failing your board exams altogether. 00:37:54.099 --> 00:37:59.480 Sure. That's usually a red flag. Is it possible 00:37:59.480 --> 00:38:03.460 to get over that red flag? It is. I think almost 00:38:03.460 --> 00:38:08.159 everything is, you know, nothing's insurmountable, 00:38:08.239 --> 00:38:11.559 completely insurmountable, but certainly it can 00:38:11.559 --> 00:38:15.239 create an uphill battle for you. Sure. So that's 00:38:15.239 --> 00:38:20.190 one thing. We can go extreme. Felony convictions. 00:38:21.070 --> 00:38:26.210 Sure, yeah. If you are a felon that has taken 00:38:26.210 --> 00:38:29.349 a lot of drugs and killed people, I think that 00:38:29.349 --> 00:38:31.469 that's probably not a— It's tough. It's going 00:38:31.469 --> 00:38:33.969 to be an uphill battle, as we say. It's going 00:38:33.969 --> 00:38:36.550 to make it harder to get into anesthesia. That's 00:38:36.550 --> 00:38:42.789 right. There are some things that you might not 00:38:42.789 --> 00:38:48.300 think about, like risky behavior. Oh, okay. demonstrated 00:38:48.300 --> 00:38:54.599 risky behavior such as say you're a climber a 00:38:54.599 --> 00:38:58.960 rock climber but you only like to free solo oh 00:38:58.960 --> 00:39:01.639 yeah that does sound dangerous it's dangerous 00:39:01.639 --> 00:39:07.400 it's it it shows uh potentially too dangerous 00:39:07.400 --> 00:39:11.840 for uh for a field that is you know rooted in 00:39:11.840 --> 00:39:15.360 patient safety and anticipatory awareness and 00:39:15.360 --> 00:39:19.710 ensuring that we are kind of actuarially responsible 00:39:19.710 --> 00:39:23.949 for risk in the operating room. Climbing a high 00:39:23.949 --> 00:39:26.769 mountain without safety gear is sort of the opposite 00:39:26.769 --> 00:39:29.250 of the way that anesthesiologists think. Yes, 00:39:29.269 --> 00:39:33.030 that's exactly true. So those are kind of things 00:39:33.030 --> 00:39:37.949 that you just need to at least think about. An 00:39:37.949 --> 00:39:40.949 incomplete application. So an application that 00:39:40.949 --> 00:39:43.269 is put together haphazardly is a complete red 00:39:43.269 --> 00:39:46.179 flag. don't have your letters of recommendation, 00:39:46.559 --> 00:39:49.000 don't have a personal statement. Your personal 00:39:49.000 --> 00:39:51.139 statement is in many different fonts with lots 00:39:51.139 --> 00:39:56.639 of grammatical errors and spelling errors and 00:39:56.639 --> 00:40:02.000 a CV that is not formatted correctly. All of 00:40:02.000 --> 00:40:05.079 these are like low bar things that everyone should 00:40:05.079 --> 00:40:07.099 be able to do, that there are resources there 00:40:07.099 --> 00:40:10.559 to do. And to your point, there are even... If 00:40:10.559 --> 00:40:12.039 you don't have personal resources, there are 00:40:12.039 --> 00:40:14.980 technological resources available to you that 00:40:14.980 --> 00:40:18.119 should kind of go without saying. Yeah, absolutely. 00:40:18.820 --> 00:40:21.239 You shouldn't be the only pair of eyes on your 00:40:21.239 --> 00:40:23.599 application. In fact, there should be multiple 00:40:23.599 --> 00:40:29.000 pairs of eyes from you, your mentors, your friends. 00:40:29.380 --> 00:40:31.860 You should be making sure that nothing sticks 00:40:31.860 --> 00:40:36.619 out and nothing is strange. That's right. And, 00:40:36.639 --> 00:40:38.199 you know, back to your first question, when you're 00:40:38.199 --> 00:40:40.159 looking at all this stuff, you know, you get 00:40:40.159 --> 00:40:43.199 really good at being able to look through this 00:40:43.199 --> 00:40:45.639 very quickly, right? And a lot of the programs 00:40:45.639 --> 00:40:48.380 that you submit them to organize it in such a 00:40:48.380 --> 00:40:51.659 way that allows people to kind of get an overarching 00:40:51.659 --> 00:40:55.940 glance very quickly, which is nice. That being 00:40:55.940 --> 00:40:59.239 said, to truly go through an application, you're 00:40:59.239 --> 00:41:02.159 reading the personal statement, reading the letters 00:41:02.159 --> 00:41:06.219 of recommendation. literally clicking into people's 00:41:06.219 --> 00:41:08.280 transcripts and looking through their grades 00:41:08.280 --> 00:41:12.539 and things like that. This can take 10, 15, 20 00:41:12.539 --> 00:41:16.539 minutes per person. So it's an arduous task. 00:41:16.880 --> 00:41:21.960 And if you're really doing a holistic view of 00:41:21.960 --> 00:41:25.940 someone, as we do, you really have to look at 00:41:25.940 --> 00:41:28.219 everything. Because the key is to try to find, 00:41:28.260 --> 00:41:31.099 if there is an admonishment somewhere, you have 00:41:31.099 --> 00:41:33.409 to find the outlier. You have to find out if 00:41:33.409 --> 00:41:36.469 the admonishment is the real story or if that 00:41:36.469 --> 00:41:41.570 is the outlier. Right. I've spent sometimes up 00:41:41.570 --> 00:41:43.869 to an hour looking at somebody's application 00:41:43.869 --> 00:41:46.230 before because there is something like a red 00:41:46.230 --> 00:41:49.570 flag, but there's also things that just make 00:41:49.570 --> 00:41:52.469 you want to interview the person as well. You 00:41:52.469 --> 00:41:55.150 know, maybe somebody took a year off of medical 00:41:55.150 --> 00:41:57.550 school for some reason and that's reflected in 00:41:57.550 --> 00:41:59.329 their transcript. I want to find out that story. 00:42:00.159 --> 00:42:02.320 Why did they have to take that time off? What's 00:42:02.320 --> 00:42:04.500 what's going on with their lives? Does that make 00:42:04.500 --> 00:42:08.980 them a threat to not be able to complete residency, 00:42:09.300 --> 00:42:12.000 for example? Which is what we're looking at in 00:42:12.000 --> 00:42:14.179 the end of the day is right. The ultimate goal 00:42:14.179 --> 00:42:18.179 is for us to recruit people who will ultimately 00:42:18.179 --> 00:42:22.300 be successful in completing residency, attaining 00:42:22.300 --> 00:42:24.559 board certification and becoming a productive 00:42:24.559 --> 00:42:28.179 member of the anesthesia community. I totally 00:42:28.179 --> 00:42:30.820 agree. One of the things that I've. try to emphasize 00:42:30.820 --> 00:42:33.659 to people who are filling all this stuff out 00:42:33.659 --> 00:42:36.159 is the three characteristics that I think that 00:42:36.159 --> 00:42:38.900 program directors look for. And you can also 00:42:38.900 --> 00:42:41.780 chime in with what you're looking for as well, 00:42:41.800 --> 00:42:44.800 or see if you agree with me. We're looking for 00:42:44.800 --> 00:42:49.400 people who will work hard, will pass their boards, 00:42:49.539 --> 00:42:54.920 and lastly, won't cause any issues during residency. 00:42:55.320 --> 00:42:58.329 Domestic strife, if you will. Well, It could 00:42:58.329 --> 00:43:00.150 be that it could be a lot of different things. 00:43:00.210 --> 00:43:03.530 You know, I've heard of residents who get felony 00:43:03.530 --> 00:43:06.969 convictions during their residency or who have 00:43:06.969 --> 00:43:10.829 to drop out for a variety of complicated reasons, 00:43:10.989 --> 00:43:14.110 which is never great. We're here to help people 00:43:14.110 --> 00:43:17.349 succeed at the end of the day. Yeah. And I mean, 00:43:17.489 --> 00:43:22.389 we're all people and, you know, people make mistakes 00:43:22.389 --> 00:43:25.909 and the goal is to. you know, get through with 00:43:25.909 --> 00:43:29.570 as few mistakes as possible. But, you know, ideally, 00:43:29.710 --> 00:43:32.269 you know, part of, you're going to find a residency 00:43:32.269 --> 00:43:35.610 program that will support you when you're down 00:43:35.610 --> 00:43:37.550 just as much as they're going to support you 00:43:37.550 --> 00:43:39.409 when you're up. I think we actually do a really 00:43:39.409 --> 00:43:41.250 good job of that. I'm very proud of that is that 00:43:41.250 --> 00:43:43.730 we, we have our residents backs. And I think 00:43:43.730 --> 00:43:48.289 that that's extremely important. But yes, to 00:43:48.289 --> 00:43:52.269 your, you're absolutely right on the money with 00:43:52.269 --> 00:43:56.659 that. let's talk about away rotations should 00:43:56.659 --> 00:44:03.079 people do away rotations uh sure why not next 00:44:03.079 --> 00:44:05.719 question no i'm just kidding uh so away rotations 00:44:05.719 --> 00:44:10.099 are uh it's a double -edged sword right um if 00:44:10.099 --> 00:44:14.219 you don't have a good anesthesia rotation at 00:44:14.219 --> 00:44:16.780 your institution then you should absolutely do 00:44:16.780 --> 00:44:20.360 an away rotation uh to get uh the full monty 00:44:20.360 --> 00:44:25.190 if you There's really a couple reasons to do 00:44:25.190 --> 00:44:27.750 one. If there's a particular program that you 00:44:27.750 --> 00:44:31.610 are very, very interested in, then that's a very 00:44:31.610 --> 00:44:34.949 good reason to do an away rotation there. If 00:44:34.949 --> 00:44:38.210 there's a rotation or an away program that offers 00:44:38.210 --> 00:44:40.989 you a learning opportunity that you would otherwise 00:44:40.989 --> 00:44:45.730 not get that you think is going to make you a 00:44:45.730 --> 00:44:47.829 better clinician, that's a good reason to do 00:44:47.829 --> 00:44:49.210 an away rotation. I don't think people think 00:44:49.210 --> 00:44:51.869 about that as much. But I think that that is 00:44:51.869 --> 00:44:55.369 a really good, whether that's transplant or trauma 00:44:55.369 --> 00:45:00.550 or some other type of niche thing. I think that 00:45:00.550 --> 00:45:02.909 that is a good way to do an away rotation. But 00:45:02.909 --> 00:45:04.469 you have to remember when you do an away rotation, 00:45:04.690 --> 00:45:10.409 that is effectively a month -long interview. 00:45:11.309 --> 00:45:14.849 I've talked to medical students who are on their 00:45:14.849 --> 00:45:19.420 away rotation. They have expressed to me as I'm 00:45:19.420 --> 00:45:21.619 mentoring them and such that they're really nervous 00:45:21.619 --> 00:45:24.599 about the interview that they have coming up. 00:45:24.840 --> 00:45:28.159 But I tell them not to worry about the interview. 00:45:28.659 --> 00:45:31.980 The interview is right now. It's already happened. 00:45:33.440 --> 00:45:36.260 For better or worse. Right. Everyone has already 00:45:36.260 --> 00:45:38.079 formed their opinion of you because you've been 00:45:38.079 --> 00:45:41.019 here for a month interacting with us. One 15 00:45:41.019 --> 00:45:45.099 -minute slot a week after your away rotation. 00:45:46.119 --> 00:45:48.940 likely not going to make a huge difference no 00:45:48.940 --> 00:45:51.280 it doesn't uh what i will say though is that 00:45:51.280 --> 00:45:54.420 somebody who does an away rotation does a stellar 00:45:54.420 --> 00:45:57.360 job on their away rotation and then absolutely 00:45:57.360 --> 00:46:03.599 mails it in and doesn't give any um it doesn't 00:46:03.599 --> 00:46:05.440 place any importance on their actual interview 00:46:05.440 --> 00:46:07.300 their actual one -on -one time with different 00:46:07.300 --> 00:46:10.679 faculty members um that's in some ways a little 00:46:10.679 --> 00:46:13.440 bit of a red flag yeah i i agree with you i i 00:46:13.440 --> 00:46:17.139 think that uh That's pretty rare to see that. 00:46:17.260 --> 00:46:20.320 Almost never. But you shouldn't take for granted 00:46:20.320 --> 00:46:23.599 any opportunity you have to put your best foot 00:46:23.599 --> 00:46:27.420 forward. Sure. What tips do you have for people 00:46:27.420 --> 00:46:29.619 who are on their away rotation? How can you succeed, 00:46:29.820 --> 00:46:35.719 stand out in a positive way? Talk to the residents. 00:46:36.599 --> 00:46:43.420 See how they can be an advocate for you. Find 00:46:43.420 --> 00:46:46.480 out. It's very apparent which teaching faculty 00:46:46.480 --> 00:46:50.559 are in and around the residence. Latch on to 00:46:50.559 --> 00:46:53.219 them. Go talk to the residency program coordinator 00:46:53.219 --> 00:46:56.119 and say, hey, which faculty really enjoy being 00:46:56.119 --> 00:47:00.300 with med students? And seek those people out. 00:47:01.320 --> 00:47:06.639 It's important to get as many stories about the 00:47:06.639 --> 00:47:10.840 program as possible. Like it or not, this whole... 00:47:11.039 --> 00:47:13.599 We're talking about how we look at applicants, 00:47:13.739 --> 00:47:18.400 right? But it's just as much applicants interviewing 00:47:18.400 --> 00:47:22.840 us as it is us interviewing applicants. Oh, absolutely. 00:47:23.099 --> 00:47:25.679 And by and large, the way the residency match 00:47:25.679 --> 00:47:30.440 is structured, people are in an advantageous 00:47:30.440 --> 00:47:35.079 position. And it gives deference to the applicant. 00:47:35.639 --> 00:47:39.539 And they're choosing us as much as we're choosing 00:47:39.539 --> 00:47:42.760 them. You know, it's important for somebody who's 00:47:42.760 --> 00:47:45.980 on an away rotation to get the full story about 00:47:45.980 --> 00:47:48.659 the program that they're at, too. Yeah, I totally 00:47:48.659 --> 00:47:52.000 agree. That's definitely one thing that I would 00:47:52.000 --> 00:47:56.599 go into my interviews thinking about is not just 00:47:56.599 --> 00:47:58.440 that I'm being interviewed by the program and 00:47:58.440 --> 00:48:00.900 they're going to ask me what my favorite tree 00:48:00.900 --> 00:48:03.719 is. That was actually a literal question that 00:48:03.719 --> 00:48:05.619 I got on the interview trail. What is your favorite 00:48:05.619 --> 00:48:07.659 tree? Yeah, if you were a tree, what kind of 00:48:07.659 --> 00:48:12.460 tree would you be? Interesting. Yeah, I know. 00:48:12.679 --> 00:48:15.559 I'm not much of an arborist, so that isn't really 00:48:15.559 --> 00:48:19.619 my field of expertise. But I think that a lot 00:48:19.619 --> 00:48:22.940 of places will ask you kind of oddball questions 00:48:22.940 --> 00:48:28.340 just to try to get a sense of who you are, what 00:48:28.340 --> 00:48:31.019 you're thinking. Speaking of which, I have a 00:48:31.019 --> 00:48:33.780 question for you. Go for it. If you could have 00:48:33.780 --> 00:48:36.860 dinner with anybody, it could be somebody who... 00:48:37.099 --> 00:48:40.639 is from the past or even from fiction who would 00:48:40.639 --> 00:48:44.260 you have dinner with that's a very good question 00:48:44.260 --> 00:48:46.139 and i know this question well because i know 00:48:46.139 --> 00:48:49.000 you asked this to people or have been known to 00:48:49.000 --> 00:48:52.539 in the past uh don't don't give away all the 00:48:52.539 --> 00:48:54.519 secrets i won't give away all the secrets so 00:48:54.519 --> 00:49:02.719 um uh it would be my my grandfather on my mom's 00:49:02.719 --> 00:49:06.969 side um i never met him He was the only grandparent 00:49:06.969 --> 00:49:10.909 I never met. He was the one that, ironically, 00:49:10.929 --> 00:49:14.929 people say I'm the most like. And I would love 00:49:14.929 --> 00:49:18.469 to meet him and hear his story. Family is important 00:49:18.469 --> 00:49:23.170 to me, and I think that there would be no better 00:49:23.170 --> 00:49:29.070 person to have dinner with. So whenever I ask 00:49:29.070 --> 00:49:32.679 that question during interviews, A lot of what 00:49:32.679 --> 00:49:35.300 I'm looking for isn't necessarily that you can 00:49:35.300 --> 00:49:39.179 come up with some more interesting historical 00:49:39.179 --> 00:49:42.500 figure or person that you really want to meet. 00:49:42.579 --> 00:49:45.219 And that piques my interest. It's not a guess 00:49:45.219 --> 00:49:46.820 what I'm thinking. What I really am trying to 00:49:46.820 --> 00:49:49.159 do is find out what you care about. And what 00:49:49.159 --> 00:49:52.320 you were just telling me is that you care about 00:49:52.320 --> 00:49:54.500 and place emphasis on your family. That's one 00:49:54.500 --> 00:49:56.639 of your values. And I think that that's good 00:49:56.639 --> 00:49:59.239 information for me if I was picking somebody 00:49:59.239 --> 00:50:02.679 out for the program is to find out. what their 00:50:02.679 --> 00:50:06.000 actual values are so yeah that's that's why i 00:50:06.000 --> 00:50:09.320 asked the question absolutely um one of the biggest 00:50:09.320 --> 00:50:13.460 things that that i look for uh when people are 00:50:13.460 --> 00:50:16.039 applying and especially when they're interviewing 00:50:16.039 --> 00:50:21.260 is is and we talk about this as a sense of grit 00:50:21.260 --> 00:50:26.199 right sense of grit um what does that mean it 00:50:26.199 --> 00:50:28.380 can mean a lot of different things it can mean 00:50:28.380 --> 00:50:31.489 that you've you know in the face of adversity, 00:50:31.789 --> 00:50:35.929 it can mean that you just have a wonderful sense 00:50:35.929 --> 00:50:38.769 of self -control. There's a lot of different 00:50:38.769 --> 00:50:43.789 ways of defining it. But it's one of those things 00:50:43.789 --> 00:50:46.550 when you know it, when you see it. And that's 00:50:46.550 --> 00:50:49.150 always a big plus when you see that for people. 00:50:50.170 --> 00:50:53.690 Yeah, I seem to recall there was an application 00:50:53.690 --> 00:50:57.070 where I saw that... somebody's house or apartment 00:50:57.070 --> 00:50:59.630 had burned down in the middle of medical school 00:50:59.630 --> 00:51:04.690 and i i saw that they they told a little bit 00:51:04.690 --> 00:51:09.570 of that story and they still didn't miss any 00:51:09.570 --> 00:51:12.489 time in medical school and kept going through 00:51:12.489 --> 00:51:14.650 their rotation and did well on their rotation 00:51:14.650 --> 00:51:18.510 wow i don't think i could have done that that's 00:51:18.510 --> 00:51:21.010 that would be an example of something that shows 00:51:21.010 --> 00:51:23.670 grit that being said if dustin and i find a lot 00:51:23.670 --> 00:51:26.480 of applications where their houses burned down, 00:51:26.539 --> 00:51:30.159 I think we'll probably look at that with statistical, 00:51:30.519 --> 00:51:33.960 statistical, uh, statistically impossible. Um, 00:51:34.000 --> 00:51:37.420 I remember one where somebody, um, the first 00:51:37.420 --> 00:51:40.440 sort of two sentences of their personal statement 00:51:40.440 --> 00:51:43.760 was something along the lines of like, you know, 00:51:43.760 --> 00:51:48.420 like I was seven and it was my job to, you know, 00:51:48.420 --> 00:51:52.780 retrieve, uh, the bread. And to do that, I had 00:51:52.780 --> 00:51:58.780 to run across, uh, an active like war zone right 00:51:58.780 --> 00:52:01.880 every day and i'm like oh my god my problems 00:52:01.880 --> 00:52:05.340 are so insignificant it's just like a complete 00:52:05.340 --> 00:52:08.599 um it's just a complete other solar system of 00:52:08.599 --> 00:52:11.599 life um and it's great to hear those type of 00:52:11.599 --> 00:52:14.980 things it's great to hear those stories um and 00:52:14.980 --> 00:52:20.360 that was he could have written uh like actually 00:52:20.360 --> 00:52:21.739 i can't remember if it was a he or she i think 00:52:21.739 --> 00:52:24.690 it was a he but he could have written about anything 00:52:24.690 --> 00:52:27.449 else for the last and those two paragraphs or 00:52:27.449 --> 00:52:29.469 those two sentences already made me want to meet 00:52:29.469 --> 00:52:32.150 that guy right yeah absolutely that's that's 00:52:32.150 --> 00:52:38.090 a heck of a hook it was a good one um so there 00:52:38.090 --> 00:52:41.329 are some people who are going through the couples 00:52:41.329 --> 00:52:43.989 matching process where they're trying to both 00:52:43.989 --> 00:52:47.550 match to the same city or maybe they're applying 00:52:47.550 --> 00:52:49.989 to different specialties but they're trying to 00:52:49.989 --> 00:52:53.039 match into the same place and they have a Something 00:52:53.039 --> 00:52:55.400 in place for that with a couples match where 00:52:55.400 --> 00:52:58.119 people can end up going to the same place or 00:52:58.119 --> 00:53:01.099 they can try. Do you have any advice or recommendations 00:53:01.099 --> 00:53:05.440 for people who have gone through that? It definitely 00:53:05.440 --> 00:53:09.980 adds a layer of complexity. You kind of have 00:53:09.980 --> 00:53:14.119 to do a little more research as to the competitiveness 00:53:14.119 --> 00:53:19.000 of both fields at that point that the people 00:53:19.000 --> 00:53:23.579 are applying to and figure out. Who's driving 00:53:23.579 --> 00:53:32.099 the bus? Because in some ways, if the competitiveness 00:53:32.099 --> 00:53:35.420 is completely disparate between the two people, 00:53:35.500 --> 00:53:41.679 one person is going to really be the one that 00:53:41.679 --> 00:53:44.780 is the key driver of where they're going to be 00:53:44.780 --> 00:53:47.559 getting interviews. So that's kind of the first 00:53:47.559 --> 00:53:50.460 sort of step is to figure out how competitive. 00:53:51.239 --> 00:53:53.940 Each applicant is in their respective specialties 00:53:53.940 --> 00:53:59.099 and how, when you combine those two, what the 00:53:59.099 --> 00:54:01.760 probability is that you're going to be successful 00:54:01.760 --> 00:54:07.900 in matching. And then you have to do a lot of 00:54:07.900 --> 00:54:12.639 legwork as to where you need to apply, what programs 00:54:12.639 --> 00:54:17.239 are potentially located close to each other so 00:54:17.239 --> 00:54:23.679 that you aren't separated by, 2 ,000 miles. That 00:54:23.679 --> 00:54:26.119 technically wouldn't happen with a couples match 00:54:26.119 --> 00:54:32.780 or shouldn't happen. But that is the... I think 00:54:32.780 --> 00:54:35.099 that's where you start is you have to really 00:54:35.099 --> 00:54:38.599 have a good understanding and a lot of self -reflection 00:54:38.599 --> 00:54:41.940 on your competitiveness and realize that you 00:54:41.940 --> 00:54:45.460 might have to apply to more programs just by 00:54:45.460 --> 00:54:47.880 definition because of the added layer of complexity. 00:54:48.719 --> 00:54:51.090 As somebody who went through the... couples match 00:54:51.090 --> 00:54:54.090 myself, I can confirm that it does add a layer 00:54:54.090 --> 00:54:56.969 of complexity. We had a big colorful spreadsheet 00:54:56.969 --> 00:54:58.989 that we used to keep track of everything, and 00:54:58.989 --> 00:55:01.210 it's hard. Everything tends to run together. 00:55:01.369 --> 00:55:04.210 It's expensive, too, to travel around, but the 00:55:04.210 --> 00:55:08.929 good news is for now that COVID has sort of made 00:55:08.929 --> 00:55:12.130 everything virtual, so it's a lot less of an 00:55:12.130 --> 00:55:14.369 arduous task to get to all these destinations. 00:55:14.829 --> 00:55:16.889 Although I think we might be getting back away 00:55:16.889 --> 00:55:21.139 from that eventually again. It's up in the air. 00:55:21.219 --> 00:55:23.800 It's up in the air. We'll see. We'll find out 00:55:23.800 --> 00:55:25.739 which way the wind blows as far as that goes. 00:55:25.860 --> 00:55:28.119 I understand both sides of it. I understand and 00:55:28.119 --> 00:55:30.280 sympathize with the fact that it's an expensive, 00:55:30.400 --> 00:55:34.420 stressful process for the applicants and that 00:55:34.420 --> 00:55:39.360 a virtual component is extremely helpful from 00:55:39.360 --> 00:55:42.360 a financial aspect and from a logistical aspect 00:55:42.360 --> 00:55:44.699 when you're potentially on a rotation that is 00:55:44.699 --> 00:55:47.820 hard to get away from. But I also understand. 00:55:48.360 --> 00:55:50.340 how important it is to see places in person, 00:55:51.139 --> 00:55:55.719 you know, walk, touch, feel, be a part of that 00:55:55.719 --> 00:55:57.719 institution. Even if it's for a small period 00:55:57.719 --> 00:56:01.099 of time, you can really get a good sense as to 00:56:01.099 --> 00:56:05.440 the camaraderie, collegiality, and general themes 00:56:05.440 --> 00:56:07.960 that run through a place. So what do you think 00:56:07.960 --> 00:56:10.360 about second looks then? Is that sort of the 00:56:10.360 --> 00:56:14.019 middle ground that people can go and see after 00:56:14.019 --> 00:56:17.519 their interview is already done? Well, that's 00:56:17.519 --> 00:56:19.019 become our middle ground, and I think it's a 00:56:19.019 --> 00:56:22.940 good one. I think you should – if you go to a 00:56:22.940 --> 00:56:28.719 place in the virtual space, go, quote -unquote, 00:56:28.880 --> 00:56:31.619 and you love it, you have a great interview, 00:56:31.800 --> 00:56:34.139 I think you owe it to yourself if you're really 00:56:34.139 --> 00:56:38.440 considering spending four or more years of your 00:56:38.440 --> 00:56:42.079 life at a place to go see the city, go see the 00:56:42.079 --> 00:56:44.679 institution. If they offer a second look, you 00:56:44.679 --> 00:56:47.630 need to try to be there. if you're serious about 00:56:47.630 --> 00:56:49.730 it. There's no reason to go on every second look 00:56:49.730 --> 00:56:52.909 because, again, that's too arduous of a process. 00:56:53.070 --> 00:56:57.289 But if you are dead serious about going to a 00:56:57.289 --> 00:57:03.429 place, going on a second look is important. Yeah, 00:57:03.469 --> 00:57:07.010 absolutely. Should people be concerned about 00:57:07.010 --> 00:57:11.389 the way they present themselves at second looks? 00:57:11.409 --> 00:57:13.230 Is a second look another interview? Can I move 00:57:13.230 --> 00:57:17.769 them up or down on the... On the rank list? Well, 00:57:17.849 --> 00:57:20.789 I can't speak for every institution because I 00:57:20.789 --> 00:57:24.909 don't know how other people do things. But the 00:57:24.909 --> 00:57:29.170 way that I think is the correct way to do it 00:57:29.170 --> 00:57:32.130 is to already have all your decisions made, already 00:57:32.130 --> 00:57:36.369 have all your lists completed so that it is not 00:57:36.369 --> 00:57:40.550 something that can move you up or down a list. 00:57:40.940 --> 00:57:44.059 or change someone's opinion or outlook on you. 00:57:44.480 --> 00:57:47.519 And I think that's for two reasons. One, you're 00:57:47.519 --> 00:57:50.900 just there as a guest. And two, not everybody 00:57:50.900 --> 00:57:55.639 might have equal resources to come do a second 00:57:55.639 --> 00:57:59.500 look or have the availability to do it. And just 00:57:59.500 --> 00:58:02.000 because someone wasn't able to do it doesn't 00:58:02.000 --> 00:58:05.519 mean they didn't want to and certainly means 00:58:05.519 --> 00:58:09.659 we shouldn't hold that against them. Let's wrap 00:58:09.659 --> 00:58:13.380 up here and get your style points overall. What 00:58:13.380 --> 00:58:15.780 style points or points of personal preference 00:58:15.780 --> 00:58:18.940 have helped you throughout your career? And maybe 00:58:18.940 --> 00:58:22.320 we can even say through the application process 00:58:22.320 --> 00:58:24.320 and through becoming an anesthesia professional. 00:58:26.659 --> 00:58:32.440 The best thing that someone can do and the thing 00:58:32.440 --> 00:58:39.579 that's been most useful for me is No matter what 00:58:39.579 --> 00:58:44.300 the circumstance, always coming into work, trying 00:58:44.300 --> 00:58:51.860 my best, being a team player, and trying to get 00:58:51.860 --> 00:58:54.860 the most educationally and professionally out 00:58:54.860 --> 00:58:59.679 of each situation. I think that oftentimes a 00:58:59.679 --> 00:59:02.300 question that we will get in the interview process. 00:59:04.139 --> 00:59:06.280 with people who don't have any frame of reference 00:59:06.280 --> 00:59:08.860 really is like, what do you look for in an applicant? 00:59:09.599 --> 00:59:13.619 And I always tell people I would look for the 00:59:13.619 --> 00:59:16.500 same things that I would look at for an anesthesia 00:59:16.500 --> 00:59:19.300 resident as I would look for as a manager at 00:59:19.300 --> 00:59:23.900 a bank or a front of house representative at 00:59:23.900 --> 00:59:27.800 a restaurant. And that's someone who is a team 00:59:27.800 --> 00:59:33.079 player, someone who tries their best. Someone 00:59:33.079 --> 00:59:38.719 who operates with professionalism and puts others 00:59:38.719 --> 00:59:41.900 before themselves, puts their patience above 00:59:41.900 --> 00:59:45.519 all else. And if you do those things, you're 00:59:45.519 --> 00:59:49.039 going to be successful. What did your wife say 00:59:49.039 --> 00:59:52.139 when you told her that you had cut your wedding 00:59:52.139 --> 00:59:55.380 ring off at work? She looked at it and said, 00:59:55.500 --> 00:59:59.519 oh, great. Is this like some type of... uh, omen 00:59:59.519 --> 01:00:03.440 or foreshadowing event. And, uh, you know, mind 01:00:03.440 --> 01:00:06.500 you, we've been together since we were 17. We 01:00:06.500 --> 01:00:08.719 met at blockbuster video. If people who are listening 01:00:08.719 --> 01:00:11.840 even know what that is. Um, wow. But it's a stupendous 01:00:11.840 --> 01:00:18.039 situation. Um, and, uh, I told her that I already 01:00:18.039 --> 01:00:21.920 had a, uh, like a silicone ring in the mail, 01:00:22.059 --> 01:00:28.420 uh, to, to appease the situation. And, um, It 01:00:28.420 --> 01:00:32.239 ultimately was fine, as I knew it would be. Good 01:00:32.239 --> 01:00:34.559 deal. Well, Dustin, thank you so much for joining 01:00:34.559 --> 01:00:39.320 me. Thank you for having me. Thanks for tuning 01:00:39.320 --> 01:00:42.420 in to this month's episode of Style Points. I 01:00:42.420 --> 01:00:44.280 really appreciate you taking the time to listen. 01:00:44.940 --> 01:00:47.320 If you enjoyed what you heard, please consider 01:00:47.320 --> 01:00:50.119 leaving a review. I'm hoping that this podcast 01:00:50.119 --> 01:00:52.059 gets popular enough to serve as the ultimate 01:00:52.059 --> 01:00:55.090 source of truth and joy in the universe. so every 01:00:55.090 --> 01:00:56.909 five -star rating and review helps with that. 01:00:57.349 --> 01:01:00.889 As always, you can contact me at stylepointspodcast 01:01:00.889 --> 01:01:05.170 at gmail .com. Take a deep breath. Open your 01:01:05.170 --> 01:01:07.190 eyes. We're all done.