Network Director

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This episode was produced by Annie Nguyen and Ashley Tam, hosted by Amber Chan, and graphic by Callista Wu and Claire Sun.

Time Stamps: 

0:00 Introduction to White Coats & Rice: An APAMSA Podcast 

0:58 Introduction to Dr. Marcus Iwane 

1:48 Professional Background and Native Hawaiian Health

4:17 The Role of Cultural Identity in Career Choice 

10:50 Health Disparities in the Native Hawaiian & Pacific Islander Community 

18:01 Addressing Generational Trauma and Healthcare Mistrust 

23:21 Building Trust & Cultural Humility in Medicine 

29:58 Community-Based Healthcare Initiatives in Hawaii 

32:29 Climate Change

35:20 Healthcare Sustainability 

35:20 Work-Life Balance & Personal Life 

46:53 Closing Remarks 

48:00 AMA Outro 

Full Transcript:

0:00 Introduction to White Coats & Rice: An APAMSA Podcast 

Annie: Welcome everyone to the 8th episode of the Asian Pacific American Medical Student Association Podcast. From roundtable discussions of current health topics, to recaps of our panels with distinguished leaders in the healthcare field, to even meeting current student leaders within the organization – this is White Coats and Rice. My name is Annie Nguyen, a postbac at Stanford University, and a member of the Leadership Committee at APAMSA. I’ll be your host for today! 

This is our Ask Me Anything Series! Each month, we spotlight an extraordinary physician who shares their insights on medicine, life, and everything in between. This is your chance to ask questions, hear their stories, and learn from their incredible experiences. Whether you’re curious about their journey, their day-to-day, or their views on the future of medicine, nothing is off the table. Let’s dive in! 

Today’s episode was moderated by Amber Chan, a medical student at the Hackensack Meridian School of Medicine and member of the 2024 Leadership Committee. 

0:58 Introduction to Dr. Marcus Iwane 

Amber: All right. Um, so just to give a brief intro before I hand it over. Um, this is Doctor Marcus Iwane. Um, he’s born and raised on Oahu, and he’s a board certified internal medicine physician. He earned his medical degree and completed residency at the University of Hawaii. And he’s currently the

chief of Kaiser Permanente West Oahu Medical Office, where he promotes Native Hawaiian health and healing. Um, so he also currently serves as clinical faculty and has been listed on 40 under 40’s Exceptional Leaders as well as best Doctors in America. Recently in 2023, he also completed the Climate and Health Equity Fellowship. So definitely be excited to hear about that. So, I’ll hand it over. Doctor Iwane, if you want to introduce yourself and tell us just a little bit to start off. 

1:48 Professional Background and Native Hawaiian Health

Dr. Marcus Iwane: Yeah. Hi. Good evening everybody. Uh, thank you for inviting me. You know, so I’d like to keep this very casual. So if anybody has any questions, you know, please feel free to ask me anything. So I’ll tell you first a little bit about myself. Born and raised in Hawaii on the island of Oahu, I did all my training here in Hawaii. Uh, that includes medical school, my residency training. I’m a internist by trade. And, yeah, after residency, I’ve been practicing with Hawaii Permanente Medical Group. Um, initially started off with a clinic in Nanakuli, which is a small little community on the west side of Oahu. We can maybe talk a little bit about that if you folks have questions about community health and what that means. And now we’re practicing in Kapolei, which is a little bigger clinic that I can share you a little bit about as well. But my passion is obviously Native Hawaiian health. So I don’t know if any of you on the call have roots here in Hawaii, or are part Native Hawaiian yourself, or have family who are Hawaiian or come from any indigenous background. But that is something that drives me to continue to do what I do, um, to serve our community and help to uplift our, our people so we can talk about Native Hawaiian health or indigenous health as well. That is another topic that if anybody has questions regarding, I can definitely share some viewpoints on. I currently serve as president for ‘Ahahui o nā Kauka, which is an association of Native Hawaiian physicians. I’ll drop in the chat our website. Um, you guys can go to kauka.org and we are a nonprofit, if you also want to learn a little bit more about ‘Ahahui o nā Kauka and what we do. Uh, go ahead and check it out. There’s a little video on the– on the website homepage as well. That kind of highlights a little bit about, you know, how we were formed, why we were formed. We established in 1998. And yeah, it’s a really it’s a really cool and very important organization to be a part of, to really focus on improving the health status of Native Hawaiians. And so yeah, we can definitely talk more about that as well. Um, but that’s a little bit intro to myself. 

4:17 The Role of Cultural Identity in Career Choice 

Amber: Definitely. From what you’ve introduced, you’ve spent most basically all of your medical training based in Hawaii still. Is there anything, I guess, growing up that kind of motivated you or inspired you to really be connected to your roots and really wanting to focus on giving back to the community instead of, you know, coming to like, the continental states or going elsewhere. 

Dr. Iwane: Yeah, that’s a great question. So I’ll share a little bit about my upbringing. Uh. First as a child. So I grew up in Oahu. I’m not sure if any of you have been here before, but, uh, Nanakuli is a– is a little town on the west side of Oahu, and my grandparents used to live there. So growing up as a child, I’m spending a lot of my weekends there. Their home was right across the beach, so that was also another good reason to go every single weekend. But my grandfather was a farmer and he has a child. He would always get me involved with getting my hands dirty in the garden with him, taking care of the– taking care of the grounds and the garden areas. And what really intrigued me growing up was hearing him speak Hawaiian language to his plants. And I was always kind of– always kind of thinking, what is he doing? You know, what is it? Why is my grandpa talking in Hawaiian language to plants? And so, you know, it was something that I really didn’t appreciate until I obviously got a little bit older. I started to learn a little bit more about my culture, including Hawaiian language and everything that comes with that. Yeah. And so, you know, I realized that at an early age, my grandfather was really teaching me the importance of connecting to land. Yeah, connecting to– connecting to the things that sustain us. Yeah. So our people, you know, being, you know, folks who have inhabited Hawaii for centuries. Yeah. You know, coming from a place that– an island that really didn’t have a lot of endless amount of resources, right? So everything was about resource management, protecting our precious water sources. You know, our– our land that sustains us, the fish that, you know, feed us from the ocean. And it was all about sustainability and really focusing on the understanding that, you know, once our precious resources are gone, there is no next state to drive through, right? There’s no next– next area to get more resources. Right. You know, so it was, it’s a very fine balance, right? That our people had a connection to land is so important. And you know that concept we refer to as something called “aloha ʻāina”. So aloha ʻāina. ‘Āina is a word that we refer to as land. And aloha obviously is love, you know, caring for. And so having this concept of aloha ʻāina ingrained in me from an early on, childhood, you know, really kind of helped me to understand the importance of making sure that you stay rooted. Yeah, you stay connected to your community. You stay connected to the land that sustains you. And that in addition to. Connecting to the importance of language. “Ōlelo Hawaiʻi” is what we refer to as Hawaiian language. And, you know, as I started to go through grade school and then eventually in college, I, you know, I took my language courses and, you know, that’s– that’s very important because in language, you that’s where you connect to cultural identity and, you know, through, through all of these things. Right? You know, you really focusing on what we refer to as cultural health. And so that, you know, really helped to lay a foundation for me as a, as a kanaka, as a, as a Hawaiian, as a Hawaiian person, as a Hawaiian, as a Hawaiian male, and, you know, carrying that through, you know, my training, um, really inspired me to figure out how to bring this into my medical practice. And so, you know, I decided to stay home for training throughout my, my college career, throughout medical school, even residency, specifically because of, you know, this connection that I have to to my in my land and being able to understand and care for our people, you know, we, we, we see this as more of what we call kuleana or responsibility that, that we have as, as, as native Hawaiians to really to really be able to take care of our own home. Yeah. And so, so that’s kind of what inspired me, um, to stay home and, you know, get even more deeply connected with community, which I feel has only helped me along once I started to establish my medical career, um, and really helped to build those connections with, uh, with folks. So, yeah, a little bit about why I chose to stay home. I’ve shared there– there’s obviously more, you know, maybe we can talk a little bit about what I do in my free time later. But yeah, I– I could not personally live away from the ocean. So that’s another reason. 

Amber: But honestly such an inspirational story. Just going from like your childhood, being with your grandfather and realizing later in life what you didn’t realize, like growing up that he was instilling in you all these traits that as a child you don’t really appreciate. But I definitely appreciate how you know you consciously are bringing that into how you practice medicine today, because I feel like it really brings a factor of humanism that I think many patients who, you know, may deal with America’s health care system today feel that we don’t really have that provider patient connection as much anymore, like the way things are driven, especially like larger hospitals or like metropolitan areas. It almost feels like patients see the doctor for two minutes and then they feel that, you know, yeah, you’re doing all this stuff for me in the background. You’re treating my physical health, but I don’t really know what emotionally is happening. So I think it’s definitely sounds great that, you know, you’ve been so conscious about that in your practice today. 

10:50 Health Disparities in the Native Hawaiian & Pacific Islander Community
Dr. Iwane: Yeah, I see something. So, Victoria, I see you put a question in the chat. Uh, Victoria,

where are you from? 

Victoria Shi: I am from new Jersey, but I’m currently doing my medical school in Kansas City. 

Dr. Iwane: Oh, fantastic. Awesome. 

Victoria Shi: Thank you so much for being here tonight. 

Dr. Iwane: Yeah. No. My pleasure, my pleasure. Uh, so I see your question. Yeah. What are some unique health challenges or needs of the Native Hawaiian Pacific Islander community that you feel are important for all clinicians to be aware of? So that’s an excellent question. You know, and so I kind of– I’ll kind of give a roundabout answer to that one, uh, by sharing another story. Um, because I like to share stories. So, you know, one of the very first patients that I began to care for right out of residency training was a young Native Hawaiian man who was diagnosed with really bad and uncontrolled diabetes. And, you know, I kept really trying to push medications. Yeah, trying to get his– his diabetes under better control, trying to stress the importance of that because, you know, his grandfather and his father, you know, both ended up having end stage renal disease on dialysis. And, you know, a lot of these bad complications and diabetes. And, you know, I felt like at his stage in his life, he, he, you know, he was at a point where he could make a difference. Yeah. And prevent, you know, his kidney function from declining and prevent his eyesight from getting affected and other things, you know, including decreasing his risk of strokes or heart attack. And so, you know, really, really pushing the medications, including lifestyle changes for him. And, you know, he really kind of seemed almost resistant to, you know, wanting to take medications. I didn’t know how engaged he was. And yeah, I couldn’t really understand why he wouldn’t want to get his diabetes under better control. And, you know, so it wasn’t until until while, you know, he he talked to me and he, you know, he said, “hey, you know, it’s not it’s not that I don’t want to take my diabetes, you know, or get my diabetes under better control by taking medications. You know, at the end of the day, I really gotta figure out, you know, how am I going to pay for these medications? Or how am I going to put food on the table to feed my family?” And so, you know, that kind of took me aback at– understanding that there’s so much, factors outside of just the medical care we deliver that influences health and wellness. And so, you know, Native Hawaiians, Pacific Islanders, especially here in Hawaii, you know, have the highest rates of chronic disease, diabetes, heart disease, obesity, hypertension. Um, we have the highest cancer incidence. Native Hawaiian females have the highest infant and maternal mortality across all ethnicities in our entire nation. And so how can this be, right? Why are people so sick? You know, I think there’s a lot of things that influence health and wellness outside of, you know, genetics, right? Outside of predisposition to getting certain certain conditions. You know, we’re talking about social cultural determinants of health. And so that’s something that’s very important for all of you to kind of understand is that, you know. Actually what we do within our four walls of the medical clinics, our hospital systems is just about 11% of a patient’s overall health pie. Yeah. The larger part of that is, you know, access to food, right? Uh, access to places where you can exercise safely, you know, so the list goes on and on. Education. And so there’s– there’s many things outside of just what we do in medicine that influences health and wellness. Yeah. So recognizing that I think is is important specifically for Native Hawaiians. Yeah. And this story is very similar for various indigenous peoples across our nation and including the world is, you know, we gotta factor in our historical determinants. 

So what are historical determinants, right? These are things that we refer to as non modifiable determinants to health. So um the impact of colonization marginalization of– of our people, you know, taking us away from ancestral and sacred lands. Yeah. And so through this you know transformation. Yeah. Through– through generations. Yeah. This generational trauma is what we refer to. It impacts health and wellness even hundreds of years down the road. And so, it’s so, you know, I think a lot of that is also a big factor, right. That we have to– we have to learn about, especially for our specific unique populations that we care for. Um, here in Hawaii, it’s obviously, you know, our Native Hawaiians and Pacific Islanders that we need to really kind of focus on so that we are approaching healthcare from an understanding and a place that, you know, we’re really a small part of the solution. So– so I think there’s a lot of things that– that, you know, we can learn. I can tell you, folks that Hawaii’s population of of Native Hawaiians is actually decreasing. More and more Native Hawaiians are now moving to various states around the continent because the cost of living is, you know, it’s hard to make it here in Hawaii. So we actually now have more Hawaiians living outside of Hawaii than we do actually here. So this is I’m I’m so happy that, you know, we’re having a conversation this evening with you folks because you folks are all going to be seeing Native Hawaiians one day. Yeah. In your– in your respective areas. And so, you know, the West Coast, uh, you know, Washington, Oregon, California, Las Vegas, right. Even Arizona, there’s– the population of Native Hawaiians and Pacific Islanders continues to grow. And so in order for us to really make a difference, and in order for us to be able to establish relationships with, with the people that we serve. Yeah, including Native Hawaiians and other indigenous populations, we gotta understand them. Yeah. We gotta understand where they came from. Uh, understand these historical contexts, all these factors outside of just their physical health. Yeah, that influences their well-being. So. So that’s just a brief, uh. Answer, I think to your question, Victoria, but yeah, it is– it is important to, to understand those things. 

18:01 Addressing Generational Trauma and Healthcare Mistrust 

Amber: I think you definitely highlighted some pretty important points there. You know like historical significance and how that impacts health down the road too and the generational trauma. So I guess that kind of made me wonder as well. Like as a native who’s practicing and working with this population, do you feel that you know, the native population and indigenous peoples have, like these communities have a mistrust of health care professionals and like the medical system because of how, you know, they’ve been treated over the years and just the effect of colonization and being marginalized in the past, having a trickle down effect now?

Dr. Iwane: Yeah, that– that is definitely alive and something that is a real challenge, you know. So what’s– what’s very important to note is that. You know, and we’re. We’re trained. Right. In a very Western way. You know, we’re trained to practice medicine, you know, by evidence, right? Um, by the book. And, you know, and so, you know, it’s very it’s very much, oh, you have this and, you know, you do this, this, and this, but a lot of a lot of indigenous cultures around the world, right? Not just Native Hawaiians have their own traditional healing methods. Yeah. That have been, that have been, have and continued to practice for centuries. Right. And so I think it’s important to note that or be aware that, you know, there are folks who– who do practice traditional healing methods. Yeah. And, you know, be open to hearing those. Uh, you know, one of the things that I love to do and where I go traveling and whatnot is always go check out some bookstores or different, different, different local areas that may sell, you know, books on on local plants that maybe are used traditionally for healing, you know, just to kind of read up because a lot of things are very similar across different cultures that you folks are starting to realize. 

Dr. Iwane: And so, so having an open mind and approaching– approaching your patients and community from– from a standpoint that– a standpoint of humility and curiosity, I think is something our great skills to have as a– as a clinician. I can tell you that that will only make you a better clinician because you’re able to build stronger relationships. Yeah. So, you know, the relationship between health care provider and the patient, I feel– and the patient’s family I feel is the strongest therapeutic force, even stronger than a medication we can provide for anybody. Right. Without that trust, without that foundational relationship its going to be very hard for you to, to, um, make change, right, to inform folks, to engage with them. And so and, you know, having a good relationship with, with your patients and their families, you know, is therapeutic not only for them it’s therapeutic for you, too, right? That’s what keeps us going, right? That’s what keeps us coming back every day for more. Right. Um, because medicine is really challenging. No matter what field you decide to go into, whether it’s surgical field, specialty, primary care, um, they’re all very challenging in its own ways. And so, you know, making sure that you have that foundation right to rely on it. That foundation is really, how do we build that trusting relationship. Yeah. So like you mentioned Amber, the generational trauma, the cultural trauma that our people have experienced, you know, even if it happened 100 years ago, for many it seems like it’s still happening. Yeah, there’s inherent racism and perceived discrimination is a real thing. Yeah. It impacts it’s a chronic stressor that increases– has been shown to increase risks for mental health disease. It increases risk for higher risk behaviors. Yeah. That impacts health and wellness. It also has been shown to affect cardiovascular reactivity and recovery increases the risk for diabetes. And so the list goes on and on. And so you know I think– I think it’s important right to talk about these things you know in forums. Yeah. Such as this. You know a lot of folks kind of like don’t feel comfortable talking about it. But it’s very important to talk about, you know, it’s not about pointing a finger or, you know, blaming this person or that person. Right? It’s about– it’s about the cultural humility. Yeah. And so wherever you folks go, wherever folks practice, you are going to have, you know, you’re going to be on indigenous rounds and in indigenous communities. And so learning in partnership with your folks and your population that you care for, I think is is extremely important. 

23:21 Building Trust & Cultural Humility in Medicine
Amber: Yeah, definitely. Oh, yes, I see Reanna, you’re unmuted. Do you want to ask a question?

Reanna: Yes. Hi, Doctor Iwane. Thank you so much for being here today. My family is from Waianae, so I have roots there. And I’ll actually be out at the University of Hawaii soon for my OB-GYN rotation with maternal fetal medicine. So I think yeah, I’m– I’m so excited to, like, come and I go to school in the Bronx. So I have some experience with like underserved communities. But I was wondering if you have any advice for just medical students in general when they are even just on a clinical rotation, we don’t have very much time with our patients. So how– how do we incorporate cultural humility and build that relationship in a– in a short period of time? 

Dr. Iwane: Yeah, that’s a great question. You know, and I think, you know, part of that is. It comes with time. You know, I think the more, uh, the more folks you’re you take care of, the more people you talk to. You develop your own style of how you build that rapport. So, you know, I can tell you that mentorship is extremely important. Yeah. So I wouldn’t be in a position I am today without having awesome mentors. Yeah. And so, you know, you learn from your mentors, right? You can see how your mentors interact with patients and how they are able to build relationships. So, you know, one of my mentors, I don’t know if you folks have ever heard of him, Dr. Noa Emmett Aluli, um, so he is a family physician on the island of Molokaʻi. And, uh, you know, one of the things that really kind of stuck with me as I started to spend time with him in his clinic before, even before I went to medical school, uh, was his ability to– to make that instant connection. Yeah. With his patients. And, you know, for– for Uncle Emmett. Right? It wasn’t so much about them, about the medicine. Right? It was about that connection. And so, you know, when, when I would see him talking to his patients. Yeah. He will be talking about what’s your last name or who who your mom, who your dad or, wait, where are you from? You know, and so, you know, he’s trying to figure out he was always about that connection on a, on a humanistic level. Yeah. And so finding that commonality with, with your patients, I think is, is probably the first step, you know, that we all should be trying to aspire to reach. You know, I think the challenge that you mentioned is we have such a short time right, in primary care. You know, we’re on 20 minute visits, but after the patient gets worked out, right after the vitals and everything gets done, uh, I maybe have ten minutes in the room with the patient right before I gotta hop onto my next one. And so, uh, in the busyness of the day, you really you. It’s very easy to get caught up in addressing your needs as a physician rather than the patient’s needs. Right? And so it’s okay to take a pause. Right. It’s okay to slow down and just kind of like talk story. You know, most of the time I can tell you if it’s a brand new patient for me or even if it’s like a patient I’ve been taking care of for ten years, sometimes I hardly– we hardly even talked about medicine in the exam room. You know, we’re talking about fishing. We’re talking about where did they last go on their on their most recent vacation. Right. You’re talking about their grandkids. We’re talking about oh their son got married and you know so it’s it’s that type of connection that I feel like matter most to our patients. So yes we do have to address their medical needs. But unless you can figure out how to– how to build that relationship, right. And get to know people on a personal level, you know, it’s it’s going to be it’s going to be hard, right, to continue to engage with them. And so that’s kind of like something that that I would actually focus on. You know, when I go in to see, see my patients and I encourage, you know, you folks all to kind of also take cues from, from various mentors and see how– see how you know, your, your preceptors, you know, interact with their patients. Everybody has a different style, right? And so yeah, here, here in Hawaii, we’re all about the connection. Yeah. And so connection is not only personally but you know, connection is from a family. A family centered approach. Yeah. So so to me that to me that’s what matters. Right. And yeah you it’s fun because you find some really interesting things about people. You know, they, they do all kinds of really cool stuff in their life. And, you know, it’s just that’s what– that’s what excites me, you know, to, to learn more about them. You know, every time I see, see a patient. Yeah, I’m learning something new about them, which is super awesome. Yeah. And it’s these things that you remember. Yeah. But it helps you to also ground yourself as a physician, too. Yeah. So so awesome. No, I’m glad that you’re going to be coming out here. You know, you feel free to message me if you want to come out and check out, check out our clinic over here in Kapolei. 

Reanna: I would love to. I’m staying with my uncle. He lives in Makakilo. So it’s perfect. 

Dr. Iwane: Perfect. Yeah. Perfect. Yeah. Awesome. 

Reanna: Everything has changed there in West Oahu. So much the past. Well, the past 20 years, I feel like. 

Dr. Iwane: Yeah, yeah, yeah. So. Yeah. If yes, please send me a message. I’m not sure. Amber, does everybody have my email? 

Amber: I can send it out in the. 

Dr. Iwane: Actually, I’ll just type it in the chat right now. Yeah. So? So please feel free to email me anytime if you folks have questions. 

29:58 Community-Based Healthcare Initiatives in Hawaii
Dr. Iwane: You know, I guess I take a little bit to kind of talk about, you know, what we’re doing specifically over here in Hawaii within Kaiser Permanente. So maybe, maybe we’ll see you soon and you can come check it out over here. But, you know, we’re talking we you know, I talked a little bit about sociocultural determinants, right. And how that influences health and wellness. And if we– if we drill down health and wellness even to life expectancy per zip code. So if we’re looking at different zip codes or zip code where Reanna has roots, you know, if you come from this zip code, your life expectancy is actually 10 to 12 years less than if you if you reside just five, ten miles down the road. And there’s different pockets like that across all islands in Hawaii. Yeah. And typically these pockets are rural areas. These pockets are areas that have a very high concentration of Native Hawaiians. These are where what we call our homesteads are located. And so, you know, it’s it’s it’s really frustrating. Yeah. To to see this. Yeah. How can your life expectancy be determined by where you live? So that really kind of alludes to the fact that, you know, there are a lot of other things that are in the wellness. And so what we’ve done specifically in our– the clinic that we– I practice that here in Kapolei is really focusing on on that cultural health aspect. Right. And building programs and building community partnerships specifically to address these needs right, within our our vulnerable populations, our native Hawaiians or Pacific Islanders. Actually, our Filipinos have a very, uh, high rates of chronic disease as well. Um, so what we’ve done over here is we’ve we built this almost like center of, of excellence for Native Hawaiians. And so, you know, within our, our clinic grounds, we have a walking pathway that has garden beds and we have a traditional healing mala or garden, and we have taro patches, two that we actively farm on our clinic grounds. And so it’s a different way of approaching health and wellness. And so, uh, you know, you’re not just you’re not just a physician, right? That comes in practices within our four walls. But, you know, your reach goes far beyond that, right? Community partnerships. 

32:29 Climate Change 

Dr. Iwane: You know, I talked about the importance of mentorship. So we have high school students that come out, or medical students come out and work the land with us. Right. Going back to. The importance of aloha ‘aina. Yeah, that I talked about early on setting that foundation. Right. That understanding that, you know, our health is directly connected to the health of our land. And so being able to work the land, being able to harvest kalo, right, or taro and incorporate that into our diet is important culturally. Yeah. And so there’s a lot of other things that, that, that we do, um, to focus on that, uh, within our, within this specific clinic that, that we have built here in Kapolei. So, you know, the other thing that’s important, right? Aloha ‘aina is also it’s also a concept of being good stewards. Right? Environmental stewardship is a– is a big thing. And so, you know, putting in energy efficient features over here. Right. To reduce our carbon footprint and reduce our greenhouse gas emissions is also very important. So that’s another big passion of mine too is you kind of mentioned earlier about the climate. Yeah. Climate change and how climate change impacts on health and wellness of our communities. And so, you know, we constantly talking about these things, right. And trying to figure out how to be on the leading edge of, you know, being good stewards of what we do in in medicine. Right. You know, health care sector, you know, contributes 8.5% of greenhouse gas emissions in this country. That’s huge. That’s huge. 8.5%. This is you know, that comes from the health care sector. Yeah. A sector that should be taking care of people and taking care of our land. Right. How come we are destroying it by emitting 8.5% of greenhouse gas emissions? Well, you think about it, right? Everything we use. Yeah, all of our– our single use devices, you know, processing of labs, processing of, you know, all of these types of things. It takes energy. Yeah. It you know, this waste has to be disposed of. And so, you know, we’re having conversations about how can we be better stewards of all of this. Yeah. So so yeah, it’s very interesting. But yeah got lots to talk about. 

Amber: I think that’s really cool having, you know, having high school students even come in and work the land physically and really being able to connect. And it’s like being able to pass that on generationally and how, you know, like harvesting things brings it back into your diet. And it’s like this self rewarding cycle. I think that’s really cool. I wish I had something like this here that my school could do. 

35:20 Healthcare Sustainability 

Reanna: I had I have a question I’ve always sort of had the struggle of like with the health care sector. And like in my background, I studied like environmental engineering and sustainability in undergrad. And so it really like shook me when I, you know, started medical school and saw like all the single use items we have and like we– for sterility, we have to have a lot of these plastics and single use items. But I was wondering if there’s any suggestion you have or like if your medical practice has put into place some sort of effective like reduction of waste or recycling of items that you’ve found to be like really useful and like very satisfying to see that in practice. 

Dr. Iwane: Yeah. So I can tell you it’s really challenging to make such a big change happen. So across a large organization. Yeah. And so, you know, just bringing it back to understanding that, you know, change starts at home, right? It can start with you and, you know, making a conscious choice of, you know, how we how we support our environment, right, individually. So I can tell you agriculture, yeah, is a big contributor to greenhouse gas emissions. And so, you know a two pound, two pounds of beef, right to have two pounds of beef land on your plate. That’s actually equivalent to about 160 miles of greenhouse gas emissions driven by a car. So that’s just two pounds of beef, right? So, you know, figuring out how to– how to how to support local I think is also another big thing. So you know, for us over here in Hawaii, everything has to come to us by boat or plane. Right. And so that’s a huge amount of, of energy that needs to to make that happen. Yeah. You know, a lot of these things we have come to rely on in our everyday life. And so how can we be better stewards of supporting local, of supporting sustainable organizations? Yeah. Within your own communities and also being a little bit more mindful of, you know, the types of things that, you know, we’re eating. Uh, because I give you the example,  85% of food that we consume here in Hawaii is not from Hawaii, but yet traditionally, yeah, our lo’i kalo systems or our agriculture, traditional kalo system supported a population of upwards of a million people. And so I think about that. Right. We have come so far away from land stewardship, from resource management, right, to relying on something that is not even produced here in Hawaii. And so how do we get back to rebuilding that, that model of sustainability of land and resource management? Because food grown locally, wherever you are at right, the shorter distance of food has to travel from from the ground to your plate, the better it is for not only the environment, but it is for your health too. Less processing, right? The food is always fresher. It’s more beneficial to your health. So I always kind of encourage folks to think about how they eat, the types of foods that they eat, the type of things that they buy, you know, and so just making a little conscious effort starting at home. Yeah. And so that includes even, you know, lower carbon forms of transportation, right. Like electric vehicles, LED lights, all those types of things. So but yes, change is necessary. I think a lot of folks, you know, across the nation now, especially in the health care sector, is looking individually within their own organizations on how they can reduce their own greenhouse gas emissions and carbon footprint. So but but yeah, I think we have a long way to go, you know. But but we’re getting there. 

Dr. Iwane: Which is which is why, you know I think individuals like you folks. Right. If you are interested. Right. If, if, you know, environmental stewardship and environmental justice is a passion of yours, you guys should really harness that passion. Yeah. There’s so much environmental groups out there, right, that are doing fantastic work. So partner with them. Right. Get involved with these nonprofit organizations. One of the things that I completed in 2023 was what we call a Climate and Health Equity fellowship. So as a ten month fellowship based out of DC, to have physicians get trained in everything that we need to know about how climate impacts health. And so it’s a really cool fellowship because I got to meet so many folks across the nation. All physicians. Yeah, we’re passionate about this work. So the reason why there’s a big push to educate physicians about climate change is because there’s this critical intersection between how climate impacts health, but more importantly, it’s not universal across the board. Much like social and cultural determinants, the impact of climate on health is is more severe for specific vulnerable populations. And these are our indigenous communities, our brown and black communities, our redlined communities. Right. And these are the communities that folks that we’re going to take care of. And so the other important thing is to notice that there’s this thing called a trust veracity index. So it looks at all professions across the entire nation. And guess who are amongst the most trusted professionals amongst everybody? 

Reanna: Doctors. 

Dr. Iwane: Yes, it is physicians and nurses. And so we have to use this, right. We have this very unique position. Yeah, that you folks are going to be entering as a physician. Yeah. Your voice matters. Okay. Your voice matters in the exam room. Your voice matters outside of the exam room. And so we can all be leaders, right? In advocating for what’s right. Yeah. For our people and our communities. So, uh, so that is something, you know, that is, I think, going to be growing in popularity and importance over the next couple of years, especially as, you know, our our global warming continues.

Amber: Yeah, it’s definitely I feel like I would echo everything you’ve been repeating how the importance of just having these conversations and just starting that thought process, like plant a seed in all of our minds and, you know, as we’re going day to day working with our patients and encountering all these single use, you know, medical supplies, it’s I would definitely admit it’s definitely not in the forefront of my mind, but having these conversations always plants that idea were, you know, looking back, I would say today I probably threw out like 13 gallons because I have so many patients in contact rooms and. Then people are, you know, using the disposable stethoscopes and the amount of gloves and everything we’ve gone through. And it’s so difficult to try to balance, you know, how we can advocate as physicians and I guess lead by example and demonstrate it when at the same time, I feel like we’re bound by the other medical side of things when it comes to these things. But I did notice we’re coming to our last five minutes. I know, Doctor Iwane, you were, you know, excited to share a little bit about what you do in your free time outside of medicine as well. Um, so if you want to wrap it up and end by sharing a little bit of what your life is like enjoying the beaches and the culture and life there, we definitely love to hear it. 

35:20 Work-Life Balance & Personal Life 

Dr. Iwane: Yes. So. So yeah. So I am married. I have two children. Uh, so our son is 11 and our daughter is 6. And so, you know, it’s a lot of time outside of, you know, taking care of patients and the daily grind of being a physician is obviously spent with family. So family is a big, a big thing, you know, that is what grounds me. And, you know, I think that work life balance. Oh, look at that. Yeah. Yes. So that work life balance as a physician is extremely important. Yeah. You know, family is is really everything. Yeah. Family is who you can fall back on in your tough times, you know, and even celebrate with you and your good times. Yeah. And so, you know what? One of my, one of my best friends is, is also one of my colleagues. You know, he he always she always tells me, yeah, we’re all going to pass away one day. Right. And so what do you want. You know, people to write on your, on your, you know, your, your gravesite or your tombstone or whatever it may be. Right. Do they want– do you want people to know you, as you know, Dr. Iwane, he was a great physician. Dr. Iwane, you know, he is a great, you know, you know, clinician or whatever, you know, or would you want people to remember you as, you know, uh, Dr. Iwane, you know, he was a he was a great father, right? A great mentor. Right. You know, so, you know, it’s I think it’s important to really focus on what matters most to you. Um, and remember that through your medical training and even as you, as you start practicing because. You know, like I said, medical, the field of medicine is– it is a challenging profession. Yeah. But it is also, in my opinion, one of, if not one of the most rewarding. Yeah. When you can make the difference, right, when you can see that smile on your patient’s face, right? You know that that’s what keeps keeps me coming back. Right. And so, you know, besides family, you know, I love the outdoors. Fishing is like one of my my biggest, most favorite pastimes. And I love hiking. And I do a bit of hunting too. So just kind of being outdoors. And that allows me to also connect to our environment, connect to the land and that’s grounds me. And you know, just having that– that time right to, to rejuvenate. Yeah. To kind of re-energize and you know that that’s important. Yeah. So whatever it may be. Right. If you guys don’t have hobbies you know that is okay. You know. But I encourage you folks to explore your passions. Yeah. Whatever it might be. Because in the tough times. Yeah. That’s just going to keep you going, right. Or to your happy place and, you know, take care of yourself. Yeah. That’s important. 

46:53 Closing Remarks 

Amber: Yeah. That’s definitely some great advice that I think as students we can all try to really take

away and actually explore. I know it’s so difficult for students. Once you start school, the hobbies, the priorities aren’t exactly up there to be pursuing them as much. But you’re definitely right. You know the things that will ground us at the end of the day, whether it is going outdoors or knitting, whatever the climbing the hobby is, is always going to be there for us at the end of the day and this exam will be over, you know, the next thing you know, but the things that really ground you are really still there. Great words to end on. Thank you, Doctor Iwane, for taking the time to speak with us today. 

Dr. Iwane: Yes, absolutely. And like I said, you folks have my contact information, my email. You can go ahead and share it. You know, even to the broader– who put in joining us today. If you folks have any other questions or want to reach out any time, okay? 

Amber: Thank you. Enjoy the rest of your night. 

48:00 AMA Outro
Annie: And that’s our latest installment in the Ask Me Anything series. If you have a specific physician or specialty that you’d love to hear from, let us know. You can reach us at professionaldev@apamsa.org. We hope you enjoyed today’s episode as much as we did, and don’t forget to tune in next time! Thanks everyone!

Listen here:

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This episode was produced by James Chua and Ashley Tam, hosted by James Chua, and graphic by Callista Wu and Claire Sun.

Time Stamps:

00:00 Introduction to White Coats & Rice: An APAMSA Podcast

00:23 Introduction to Paul Tominez

02:06 Plant Parenting

06.28 Pharmaceutical Chemistry Major

10:10 Solo Traveling to 5 Countries in 1 Year

13:31 Military Match

16:46 Specialty Exploration and Why General Surgery

25:30 Challenges With Moving and Adjusting to New Places

29:43 Prioritizing Your Joy 

31:48 Hopes For Future Career

34:26 This Or That? Questions

37:42 Advice for Pre-Health and Medical Students

Full Transcript:

00:00 Introduction to White Coats & Rice: An APAMSA Podcast

James: Welcome everyone to the seventh episode of the APAMSA podcast. From roundtable discussions of current health topics, to recaps of our panels with distinguished leaders in the healthcare field, to even meeting current student leaders within the organization, this is White Coats and Rice. My name is James Chua, second year medical student at Touro Nevada, and the current fundraising director at APAMSA. I’ll be your host for today.

00:23 Introduction to Paul Tominez

James: For today’s episode, we have Paul Tominez, a fourth year medical student at UCSF School of Medicine and a proud graduate of UC Davis where he received his degree in pharmaceutical chemistry. During his time in APAMSA, he has served as the Region 8 director and now serves as one of the Membership Vice Presidents on the executive board. Originally from the island of Guam, Paul is an Army Health Professions Scholarship Program recipient, and he has recently matched into, well stay tuned for the rest of the episode to find out where. But spoiler, it’s another island. Former collegiate rower and highschool athlete, Paul’s interests include staying on top of his fitness by running and working out. He’s also an avid solo traveler, having a total of five countries under his belt this year. Without further ado, join us as we explore Paul’s incredible journey in medicine, his insights on leadership, and the unique passions that shape his inspiring story. Paul, welcome to the show. How are you doing today?

Paul: I’m doing good James, thanks for having me.

James: Yeah, no, we want to get as many of the executive board members on this podcast just so we have a very, more clear insight on to who you guys are, because you guys are like the leaders, you guys are shaping basically the next generation of APAMSA.

Paul: Yeah, we’re kind of this weird enigma in APAMSA that we have all the directors reaching out to our local chapters that we kind of just work in the background and a lot of people don’t get to meet us in person.

James: Yeah, you guys are pulling all the strings. But before we get on to the interesting questions we have in store for you, I have a couple questions myself. Just so I and our viewers or listeners can get to know each other better.

Paul: Of course.

02:06 Plant Parenting

James: So first, you are a plant dad.

Paul: Yes, I am.

James: Tell me more about that.

Paul: Yeah so I guess I started my collection in medical school, I think it was during my second year. But growing up is actually where I started taking care of plants so growing up on an island. We had this big yard that like was basically ours to do whatever we wanted to. So, my dad would plant a lot of fruit and vegetables. My mom would plant all of her flowers and other more decorative plants. And from like the earliest age I can recall like helping them in the garden in the afternoon. And like I’d get off school, change and then we’d be outside playing with my dogs, planting things, getting things, like harvesting, whatever we had growing that summer. And then in high school, I kind of cleared out this plot of land and we actually like built like, where it was like a farm and we had like a bunch of eggplant, papaya, I think we had cucumbers and maybe like several like pineapple plants and dragon fruit. And my dad was in the army, so he deployed like, I think later that summer, so I was the one mainly taking care of it. And it was actually like pretty relaxing. And I kind of lost touch with that during undergrad. I didn’t have any plants in Davis, but then in medical school, I stopped by Home Depot one day and was kind of just strolling around as one does in Home Depot. And I picked up two plants and then now I have an entire collection sitting by my window. And I think I probably have an addiction but I need some control.

James: Wow. How many plants – what would you say your favorite plant is?

Paul: Oh, I think it was the first one I got. It’s called a Ficus Audrey, but the interesting story behind that is that… So back in Guam, the other name for Ficus Audrey is called the Tatamuna Tree. So Tatamuna are the spirits back home in Guam that kind of like watch over you and you don’t just respect them. So another word is that these are big Banyan trees, the massive ones you see in the movies with all the things hanging down the sides. So I didn’t know that at first, I didn’t know this was the same plant. So now I playfully think that I have a big banyan tree growing in my apartment with spirits that may or may not be there. And it’s been growing really, really well. It was a super easy plant to start off with. And spoiler, unfortunately I’ll have to get rid of all my plants at the end of the year, but shhh. We’ll get to that soon. 

James: Yeah, I’m sure they’ll go to a very good home. It’s also interesting though because, so you grew up to some degree like growing your own fruits and vegetables.

Paul: Yeah, we also had calamansi. My nino had like tangerines in his yard. I remember seeing bananas. Obviously an island we had a lot of coconuts and avocados, mangoes yeah a lot of like very tropical fruits which I took for granted and then coming out to California’s like oh shoot you’ll have the same kind of fruits that we have back home.

James: Yeah no it’s funny because I also so I’m in Vegas a very desert climate environment, um one of the first things that my dad gave to me as a gift was a potted calamansi tree and it was already fruiting right? But like, lo and behold, my roommate, so I kept it indoors. I was told you can keep it in its pot for 5 or so years, and I was like “Perfect, by the time I’m done with medical school, I’ll know where I am for residency,” and than I can put it like, in the ground. But then I kept it inside and then my roommate kinda got mad because he was like, “yo, I think these are kinda toxic to dogs and worried that my dog is going to eat them all.” And I was like, “Oh man.” So I had to move it outside and then within a week it just shriveled up. 

Paul: Oh no, I didn’t know they were toxic to dogs because we have plants back home and I guess I never saw my dogs eat it but.

06.28 Pharmaceutical Chemistry Major

James: I am not studying to be a veterinarian and I cannot speak on how strict of a dog father my roommate is. It’s whatever, but in any case enough about plants I want to talk a little bit more about your medical journey because I think that’s why we’re all here. We want to get to know you know what motivates you and what drove you to become a physician but even before that something when I was reading about your history something that I was really interested in is, you received your degree basically in pharm. How did that translate over to medical school? Were you considering becoming a pharmacist first or something like that?

Paul:  Yeah, so I think I decided my major back in high school. I really liked my chemistry teacher and the class. I took AP Chem and really, really enjoyed the topic. So I kind of knew I wanted to major in chemistry in college. Kind of jumping ahead. So for college at Davis, there’s a general chemistry major, which I applied into, but then I was kind of going through the requirements and it required linear algebra, a bunch more complicated math topics, which I had no interest in taking but they had pharmaceutical chemistry as an option and that aligned a lot better with the pre-med requirement so I went into medical– I went into undergrad knowing that I wanted to be a doctor already so, I switched majors because it was a little bit more easier to integrate the requirements for medical school while also avoiding the death of linear algebra, super extensive quantum physics. And I was able to switch pretty easily because I had a few friends taking those classes and I don’t think I would have survived taking those. 

James: Yeah. No, I can definitely relate. When I went to my undergraduate, the University of San Diego, I received my degree in biology, just general bio, no specific specialty within it. But I remember like, I was doing really well in my chemistry classes. So I thought I was like, “Oh, maybe I should major in like biochemistry instead”. And then, you know, I love chemistry I love organic chemistry too. But when they recommended you have to take inorganic chemistry or these really niche chemistries, I was like, this is… this is not for me. And I also, like on a similar note to your linear algebra, for us, one of the requirements is like AP Cal– or uh, Calculus 1. And so if you’re a Biochem major you have to take Calculus 2. And I was like, I didn’t even need to take AP Calculus– or like Calculus here because I took AP Calculus and that covered it, so I was like “I can’t do anymore man, like physics is gonna be the end of it”.

Paul: I know, because like I didn’t make that change until maybe three quarters of the way into my first year of college, so I was already taking the calculus for engineers and that definitely was like a rough time. I wish I’d made that decision a little bit earlier, but you know, hindsight is 20/20. And then, yeah, I’m glad I kind of switched out of it because I had to take one semester of physical chemistry and took it during the pandemic, and that was a rough time. I’m glad I avoided the subsequent classes that would have followed after that. 

James: Yeah, no, I can only imagine, I can only imagine how difficult that journey may have been, but hey, it got you to UCSF nevertheless, so.

Paul: It did, yes. 

10:10 Solo Traveling to 5 Countries in 1 Year

James: Yeah, but even though– before we talk more about your medical journey I want to talk about your traveling. So we have five countries this year, huh?

Paul: Mhmm, ya, five countries this year.

James: Have all of them been solo?

Paul: Yes, they have, or I guess, technically, they’ve all been solo. One of them, my friend joined along, but he could not continue on with the trip because of some other personal reasons. But for the most part, yeah, they’re all solo. This is my first time traveling solo internationally. And the other few times I’ve been internationals with my family. And it’s been something I’ve been thinking about doing for the longest time, but I was always scared to do it. One, because traveling internationally by yourself, you don’t know what to do if there’s something that goes wrong. How do you ask for help? I was also worried about the language barrier, navigating public transportation, but things actually worked out really really nicely. 

James: So which countries did you end up– places did you end up visiting? 

Paul: Yeah, so I took my first trip in September of this past year. So I went to London first and then I took the Eurostar to Brussels and Belgium and then I went down to Paris and I went up to Amsterdam. I spent about, I think I was gone for 10 days, 10-11 days, and then I recently got back from Montreal, I think I left the day after Thanksgiving. I spent like five or six days there.

James: Yeah. How did you find the time to do that being a third/fourth year in rotations?

Paul: Yeah, I guess one of the nice things about UCSF is that once you submit your ERAS application, your schedule lightens up very nicely. So over the span of September until now I’ve had a very light class schedule. I only had one rotation that I had to do. I’ll be going back to the hospital in a couple weeks. So I was doing quote unquote research during the time. So I was able to do that on the side while also getting to travel internationally. I saved up a lot of credit card points so they would pay for my hotels very nicely. And yeah it was a nice experience. I’m hoping to take a few more trips hopefully before graduation. 

James: Yeah no I really, so since I’m only a second year and I don’t know how truly rigorous rotations are, I’m always like I know Match for us normal folk for us civilians is in March right and so I’m just hoping that when March rolls around it’s like oh from March to May and May is our graduation it’s like alright everyone, let’s go on the vacation that we all talked about for four years. 

Paul: Yeah. Yeah. Even before that too, like if you’re able to get all your rotations done, like just advice for anybody who’s able to do this, if you’re able to pack everything earlier on, let’s say finish and like, I know a lot of my friends are finishing in like December, January. So between February until graduating, they’re traveling the world and staying at home doing whatever they want. So if you have– if your school has the capability to push things a little bit earlier on in your fourth year, definitely I would take that. 

13:31 Military Match

James: Yeah. Well, since we’re already on the topic of medical school and all of that. Let’s just start. What– so I kinda spoiled it just a little bit in the beginning but what field or specialty of medicine are you interested in and why?

Paul: Yeah, so I applied into general surgery this past summer, so once again I am one of the Army HPSP recipients. Our match process is a little bit earlier, we found out our results a couple weeks ago so I matched into general surgery at Tripler Army Medical Center in Honolulu, Hawaii.

James: The pink hospital correct?

Paul: Yes, the pink hospital. They currently have a big I guess Christmas tree outside you could see it from like off the cliff.

James: No, it’s funny, so I was actually very interested… So let’s dive more into this. So you mentioned that your dad is in the army, right? Yeah. So did that play a big role into you choosing the Army HPSP? Or did it play a role in you choosing gen surg?

Paul: Oh definitely. Yeah. I guess for the Army specifically, so my grandpa was also in the military. I think he served in the Korean War I want to say. Don’t quote me on that. And then my dad was, served in the Army for I think 33 years. And then a bunch of my cousins are also in the Army, not in the Army, but in the Air Force. And then I went to what’s called a DoDEA school, which is like a school for all military kids and federal workers to have their children go to the same campus. So I was surrounded by a lot of like department of defense people and children. So that was definitely a big influence. And then I guess for me, the financial aspect of it was a big part because being from Guam, you are not considered in-state for anywhere besides University of Hawaii. So the cost of medical school would have been egregiously expensive for me wherever I went. So it kind of helped take off that financial burden of being able to attend medical school. 

James: Gotcha. You know, something that I don’t share with a lot of people, but I now I guess I’m going to share with every person listening, is that so my dad was also in the Army. And so for a brief moment, I was really interested in doing HPSP. But, um, also on that note, since my dad when he was active duty, he was once stationed in Washington in Tacoma. And so that’s actually where I was born. I was born in Madigan. And so I was, yeah. So I always think to myself that even though I’m in M2 right now, that maybe one day like I could sort of circle back and end my story in like Seattle slash Washington, you know, like that’s where I was born and that’s where I want to end my career you know? But we’ll see, we’ll see. 

Paul: Ya, I actually did a rotation up there at Madigan 4 weeks this past summer. They have an excellent general surgery program and they have a couple civilian doctors who work at the hospital. If you’re interested in general surgery, you can definitely work up there. 

16:46 Specialty Exploration and Why General Surgery

James: I’m currently interested in psychiatry, but you know, you know, things, things really could change. And on that, oh yeah. Yeah. Yeah. Because when I was, again, doing my research about you, you know, two years ago on your APAMSA’s bio, it said that you were interested in emergency medicine. So why did you switch from emergency to gen surg?

Paul: So I think during my third year I had so many life crisis of what I wanted to do in medicine. So I came into medical school thinking I wanted to do emergency medicine. That was the only thing I wanted to do. That’s mainly because I did research in emergency medicine during undergrad and during my gap year. I really liked the big, I guess, catchment of patients that you get to see. So it’s a very wide patient population. Everyone ends up being in the emergency room at some point unfortunately, in their life, so you get to see a wide array of presentations. Your ability to come up with different differentials very quickly to provide critical care and a very like adoptions to do that in a very resource limited setting was something that was very attractive to me and also kind of working as like the quarterback to coordinate care for all these patients who are coming into the hospital. So whether they can go home safely whether they need you know be admitted or they need to stay in the emergency room for a couple more hours, maybe a day or so. That was what really drove me to the field, and also the flexibility. So I heard that you can pile your shifts earlier on in the month and then take the last half of the month for you, whether that be traveling, teaching, doing research and so on. But then during my third year, I got more exposed to the different specialties. So I kind of got more interested in internal medicine because I really liked the depth of knowledge that they had for all the different specialties and being able to coordinate care more long term for these patients. And oftentimes when you care for patients in the hospital, like the relationship with them is very intense. So you’re caring for them for a span of 2-3 days to upwards of several weeks. And you get to see them every single day. You get to see them progressing, changing– their clinical status changing, which you don’t necessarily see in emergency medicine, because oftentimes you give them to a consultant or admit them to the hospital for medicine, or they get discharged. You do get to see some repeat patients who come in frequently, but you don’t really get that long-term care that a hospitalist will get. So I kind of got interested in being more like in the hospital, like on the wards through internal medicine. But I still liked the idea of critical care. So I thought of, okay, let’s do a critical care elective or pulmonology elective because I really like– unfortunately really like very sick patients. I like the complexity that they have behind them. And then I finally had my general surgery rotation. It was– I personally, I always felt like surgery could be an option for me. But I had never gotten any exposure to that. So I’m the first one to go to medical school in my family and have any exposure to surgery beforehand. But when I got to the OR I was… “wow, kike this is an incredible environment.” My first exposure was through a pediatric urology elective where, on my very first day being in the OR, the fellow handed me the scalpel, held the skin taut, and allowed me to do the first incision. I was like, this is insane. Like I’ve never held a scalpel before, never had cut anyone before and he was allowing me to do something. So that kind of like stuck with me and throughout the the two weeks of that elective they continued to allow me to do different things they taught me how to suture things closed they taught me how to tie things. One day it was just me and the attending so I was basically just opening for the case with just attending again with limited experience as a medical student, which was a very like incredible like memory that I’ll continue to take with me going forward. And then I had my actual general surgery rotation the week after for two months. So I did four weeks of vascular surgery and then four weeks of acute care surgery. For my time in vascular surgery, I liked it because again, the patients are very critically ill. So a lot of the vascular patients have multiple comorbidities, the cases are very long and complex. I think the longest case I was in was maybe I want to say six or seven hours. And I think that was only planned for like a 45 to hour and a half case. So it ended up just being at one point it was just me and the fellow trying to figure out like what to do. And I was like assisting the fellow in like kind of getting hemostasis and like holding things with like the forceps and cutting things, which was a very good experience. And then a lot of the patients end up going into the ICU. So I kind of got to see that, you get to do surgery but you also still get the care for these critically ill patients as like the primary team. So it kind of combined two interests that I had. And then the following month, so I did acute care surgery, which is basically the consulting service for general surgery. So what that means is that whenever I guess the hospital service needs like a consult from surgery, you’ll call the acute care service. So would that be for like a bowel obstruction or let’s say in the emergency room, they’re admitted for appendicitis or cholecystitis, you call that service in the hospital. And I really liked that service because there’s a lot of running around. So I think at one point, our list ballooned up to like 30 some to 40 some patients. So our patient list was too thick that we couldn’t staple it together. And I really liked the one– again running around. So running between the OR and the floor to check on non-patients. We just had a bunch of cases going on it throughout the day. I felt like the residents allowed me to do a lot. So one, care for the patient and write notes of course, and then also in the OR getting to close, drive the camera for a lot of laparoscopic cases, and then closing of course honestly with just the attending sometimes, which kind of stuck with me as well. And then the very last case of my rotation was an ex-lap and that was the first ex-lap that I had ever seen. And when we’d gone to open the body cavity, the blood was just gushing out of the patient, unfortunately. But that really stuck with me because I got to see how quickly these general surgeons had to think to figure out what’s going on. And while also, again, using their hands to see where the source of bleeding is. And I really liked how quick on their feet they were thinking. Also being able to make a difference in the moment at that time that you don’t necessarily get to see in other specialties. And this emphasis of using your hands thinking critically. Very sick patients continue to stick with me through all of my um through like all the other general surgery rotation that I did. Even in my GYN surgery rotations where they allowed– again allowed me to do a lot of things in the OR continue to stick with me. And ultimately, like it was the teacher I had in the OR that drove me more and more towards that general surgery path. 

James: I can see why you have felt like so inspired to pursue this specific route. I think in my own experiences. So even before, so I mentioned I was interested in psychiatry, but prior to this, I was interested in infectious diseases. And I think that was from all of my mentors throughout my undergraduate and post-grad time. Like they were the ones who like wrote off however many hours I shadowed them in the hospital for applications but when I went with them and learning from them and getting inspired by them, I think that’s what really propels us forward. Especially in our medical journey you know?

Paul: But it truly is. Ultimately, your clerkship year is decided by who you’re working with. You can have a tremendous attending who gets you involved with the cases and teaches you a lot and allows you to do a lot of things. Or you can have the opposite of where you’re basically just shadowing as a medical student, which may not be the most exciting thing in the world. So your teachers, your mentors, your attendings, even your residents will make or break your clinical rotation. 

25:30 Challenges With Moving and Adjusting to New Places

James: Absolutely. But I think medical school has its ups and downs, and so we talked a lot about all of the ups right now and how great your rotations have been. I’m sort of curious about the antithesis of that, like what has been the more challenging part of your medical journey, you know? Like was it in med school? Was it in undergrad?

Paul: Yeah. I think I mean, I’ve struggled a lot throughout my life. I think– so I moved away from Guam at the ripe age of 18. I think I was only 18 for like two weeks before starting undergrad. So I think that was a pretty big struggle trying to figure out how to be an adult, how to manage being a college student, making new friends, building a new support system in a place that was completely unfamiliar without any existing family in like a several hundred mile radius was challenging. So, that first couple of like quarters in undergrad, it was like hard. I wanted to go home almost every single day, I was trying to call my parents every single day. The time difference alone made it hard to be able to make that connection, right? I think towards like halfway through, I was like, “Oh, like this is too much. I’m going to transfer back home and kind of just go back, go to school back in Guam.” But I stuck through it. I was able to find community through my club rowing team. Built a lot of, built a lot of lifelong friends that kind of gave me more balance for, for school. So we had the school side and then I would be working out with my teammates. So that kind of helped keep me cemented at UC Davis and then as the years went on, continued to feel more and more comfortable with being in Davis, you know, buying my own groceries, doing laundry, cleaning and whatever, and then also managing, being a pre-med. And then kind of experience the same, I guess, adjustment in medical school. It wasn’t a big move, so Davis is only what, like an hour and a half from SF, if there’s no traffic. But again, San Francisco is a very different place than Davis. I always joke around that Davis was a nice stepping stone for me, going from an island in the Pacific to California to a small college town, now being in a city of 900,000 people. So I kind of had that same similar adjustment, trying to find like, okay, who do I connect with? How do I manage my medical school? How do I navigate being in a new city? Manage being able to drive in a city, I just got in my car a year ago, so figuring out how to drive in this very cramped city. But I continue to adjust. I think the hardest parts for medical school is that you’re surrounded by such tremendous people, people who’ve done incredible work, both your colleagues, your classmates, the residents, the attendings. Oftentimes you can feel like wow, am I good enough? Am I good enough for this? Am I putting in enough work? But being able to acknowledge that you’ve done the work, you’re here, you made it, like, you’re going to be a doctor at the end of the day. And to remind yourself that constantly really does help to kind of manage your expectations. I think being able build like good work-life balance is something that I’m continuing to work on. I think I built it pretty nicely during my first year and a half, but during clerkships, it kind of took the backseat because of how much you’re trying to learn, how long your hours end up being, kind of, I personally tried to prioritize as much learning as I could for clerkships while at the expense of like, you know, like, my personal wellbeing. So now that I’m in my fourth year, I’m trying to rebuild all the hobbies I lost over the last year: solo traveling, taking care of my plans. And hopefully build that, like, routine for residency coming up in the next six months or so.

29:43 Prioritizing Your Joy 

James: I can definitely speak as well on how important it is to maintain, you know, these hobbies that you have, that keep you grounded during medical school. I remember like prior to medical school, I used to go to the gym very regularly, but then when MS1 started I was just like no time for studying– or no time for working out, all time for studying. And I think that was just me being like… I was just not prioritizing what needed to truly be prioritized and that’s, you know, your physical and mental health first. And so now that we’re in our second year, I’m– it’s kind of people say it’s pretty wild. But for me, my personal schedule is that I wake up at 3am to go to the gym but mind you that means I go to bed at like 9 to10. I’m still getting about 6 hours of sleep. But I just like starting off my day with that one thing that like is so routine, you know, because things are so rapidly changing and it’s hard to stay grounded. So yeah, yeah. 

Paul: Yeah. I mean, kind of speaking to that. Yeah. I mean, I used to go to the gym a lot, especially during undergrad and honestly during my first year and a half of medical school, but during clerkships, your schedule is not really your own. So being able to fit in like what brings you joy during that time, like it’s a struggle because you can always study more. You can always try to get more sleep, but you really have to make time for the things that bring you joy, whether that be your hobbies, whether that be working out, whether that’d be like working on your mental health, or even meeting up with your friends because for clerkships everyone’s spread across the city or the Bay Area or wherever you’re going to medical school and it’s hard to talk to people at times. It can feel very isolating especially if you’re the only medical student on your team. So making sure you also maintain the connections you make during the first year and a half. Having people you can rely on to kind of like decompress, talk about what you’ve been experiencing like during your clinical day, can really like change your experience overall. 

31:48 Hopes For Future Career

James: Yeah, absolutely. So now we’ve taken the time to talk about all the highs and your incredible rotations and surgery and how that inspired you. And we talked about the lows and all of the challenges that shaped you into the medical student you are today. I’m now curious what we can expect for the future. So in other words, if we had a crystal ball for you and we were trying to predict your future medical career, what is the one thing you are looking most forward to now that you’re going to be what, an 01? An 01– is that not the term? Like for officers?

Paul: Yea, so I’ll actually be a captain which is an 03. 

James: Oh my god, so you’re skipping a little bit.

Paul: Yeah, so I’m skipping a few!

James: So skipping first and second lieutenant.

Paul: I’m actually a second Lieutenant right now. 

James: Oh, okay. Yeah. For medical school year, you commission as an 01and then once you graduate, you become an 03.

James: Got you. Okay, thank you for the clarification. Well, in any case, what do you look forward to in your future medical career or even military career?

Paul: Yeah. So I kind of touched on this before, but it was all again, my decision to go into surgery was based off the residents and the attending that I had. So I’m really, really looking forward to being able to teach as, as a physician over the past couple of months or even over the past year, I’ve been leading a lot of like, suturing workshops, knot tying. And I’ve also been tutoring for the school of medicine and I’ve really enjoyed my time being able to teach younger medical students like all the knowledge that I’ve gathered over the past several years. So I think at least at Tripler they do an excellent job of trying to emphasize teaching for medical students so I’m looking forward to being in that resident position and being able to have like all these chalk talks and teaching medical students how to like suture and knot tie and all like the different surgical pearls. And then ultimately I would love to continue mentoring like medical students and pre meds and others like people in general who are interested in medicine, because I feel like a lot of wisdom can be passed down through the experience that you live. But everyone’s journey is gonna be different but being able to hear what other people’s journeys were like and what the life lessons they took away from that can really help someone navigate this foggy field of medicine that often for people who don’t have family in medicine itself can be kind of difficult to navigate at times. 

34:26 This Or That? Questions

James: Yeah, absolutely, that intergenerational connection between generations and generations of physicians, it really carries on. And I look forward to the day when you know you’re an attending and APAMSA can call back to you so that you can mentor another bright-eyed future captain. But yeah, in any case, thank you for sharing so much about your medical journey. We’ve really learned so much about your professional side and the academic side, but I wanted to end the podcast more on a lighter note. And I’ve been asking every single person we do this 1-on-1 series with a bunch of this-or-that questions just so we end on a goofier note. It’s just gonna be A or B just choose one, you can give an explanation, but it can be pretty rapid fire. I have actually found that every single person I’ve interviewed has to always pause and then expand upon. So, feel free to do that as well.

Paul: Alright I’ll try to be as rapid fire as possible.

James: I’ll just give it to you then. First, city or beach

Paul: Beach

James: Cats or dogs? 

Paul: Dogs. 

James: Text or call?

Paul: What was that? Sorry, one more time. 

James: Text or call? 

Paul: Text. 

James: Black or white? 

Paul: Black. 

James: Morning or night? 

Paul: Morning.

James: Summer or winter?

Paul: Summer

James: Breakfast or dinner?

Paul: Breakfast

James: Would you rather have the power to be invisible or the power to read minds?

Paul: Be invisible.

James: You know, you’re actually the first person to answer that. 

Paul: Oh, really? I think my anxiety would go off the rails if I could read people minds. 

James: Would you rather have 100,000 to spend on yourself or a million you could only spend on others? 

Paul: A million to spend on others. 

James: We have such kind hearted guests, everyone always says that. And then finally, for our final this or that question, would you rather retake step one or retake?

Paul: I think I’d rather retake the MCAT unfortunately. 

James: Okay, so I’m gonna ask you why. 

Paul: I think I’m the first one who probably said that right? 

James: Yes, that is correct.

Paul: I don’t know, I really like basic sciences. I mean I was a chemistry major so like that wasn’t like an issue for me. Really love biology so biology and biochem. So that was like, fine. The only issue with the CARS section, which I think I could do better if I actually practice CARS. And then the psych-sociology is like, yeah, you just do the flashcards. So yeah. STEP1 was rough for me. 

James: Yeah, I really thought we were gonna have like a 100% unanimous step one answer. Way to break the mold. So that’s wild. Alright, well that brings us to the end of our This or That segment. Thank you for your honesty. 

37:42 Advice for Pre-Health and Medical Students

James: As we wrap up this episode of White Coats and Rice we love to close out our 1-on-1 series seeking advice from our guests. So, Paul, what is one piece of advice you’d like to share with someone navigating the journey of medicine/medical school?

Paul: Yeah, I think making it your own journey is a big one. I think there are so many different ways to be successful in this field and ultimately it will be your own experience in the end. So take all the advice that you get, take all the experiences that you see with a grain of salt. Integrate into your decisions but ultimately make the decision because you want to do it. No one else can make the decision for you or people will try to make the decision for you, but ultimately again, like it’s your career, your life. So building that confidence to be able to navigate this incredible field of medicine with confidence is… It can be challenging at times, but once you start to build the repetition of doing that, life gets a lot easier.

James: Thank you Paul for sharing so much about you. It has really been such an honor to have you on the podcast. Thank you for sharing your incredible journey from the beginnings on the island of Guam to where you’re headed next, to the island of Hawaii. It has been so inspiring. If our listeners want to contact you his current email is membership@apamsa.org feel free to shoot him a question if there’s something you want to learn more about, whether it’s maybe a military health scholarship or anything like that I’m sure he’s an open book. To everyone tuning in we hope you found this conversation as meaningful as we did. Be sure to join us next time for more stories that uplift and connect – we hope to see you all at the National Conference at Duke University this upcoming Mar 7 – 9, 2025. Thank you Paul!

Paul: Thank you for having me!

Listen here:

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This episode was produced by Annie Nguyen, Reanna Dona-Termine, and Ashley Tam, hosted by Annie Nguyen, and graphic by Callista Wu and Claire Sun.

Time Stamps: 

0:00 Introduction to White Coats & Rice: An APAMSA Podcast

0:57 Speaker and Event Introduction

2:40 Dr. Grace Kajita: Support, Simplicity, and Presence

8:39 Dr. Indu Partha: Attitude, Business, and People

14:25 Dr. Nolan Kagetsu: Policies, Time Off, and Work-Life Balance

18:42 Dr. Caroline Park: Balance, Teamwork, and Growth

25:56 Q&A From Audience

27:00 Navigating Conflict in Residency: Strategies for Professional Growth

32:33 Common Pitfalls and How to Avoid Them

36:38 Endurance in Medicine: Sustaining Passion and Well-Being

41:00 Finding Our Voice: Asian Identity in Medicine

50:48 Closing

Full Transcript 

0:00 Introduction to White Coats & Rice: An APAMSA Podcast

Annie: Welcome everyone to the 6th episode of the Asian Pacific American Medical Student Association Podcast. From roundtable discussions of current health topics, to recaps of our panels with distinguished leaders in the healthcare field, to even meeting current student leaders within the organization – this is White Coats and Rice. My name is Annie Nguyen, a postbac at Stanford University, and a member of the Leadership Committee at APAMSA. I’ll be your host for today! 

This is our Preparing for PGY-1 Event, where doctors Grace Kajita, Indu Partha, Nolan Kagetsu, and Caroline Park share insights on navigating the transition to residency. These four program directors provide concrete advice on making a great impression, choosing the right program, and managing the challenges of intern year. Whether you’re preparing for PGY-1 yourself, or simply looking for professional development tips, this event is for you! Let’s dive in!

0:57  Speaker and Event Introduction

Annie: So thank you everyone for coming today. we’re very excited for this event, brought to you by our Leadership Committee. We hope that we can provide some meaningful insights on how to best prepare for PGY-1, or just in general, how to navigate your journey in medicine, since everyone here might be at a different stage. Um, to do this, we’ve gathered the most incredible panel, Um, to help share their tips with you. And just as a brief overview of the events, we want to start with a presentation where each of our panelists will share their insights, and then we’ll open up to all of you for a Q&A. Um, this event is definitely for you guys, so don’t hesitate to ask questions. You can drop them in the chat. You can also just raise your hand or unmute. Um, we just want to make sure that you get all your questions answered. So without further ado, I wanted to introduce our panelists. We’re going to start with doctor Grace Kajita. She’s an internal medicine program director at the Albert Einstein College of Medicine. We have Doctor Indu Partha an internal medicine associate program director at the University of Arizona, Tucson. Um, we have Doctor Nolan Kagetsu, a former radiology program director at Mount Sinai. And last but not least, Doctor Caroline Park, the trauma medical director and former fellowship program director at UT southwestern. So, big round of applause for everyone. And just before we get started, as Doctor Partha mentioned, if any of you are comfortable turning on your cameras, we would love to see your faces. It’s nice to talk to other faces. Um, okay. So I’ll go ahead and share my screen.

2:40 Dr. Grace Kajita: Support, Simplicity, and Presence

Annie: We’ll start with the presentation, and we’re going to hear first from Doctor Kajita.

Dr. Kajita: Thank you so much for that great introduction, Annie, and it’s really a pleasure to be with all of you again. I think this is my second APAMSA event and I’m really excited for all of you. I don’t know where everyone is at this point in the process, but I’m going to address a common concern that lots of people have coming into residency. One thing I do want to do before I start is just sort of say a little bit about myself. I’m a general internist. I currently work at the Montefiore Medical Center in the Bronx, at one of the smaller internal medicine residency programs, we’re primarily international medical grads. But I used to work at NYU. Everyone always has the same questions, so please feel free to stop me if you can’t hear anything or also to ask questions afterwards. Now, yes, that’s me on my– on this slide. It’s not a great photo. This is one of the reasons why we don’t turn on our cameras when we do these things right. But I’m going to make a point about this at the end of my sort of three major bullet points. And what you’re going to see on the slide is that I’m not talking about stuff you should read or learn or skills necessarily to get better that going into residency. And while, that’s really important. And I understand you’re worried about this, I’m going to talk about some of the peripheral things about your life outside of the hospital, because that really needs to be worked on or cared for just as much as preparing for the academic stuff. So when people ask me, should I review EKGs or chest X-rays? These are sort of the questions I ask them. So for starters, and by the way, you will get some amazing pointers from the other slides that are to come. I’ve seen the slide show, so I’m excited for that as well. So medical school is really different from residency because it’s still at school. And remember that when you go into residency, the expectations are more along the lines of a job. So your work day is different, your downtime is different. Your ability to connect and just hang with people is completely different. One thing throughout everything is that we know you’re outstanding academic achievers, but you also in this space, need to make time to connect. Refresh. Stay close to the people who’ve supported you throughout this journey. So my first point is please establish your support network before you start your residency. And what does that mean? Who are your people? Who are the people who keep you supported that you could call, you know, anytime something is going on? Sometimes it’s a mix of family and friends and mentors. Identify those people. Then make a clear cut plan on how you’re going to stay in touch with them, meaning maybe you want to call them once a week, but if you’re working nights, you’re not going to be able to call them at the same time. So adjust that plan, but don’t let it go, because the more you lose contact with those people, the more isolated you’re going to feel. And residency is a really hard time to feel isolated. So think about your people. Secondly, and I think you guys are of a generation where you do this really well. Simplify your life, okay. Take out the extra stuff and the things that are a hassle, even if they seem cool. Just to make it easier again. You’re kind of. You kind of have a working life now, right? So your time is going to be really, really busy. You come home from the day, you’re going to be tired. So if you, for example, I’m in New York, you think I’m going to be working in the Bronx, but it’ll be really cool to live in Brooklyn. I tell all the interns, please don’t do that. You wouldn’t be miserable with that commute. You’re going to fall asleep if you’re driving. Think about keeping it simple, at least for your first year. Now, I know some of you really have a preference because you want to stay close to family. That’s okay. Or for other reasons. But try to allow yourself plenty of time to do things outside the hospital and outside of work. And by that, I need you also want to make everything as automatic as possible. Your bank payments, your student loan payments, everything. When you prepare a meal, make extra, bundle it so you have leftovers to take for lunch the next day or to have for dinner the next day. Keep it simple if it means a food delivery service. That’s okay too. But set that all up before you start residency, because if you can-, or work on it along the way, it just makes it easier when you have fewer things to worry about. Finally, under this point, remember that you’re just going to be sort of a little bit out of water at the beginning, even if it’s your medical school or a program affiliated with your current medical school. Assume that everything’s going to take longer than it needs to take, right? So just schedule it for double the time. Don’t overbook because that leads to a lot of disappointment. Yes. You think you can go hang out with your friends at a bar after a long call, but you’re also going to do your laundry beforehand? Keep it real. Okay. Finally, and this relates to that point I mentioned earlier about turning on the cameras or seeing each other. Be kind and be present to yourself, your patience to everyone you work with, and show kindness to the first person you see. It’s the person who is assisting patients at the door, the greeter, security guard, whoever it is. Eye contact is amazing. It makes such a difference. Especially since we’re Zooming so many things. Even turning on the camera during the Zoom will make you feel a little more connected to your teachers, your colleagues. And all of that will definitely, although it might feel like a hassle at a time or you’re having a bad hair day, really, people don’t care. Just be there for everyone else. And that’s basically what I have to say. And so I’ll pass it on to my colleague if that’s okay. 

8:39 Dr. Indu Partha: Attitude, Business, and People

Dr. Partha: Wonderful! Thanks so much, um, Annie, for the invitation and Grace. It is a pleasure to hear your tips. I, um, cannot agree with them more. Um, so helpful and really so relevant. I am Indu Partha and I am also a general internist. I am a primary care physician by training and passion. And I am one of the associate program directors with the University of Arizona College of Medicine in Tucson, and heading up the ambulatory education side of things for our internal medicine residents. And I really do need to echo what Doctor Kajita said is, you know, we aren’t really here to tell you about what books you should be reading and what you know, learning you need to do to be a successful resident. Because truthfully, that’s what residency is there for. We’re there to educate you. We’re there to train you. We can teach you how to be smarter, but we cannot, um, in– teach you how to have more integrity, more humility, more compassion and more enthusiasm. And those are the qualities that I would love to see you all bring to your respective residencies when you get there. Um, I’ve kind of broken it down to what I thought might be helpful tips for you all as you prepare for residency. And honestly, if you’re earlier in clerkships, I think these are helpful tips as well. Um, and I’ve broken it down into kind of the approach to your attitude to the business and to the people. So in terms of the attitude, this kind of speaks to Doctor Kajita’s. Um, advice to be connected to um. Be integrated with the people around you. Um, and what are your bring– what you’re bringing to the table each and every day. Cannot highlight enough the need for you all to ask for help and feedback and learn how to do so early. Um, think about what you’re bringing to your team, to your junior residents, to your faculty. That energy is very contagious, and what you bring spreads like wildfire and a great attitude. You know, you’ll be working hard regardless, but having a positive, um, not unrealistic attitude, but just a positive ‘we can do it. Let’s work together’ attitude can really go a long way to, um, making residency a lot more fun, a lot more enjoyable, and I might say easier. Um, one of my favorite sayings is water your flowers, not your weeds. Um, this is sort of, put your attention into the places that are giving you back what you need, but also learn how to focus on the things you do well, not always focusing on the things that you do poorly. Um, and really highlight those and spend time growing those passions, um, both clinically and personally. Don’t speculate. Ask and clarify. You know, don’t think ‘I think this is the diagnosis for this patient’, um, yeah. ‘I think they are taking their medications all the time. I think this is what my program director means when they are telling me we have to do x, Y, and Z’. Just ask. Clarify. Don’t write your own narrative and story about what’s going on. Check in with others. If you’re having a rough day, hard time, chances are very, very likely that others are as well. This is how you guys all will work together. Um, and kind of hold each other’s hands through a tiring and rough time of life as being there for one another and check in. Hey. How are you doing? Can I help you? I need help. Can you help me? Um. Be a hand raiser. Again, this goes along with. Turn your camera on. Volunteer to do things. Be available. Be enthusiastic. Um. Any and all faculty are overjoyed when residents show up with enthusiasm and interest. Um, in the midst of their busy days, it’s speaking to the business of things as well. There is business to be done. Please get your paperwork done on time. Believe it or not, this is what program directors and APD’s discuss about their residents. Make sure you set aside time to study. Answer the emails that you get. Please don’t ignore those. It’s part of being a responsible adult resident, which you guys all will be. So please make sure you’re, um, being responsible and replying. And then first and foremost, you need to show up. Show up to conference. Show up for other people. You’re there to learn. And those conferences are important and have been prepared for you to learn. And lastly, don’t forget about the people. Build relationships with your peers. Uh, with your attendings. Learn about your patients beyond their illness. Find the senior residents you admire and emulate how they behave. Ask them, how do you do what you do? How did you learn what you learned? Um. Your chief residents are going to be working really hard on your behalf. Please treat them with thoughtfulness and respect. It’s not an easy job. Um. So do trust them. And lastly, assume positive intent first. It’s really easy when you’re tired and overworked to think, oh my gosh, everyone is kind of out to get me. But if you take a step back, assume a positive intent. Take away what you can from it and then put the rest aside. Um, I think it’ll do a lot towards keeping you happy and healthy as you get through your residency. Um. That is what I’ve got for you. Thanks for your time. 

14:25 Dr. Nolan Kagetsu: Policies, Time Off, and Work-Life Balance

Dr. Kagetsu: All right. Thank you. Thank you everyone. Um, it’s great advice from my– my colleagues. Um, I’ll summarize some things. Um, just a reminder. You’re an employee, not a student. I think I forgot that one of my first days, because when I was sick, I didn’t just. I just didn’t show up. And then somebody said, you know, you’re not a student anymore, so, um. Yeah, I and so it seems obvious and stupid now, but whatever. Just saying that, putting it up there. Um, so sometimes different programs have different policies. So you just have to, um, clarify what the policy is at your place. When I was a program director, if a resident said, ‘oh, I have to have a dentist appointment’, I said, ‘okay, fine, that’s like a sick half day or a sick hour or something’. But some programs are more hardcore, if you will. And they say, oh, you get wellness days. So that way you can go to the doctor once a year. And it’s like, I’m thinking, that’s not very generous, but it is pretty common. So, um, I think certainly when you’re an attending, if you have a doctor’s appointment, colleagues will cover you and you’re not you don’t have to take vacation time to, to, um, have medical care. So anyways, I think the key thing is, um, figure out the expectations, the policies, so that you, um, whatever, um, don’t break break rules or or don’t mess up, whatever the culture is. Another thing that is interesting, some people, even for attendings, they you have to kind of get a sense of what personal days are. So personal days. Some people would say, oh, that’s only if I have a personal emergency, and if I want to take a personal day to go shopping, then that’s an abuse of the system. Um, I would say in some ways, personal days are like extra vacation days, and but you have to make sure that’s the culture of your organization. Like the way I used to run it is personal day is essentially like a vacation day. And, you know, if you had a genuine emergency, then you would essentially take an emergency vacation day. And if you had run out of vacation days and have an emergency, well, then maybe you can pay it back next year or something like that. But I think I, even some faculty I remember would essentially not use their personal days when– and for them it was not fair that people would use them. So I think it’s just a better place to be with, if you– if the PD says you know what your personal days are like PTO and use them or or lose them, frankly. And then for some of them I call– I had one resident that, um, you know, there was a scheduled exam that was going to be on Lunar New Year. And for her, that was a– one of the most important days of the year where she had to, I don’t know, you know, always saw her family. And so if there’s 1 or 2 days that are really important for you, I think the program director should try to accommodate, those 1 or 2 days. Um, and, uh, you know, maybe if 15 out of 20 are asking for Lunar New Year off, then obviously that’s going to be an issue. But or perhaps have some sort of lottery system, but I think it’s okay to ask for, um, perhaps 2– 2 holidays should, uh, not break the bank, if you will. I had one resident who for him, his most important day to have a personal day or vacation day was Halloween. And so, you know, for him, that would have been terrible if you did not have Halloween off. So we brought Halloween, and that’s it for me. Happy to take questions at the end.

18:42 Dr. Caroline Park: Balance, Teamwork, and Growth

Dr. Park: Um, I just want to say thanks to Doctor Kagetsu actually, because he reached out to me, uh, on Twitter and, uh, told me about this opportunity. So I think, number one, just, um, looking out for each other. I think that’s the really incredible thing about not only just, you know, us humans, but, um, you know, being in medicine, which is actually a pretty small world and kind of leaving all the other, you know, bits of advice that everyone has given you. If you think about it, you know, we’re going to be working 80 hours a week. You’ll be working 80 hours a week, which is really like that’s double the standard workweek, right? Like that’s crazy. Some people think about that and be like, that’s insane. That’s two jobs. And that’s the reason why I think it’s so important that you spend quality time. It’s not going to be a lot of time. It’s not as much as you used to have, but it’s really high quality and you’re very deliberate about the time that you choose to, you know, meet certain people or whether it’s for yourself or for other people. So, um, that’s just my little segway for my introduction. So, um, first of all, I’m really glad for Annie, uh, for, for pulling this together and all the other, uh, leaders in APAMSA. I’ve actually never been to an APAMSA event, so I’m super excited to be a part of this. I’ve actually been thinking that I have not been very good about being in, like, our own society of Asian-American surgeons, and like, that has been like my priority this year to be, like, more, uh, present, uh, because I really do think that it’s important that, you know, you guys look around your generation, you see mentors that look like you, right? Um, and so then you can kind of see, like what? What are their paths? How are they able to get there? Right? Like, I feel like that’s how people are more comfortable, um, sort of choosing those careers, right? Like. I was kind of intimidated about being a surgeon because I looked around and it was a bunch of white males, and I was like, how do I really fit in here? Right? And I think the more that I went through my clerkships and obviously residency, it changed. And so it’s, it’s become a lot more diverse and in fact, more women than men are. So background for me. I’m an acute care trauma surgeon, so I do both emergency general surgery and trauma. Um, I am now in Dallas. Um, so I trained in Boston and I’m actually from New York, so I’m jealous of all the people that get to enjoy New York bagels, because the bagels in Texas are terrible. Um, and then I train in Los Angeles for fellowships, so now I’m all over the country. I used to be the associate program director for the fellowship, and I am very good friends with a lot of the associate program directors for the residency as well. Um, so number one, uh, I’d say that, you know, when you are first exploring this new city because oftentimes you guys are moving towards totally different cities, different states, right? Like, explore that place before you have to hit there, like day one, right? Like, where is the hospital? How am I going to commute to get there? Like practice the commute, right. Whether it’s biking, walking, subway, car or whatever. Um, because you might find like, for example, in the snowstorm, when you’re parking on that street, you got to dig your car out of the snow, right? And that’s an extra 20 minutes. 30 minutes you have to factor in to your commute. Um, I personally, I was like, I pay more money just to get covered parking if I were in a snowy city. Um, so just get the lay of the land, you know, talk to the other, you know, people that live there now, whether they’re medical students or interns and be like, where do you live? Why do you like being there? Right. Like, just figure out that place. Um, and for anyone in residency, you’re going to be in a new rotation every month, every 30 days, 31 days. You’re going to be thrown into a completely different world. Pediatrics. Gastroenterology. Cardiology. Like, I think honestly, that’s one of the best things about medicine. You get to just experience. I think it’s almost like a new country. It’s a new language. You’re looking at different body systems. You’re learning the lingo of certain things, right. Vascular surgery, it’s all about pulse exams, circulation, inflow and outflow. And I think it’s really cool. I think that if you look into each rotation as being an expert in that field, like this month, I’m going to be a pediatrician next month. You know, I’m gonna be a gastroenterologist and really, like, immerse yourself in that. I feel like you can get your best shot of, like, thinking, is this the kind of life I want? Right? Um, some of you guys already know what you want to do, and that’s great. But I know a lot of people that change your mind as they’re going into medicine, so keep an open mind. Um. The other big thing that I learned was reaching out to the interns that are already on service and kind of like figuring out their hacks, right? Like, what’s the fastest way that you get information? Um, how do you print out lists? Like, how do you like, what’s the way that you build your electronic medical records, sign out sheets, right. Like everyone’s got a different way of doing things. And those little hacks that the interns give you are going to be gold. Um, and then the big thing, and I’m sure you guys have figured out as medical students and, you know, the staff figure this out to the attendings. We know when, um, you know, when people are working really well together as a team. And we can also feel at least like when there’s, like one person that just wants it all and doesn’t want to share with anyone else. And that’s just not helpful. Um, and because at the end of the day, it’s all about the patient, right? And I think that being a part of the team and not just being it’s me because you’re past already. You got through the gates. You’re now a doctor. Okay. Now you just focus on taking care of the patient. It’s not about winning anymore. Okay. Um, so the next thing I already kind of talked about, but just kind of like immersing yourself, you know? And if you’re like, I really want to be, you know, an interventional radiologist. Well, you know, go do that rotation. Ask them what their lifestyle is like. Like, I’ve had plenty of medical students ask me, like, I really love surgery, but gosh, like, these calls are so hard. And I tell them, like, that’s not my whole life. I don’t do this all the time. Um, that’s only half of my month. And the other half don’t even see me because I’m in my office. I’m like, running around the lake, like I’m doing other things. So our lifestyle is very different from what you see as a student, from what you see as a resident, from what you see a fellow, it is so a different hour that you have to wake up at the time that you go to bed and the kind of responsibilities you have. So don’t think that your experience as a med student is like, that’s what my life’s going to be, it will change. The last thing, I am very, very active. Um, I have a lot of hobbies, but I realized that when I became an intern that my 20 hobbies came down to, like, three hobbies. Right? So it was like I had some very, very, very selective about things that I really love to do. I love to bike. I love to run, and that was pretty much it. So I knew that it was are the only two things. If I had an hour on the weekend, I was going to do those two things. So be very, very selective about your hobbies and just pick the ones that like really, really mean a lot to you. Um, the other thing I was just going to say, just like, listen to your body. Like, you know, when you’re really tired and you just have to, like, say, okay, enough is enough. Those clinic notes, I’ll get to them, right? Like, I actually need to sleep. And I think the people who are, like, chugging the Red Bulls and the Celsius drink and all that stuff just to stay awake like it’s temporary, but you’re going to crash at some point. So, um, you’ll get a sense of like when you’re pushing yourself a little too hard and you’ll get a sense– you get a better sense of that. I think you kind of know, like when to kind of back off a little bit. But listen to your barometer. Um. That’s all I got. 

25:56 Q&A From Audience

Annie: Okay. Thank you so much for each of those insights. I hope that someone on this call was able to take something with them. Um, I know that I personally am pretty far away from this step, but I think that in general, there are some very useful tips here on how to navigate medicine and how to take care of yourself while doing that. Um, so before we jump into questions, I just wanted to see if, um, anyone is if anyone is uncomfortable with us recording the Q&A part of this. Otherwise, good to go. Okay, perfect. So now we’re going to open up the floor for questions. Feel free to drop them in the chat. Or you can, like our panelists said, be brave. Um, unmute turn on your camera and ask anything you’d like.

27:00 Navigating Conflict in Residency: Strategies for Professional Growth

Donna: Uh, hi, I’m Donna Tran. I’m a fourth year. I’m going to psychiatry. Uh. Super excited. I had a general question. Um, can you give your tips on, like, when you don’t get along with your co-residents, either in your cohort or outside of your cohort? Um, and attendings, like, how do you handle those kinds of conflict? Especially now that I’ll be PGI one at the bottom of the totem pole. Again, not like med students, but you catch my drift. 

Dr. Kajita: Um, I’m happy to start. Uh, because I’m feeling talkative tonight. That is a great question. Right? Like, who do you go to? Like, you don’t want to be the person who’s, quote, high maintenance or ratting people out. You also, um, don’t want to have that kind of conflict, right? And can I just say something, even though you’re quote at the bottom of the totem pole or the– we don’t say that anymore, but if you’re at the bottom of the ladder, you know, you’re really you’re just as important. In fact, you’re one of the hardest working members of the team. So please don’t diminish your role as a PGY-1. Um, my suggestion would be that, um, usually, um, feel out when you start a program, your chief residents. They are a great place to start because usually they’re doing extra work to support all of you guys. Feel them out and check in with them. The other thing is, if it’s an attending conflict, you can sort of ask your colleagues, I’m not sure. And sometimes I’ll tell you now that’s the way the attending always is, right? But don’t bottle it up. Right. Think about it. Take it home. Think. Sometimes people are having a bad day. You can sit with your discomfort for a little bit, but if you know it’s impacting your work, please, um, reach out to someone. And there’s so much more I can say about this, but I want to leave it for other people to talk. 

Dr. Kagetsu: I’ll just make a comment. Uh, hopefully your hospital has an ombuds office, so depending on the issue, uh, reach out to the ombuds office and they can deal with– help you deal with issues, uh, confidentially and impartially and all that sort of thing. Um, but, yeah, it’s a good question. 

Dr. Partha: I would just add, I, I totally agree. Donna, I think unfortunately, this is a reality. You know, we don’t get along with everybody. Um, and if it is causing issues with patient care in your day to day well-being, you know, first and foremost, you might want to see if there’s an ability for you to just sit down and chat with the person, like, um, we all have different communication styles. It might just be a matter of saying, hey, just want to let you know a little bit of something about me. You know, you might think I’m kind of slow or you seem to be– I know I might be a little slower, but I work. I need to process things. I appreciate that we’re, we have a time constraint, and I can see that you would like me to be faster. So, um, you know, can we work on something? Because this is the way I work? And and just kind of putting it straight out there, if it’s sort of obvious why you both are clashing is just to say, you know, we’re going to be working together. I really want this to be a positive working relationship. This is how I work. How do you work? Can we figure out a way to, um, work together? And because inevitably, you guys will be back in contact again in a residency program. Um, but as others were saying, there should be a process if it’s actually really, um. An unhealthy situation. Chief residents. Associate program directors, program directors, etc. should be able to help. 

Dr. Kajita: To be clear, the other thing I wanted to point out is that conflict is part of working with other people. But let’s be clear if it’s harassment, please report it. Period. 

Dr. Park: Yeah. The only thing else I would add is that, like, you know, if it’s related to a patient, like, you know, obviously like take care of the patient first, unless it’s something that’s completely egregious, like, you feel like the patient’s life is in danger. Um, and I think there are some things that we have, you know, discussed as a high reliability organization. Those are things that you make here. But, you know, asking things like, hey, can I ask a clarifying question, you know, did you mean to do this? Or like, I just want to understand, like you want to do this, you want to administer this medication for this thing, you know, and just repeating it and, you know, maybe that will maybe that person would be like, oh, no, that’s definitely not what I meant. Um, and so it’s just kind of allowing the opportunity for them to maybe, you know, rethink what they said. Um, what I’ve heard some other people say, it’s like if someone says something like, really insulting, uh, I know other people have said, can you please repeat that again? And they usually don’t, because they realized that it was something that was just not appropriate at all. Um, and that’s, I think, some way of kind of asking people politely, um, to kind of address the question if it has to be in a public place without like, you know, having it escalated to something else.

Donna: Thank you. 

32:33 Common Pitfalls and How to Avoid Them

Annie: Those were some wonderful responses. Thank you guys. Um, we did have some questions submitted to our RSVP. So the first was what are some common pitfalls in intern year and how can I best prevent them? We did touch on some of these earlier, but if you guys have anything to add. 

Dr. Kagetsu: Oh, I’m just thinking one of my residents asked me you were a program director for 15 years. What advice do you have? So I said, you know, every day is a job interview. And, like, I don’t know if that’s what they wanted to hear, but it’s kind of true that, you know, um, and in fact, these days and that given given the toughness of the job market, some of the residents that, um, end up working at the place where they did residency, I recommend they do a fellowship elsewhere. But then you come back with this kind of secret knowledge and can be an attending. So we have had former chief residents end up working with us. And I would say, you know, um, consider a, um, a leadership position, like a chief resident. 

Dr. Partha: I would say one of the biggest pitfalls that I’ve seen, again, speaking in internal medicine is time management. You just do not have the time that you did as a student. Um, so figuring out that nice balance between I want to spend time with my patients, get to know them, but I do not have the, um, time that I had as a student so quickly realizing that you want to get your time management skills under control sooner rather than later, rather than waiting too long when you’re kind of struggling because you’re too embarrassed to say, I need some help here. So probably pitfall number one is not knowing how to ask for help soon enough. 

Dr. Park: One of the more memorable things that I had as an intern, I was talking for a friend at a hospital I had never been to for a week, and I, um, was late to sign out in the afternoon, and I just didn’t have all the numbers because I’d been running around all day. And the chief resident just, like, humiliated me in front of everybody. And I still remember that day. And you know, the lesson I took away from that was could I have been more efficient? Absolutely. Um, but as a chief resident, did I do that to somebody? Absolutely not. And I think you just learn, you know, there are just certain things you just won’t be able to do. And just don’t lie about it. Just you didn’t get it done. And you think about it when you go home and you’re like, how could I have done to make that better? Right. Observe other people. Right. How are they doing it? Like some people might, you know, make their lists a certain way. They might do checkboxes. They do, you know, whatever it is, it’s like– kind of gauge, like what’s going to work for you, right? Like, you might have a system as a for the medical student. Um, so I think for the med student, fourth year is a great year to start refining those things. Like what technique works for me? Do I like the multi-tip pens with all the colors and the color system works for me by whatever. Like if you figure out a system that works. Well, I think the biggest thing is that you will make a mistake at some point. Okay. And it’s just going to happen, right? Something’s got to happen at some point during your intern year. And I guarantee you every single year that you are a physician and it happens to everybody. Okay. The question is, is what do you do about it? And do you have a safe place to talk about that? Right. So don’t like bury it inside of you and say, I’m a terrible person and I’m not good for this job. There’s a reason why I’m sitting in this conference right now is the reason why I care about it, is to do that like you got here for a reason. So don’t forget that. 

Dr. Kajita: I think that’s we’re all great. And right now I don’t have anything else to add. 

36:38 Endurance in Medicine: Sustaining Passion and Well-Being

Annie: Okay. I’m going to ask a second question and then we’re going to open it back up. But the second was how can you stay the course throughout the length and the rigor of training mentally, mentally, physically, etc.? 

Dr. Kajita?: Um, if I may, I think this goes back to something that Dr. Park said it’s just kind of checking in with yourself, right? And I think that as part of checking in with yourself, don’t compare yourself to other people. Right? Be honest with yourself and remember that you’re doing this for your patient and yourself, and you just can’t do it well unless you leave something in the tank for yourself. So if that means that you have to tap out, that’s okay. If it means that, um, you need professional help. That’s okay. Um, but definitely, um, don’t ignore the signals that your, your emotions and your body are sending you. 

Dr. Partha: Um, I would add, uh, I forgot to mention I listened to a really great podcasts. If any of you listened to Hidden Brain, it’s wonderful. And there was an episode from September 2023 called Being Kind to Yourself that I highly recommend. So I think you can be, um, sustained in your career if you learn how to be kind to yourself, uh, to again, kind of tap on to what Dr. Park had mentioned, do things you love, take care of your body and your mind, and surround yourself with the people and the things that you love. Um, you know, nobody can do this by themselves. So rely on your friends, your family, your loved ones, whatever brings value and meaning to your life, whether it’s arts, religion, music, exercise, um, and choose a path that you can do on your worst day, is the best advice I could give you when you’re choosing what you’re going to choose for your lifetime. Um, and ask the people who have been doing it as Dr. Park mentioned, don’t imagine, oh, this is what it must be like. So I’m not going to do it or am going to do it. Ask the people who are doing it so you make a good choice. Um, because the road is long, the career is long. It’s a great thing. But also know that you can change your path a little bit as well. So you’ve got flexibility in this job. Um, so don’t feel like you’re going to be stuck. Um, but make– make as good a choice as you can when you start. 

Dr. Kagetsu: It’s my turn. I have nothing to add. Good advice. Or although I could kind of joke and say choose a specialty like radiology and it’s not so stressful. But that’s what propagates a stereotype. But it’s kind of we kind of deserve it. 

Dr. Park: Um, it’s not really advice. I just find it ironic that we have, like, been basically engineered to become perfectionists. And, you know, you kind of have to unlearn a lot of those, I don’t want to say bad habits, but I mean, to some degree they are because like you have, you know, been this way and been successful and that’s what made you so successful. But it can be also very destructive. And I think at some point you kind of have to know, like, okay, pushing myself too hard here, like I don’t have to be perfect for this one, right? Like I just have to do my best. So they’re very different things. 

Dr. Kajita: Yeah. And along those lines, I think we tend to think of big ones as success and fulfilling. But sometimes it’s finding the joy in the small moments, like you’re having a really lousy day and this happens everywhere, right? You’re having a terrible day. But then there’s that one thing where you connect with someone. You realize that you change something just a little bit, and if you can find a little bit of joy in that, that will keep you going. And as Dr. Partha was saying, um, choose something that can give you those moments, moments of joy. Maybe it’s radiology. So. Find joy. 

41:13 Finding Our Voice: Asian Identity in Medicine

Dr. Partha: Can I ask a question, Annie? I guess I’d be curious either for, um, the other panelists or some of the students. Uh, because this obviously is sponsored by a APAMSA and similar to Dr. Park, I hadn’t really been, you know, involved, um, the whole kind of Asian identity, South Asian identity as an Indian, I can say, can be a little confusing or mixing. Um, until I had done an event with Dr. Kajita and really enjoyed it. But I’d be curious how you all might feel that your Asian identity has impacted or not your medical path, or what do you think might be, uniquely a an experience that you all have had in as a person in medicine. Um, that someone who does not come from an Asian background may not be able to share.

Donna: Um, I just want to give a quick introduction, so. I’m sorry. That’s my dog. Uh, I’m Donna Tran. I’m the immediate past national president or her president is Joyce. She’s amazing. Um, but to answer one part of that question, we are working on expanding our alumni network and doing an outreach to see if we could kind of create a space for pan-Asian, um, physicians, because there isn’t really one, like there’s a national medical association, there’s a Hispanic association, but there actually really isn’t one on that scale for all Asian Americans. And so that’s something that we’re working on. And we actually have Dr. Kagetsu who’s one of our senior, uh, alumni advisory board members and also leads our faculty as well, uh, for APAMSA. So I would actually kind of put him on the spotlight. Sorry about that. I know you like it, though. Um, and for him to kind of answer that question since he, you know, obviously, you know, went to residency and did stuff before APAMSA, so, you know, came out. 

Dr. Kagetsu: Thank you Donna. Um, you know, I, I actually kind of have, um, imposter syndrome for being called an APAMSA alum because it didn’t exist, and I wish it did, but I think there are like, you know, we perhaps some of us on the call have experienced this. You know, somebody would always mistake me for the other Asian, uh, student and, and that sort of thing. So, um, yeah, I don’t know, sometimes maybe we feel we’re invisible, I suppose. And, um, I think the founders comment that there’s kind of a stereotype that the students are just quiet and, and, uh, and perhaps that was a survival skill for some of us. And, uh, I think we we do have to, um, almost prove that, um, we’re not that quiet stereotype and and, uh, speak out when the, when the time is right and that sort of thing. So I think it is, um, in my part of the stereotype, maybe positive that, you know, we’re smart, smarter than the average student or something, but I don’t, I don’t– It would be interesting to hear, hear my colleague’s thoughts. 

Dr. Park: Uh, I did, I mean, I, I went to high school– elementary school. There weren’t a whole lot of people. I actually grew up in the Bronx. Um, and, uh, it didn’t have outside of, like, Korean school on Saturdays, I didn’t actually really have much interaction with, uh, Asian Americans, specifically Koreans. Uh, and so I think just like a lot of people, um, in my group, it’s like you tend to gravitate back towards that and you want to learn, relearn your language and all these things. And, you know, in your second, third, fourth decade of life, um, I find that I kind of do live to the stereotype in some ways. I am a little– I am actually a very big introvert. And, uh, I actually did not get the best scores in my surgery rotation because I was so quiet. Um, people kind of misinterpreted that as being disinterested, which is too bad. And so I kind of struggled with, like, how do I show my interest without, like, being the loudest person? And I still struggle with that. And I think it helps when you are an environment where people notice your hard work. Not everyone is like that. Not everyone has bosses that kick off for people who are like just going through the ride, doing a good job and doing the right thing. Um, and we can easily get lost in that so easily. So there’s a reason why there are not that many Asian-American surgeons in leadership roles. I think there’s a lot of reasons why we get passed up on the things. We either don’t seek them, we get passed up on things or whatever it is. Um, so I– for me, anyway, I think it’s the first personality thing, I think it’s a cultural thing and it’s something I’m still working on. Um, but, you know, I think unless we talk about it and we kind of approach other people like this, it just will continue to perpetuate. 

Dr. Kajita: So I think I would echo what, um, the other panels said and Dr. Parker just put a comment in the chat box about the bamboo ceiling. Uh, there are many ceilings. And I think, um, you know, there’s an assumption, obviously, that certain obviously just stereotypes that go with race, ethnicity, uh, identity groups and you’re sort of saddled with those and you also have to acknowledge that some of those values are not necessarily bad things if you’re a little quiet. Right. And the other thing is that, you know, don’t always assume that I’m good at math. I was terrible at math. It brought death. Really. So. So it’s tricky, right? Because I think we struggle. Then also, what does it mean to be, um, uh, sort of, not your your voice not being heard or feeling underrepresented because I think sometimes Asians are not considered the classic model of underrepresented minorities, for example. So I think hearing from people I work with now, residents and so forth, I’m happy to see that a lot of that has changed. Um, but I still think that it is something that it is, um, something that I find hard when I see an evaluation. It’s like the too quiet thing. They’re thinking, okay with that, right? Um, and that part of it has not changed entirely, I think, to some degree. And that’s my two cents. 

Donna: Yes, you’re all goals, I think everyone here can agree on that. You’re all goals for us. And if you would like to still stay involved just with, you know, at a med student level or even interested and, you know, seeing what, you know, a pan-Asian physician organization kind of looks like, please, um, just let Annie know and then she can, you know, give your emails to our appropriate, like, APAMSA student directors. Um, just because. Yeah, just because, you know, it wasn’t around when you weren’t in med school or you didn’t have a chapter. Uh, I think the goal for us is that, you know, advocating for health is, you know, a lot better in bigger numbers, right? And there’s just so much untapped potential in the, you know, power of numbers. And so just giving everyone on the same page, I think on the backdrop of COVID and anti-Asian racism has really brought everyone together. And so hopefully moving forward in the next few years, we’re going to be building that up. So yeah, please let her know if you’re interested in keeping in the loop for that. Even if you’re, you know, from different backgrounds, like even on national board APAMSA, we have a South Asian and Southeast Asian, LGBTQIA, women in medicine directors. Like we try to hit every target I can to be as inclusive as possible. 

Dr. Partha: No. That’s wonderful, I guess. Um, it this the South Asian term, and this is how old I am, is kind of a new term. I was never South Asian, and growing up I was just Indian. Um, and so when I went to went to undergrad at Stanford many years ago, I was like, oh, there’s an Asian American student group. Of course I belong there. And I’d go and show up. And I was literally like, the only Indian there. I was like, oh, am I not Asian? Um, and there was not an Indian student group at that time, which sounds unbelievable in the Bay Area to say that now. But we started an undergrad Indian student group because there was a graduate student one, but those were mostly students who were international students. So it’s very interesting. And I find it– I think there’s a lot of commonalities between Asians of many backgrounds in terms of culturally and, um, how we’re brought up the whole ‘we’re great hard workers, and there’s many of us, but fewer of us’. My husband and I always laugh like we’re always the Indians and not the chief kind of thing. So, um, I think there’s a lot of great work, um, that can be done. And I’m excited that there’s all these really passionate students who are being motivated to do this. And it begs the question of just the science as well, like studying Asian American health and moving that forward. So kudos to all you guys for really, you know, not just talking about the change but making it so it is a privilege to be with you guys. 

50:48 Closing

Annie: And that’s our latest installment from the Leadership Committee. If you have a specific topic or specialty you’d love to hear more about, please let us know. You can reach us at professionaldev@apamsa.org. We hope you enjoyed today’s episode as much as we did, and don’t forget to tune in next time! Thanks everyone! 

Listen here:

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This episode was produced by James Chua and Ashley Tam, hosted by James Chua, and graphic by Callista Wu and Claire Sun.

Time Stamps: 

00:00 Introduction to White Coats & Rice: An APAMSA Podcast

00:52 Introduction to Dr. Neel Singhal

01:24 Day in the Life of a Neurocritical Care Physician Scientist

03:57 Why Neurocritical Care?

05:16 Evolution of the Practice of Neurocritical Care

06:48 Neurocritical Care at UCSF 

07:51 The Various Roles of a Modern Physician

09:44 -Omics Research in Medicine

12:11 Recommended Experiences to Pursue Neurocritical Care

13:22 How to Find Mentors  

14:33 How to Stay Grounded

16:09 Having a Partner in Medicine

18:03 Maintaining Relationships and Friendships While in Medicine

19:37 The Role of Research in Work-Life Balance

20:45  How to Be Present for Your Family

23:39 Taking Care of Yourself

25:44 Intramural Sports and Friends Outside of Medicine

26:43 Taking Vacation Time and Traveling

29:20 What Would You Have Done Differently?

31:02 Taking Advantage of Free Time Before Residency

32:45 Closing: What is One Thing that Brought You Joy Today?

Full Transcript 

0:00 Introduction to White Coats & Rice: An APAMSA Podcast

Annie: Welcome everyone to the 5th episode of the Asian Pacific American Medical Student Association Podcast. From roundtable discussions of current health topics, to recaps of our panels with distinguished leaders in the healthcare field, to even meeting current student leaders within the organization – this is White Coats and Rice. My name is Annie Nguyen, a postbac at Stanford University, and a member of the Leadership Committee at APAMSA. I’ll be your host for today! 

This is our Ask Me Anything Series! Each month, we spotlight an extraordinary physician who shares their insights on medicine, life, and everything in between. This is your chance to ask questions, hear their stories, and learn more from their incredible experiences. Whether you’re curious about their journey, their day-to-day, or their views on the future of medicine, nothing is off the table. Let’s dive in!

00:52 Introduction to Dr. Neel Singhal

Annie:  Today, we’re speaking with Dr. Neel Singhal, a physician scientist at UCSF specializing in neuro critical care. Dr. Singhal earned his medical degree and doctoral degree in neuroscience from the Perelman School of Medicine. He then completed a residency in neurology and a fellowship in neurocritical care at UCSF. He is a member of the Neurocritical Care Society and American Heart Association, and his research focuses on improving the diagnosis and treatment of neurological emergencies, including stroke and traumatic brain injury.

01:24 Day in the Life of a Neurocritical Care Physician Scientist

Annie: Dr. Singhal, we’re very excited to have you here today. Thank you for being here. if you could start with just a brief introduction about what a day in your life looks like. 

Dr. Singhal: Thanks so much for having me and happy to be here and impart any wisdom or lack thereof that I’ve learned over the last many, many years in academia. At this point, although I don’t feel that old when I look back at the calendar and see how long I’ve been in medicine. It’s it’s been most of my life at this point, um, or more so than when I was a kid. A little bit about my day looks like I would say, I finished my training, my fellowship in 2015. So I’ve been out of training, just for about ten years, and I would say year-to-year of what I do in a day or what I do over a calendar has changed somewhat. I would say right now I’m reached somewhat of an optimal state for at least you know, what I want to do. About two thirds of my time is protected for research, and then about one third of my time is clinical work. On an average week I’ll see patients half a day a week, and then the rest of the have reserved for research and administrative activities. One week out of every two months or so, I’ll spend the entire week in the hospital. You know, in terms of rounding on patients and the neuro critical care unit or neurology services. On a day to day running a lab for those of you that have worked in labs, I do a lot of the things that you’ve seen your PIs do. I would say I spend a two days, writing, whether it’s papers or grants. Writing is a never ending thing that you continually evolve with how good you are at it and how quickly you can do it. I spent a lot of time analyzing data. I still have a very small research group. you know, two and a half full time personnel and three students, and while they’re busy generating a lot of data, I end up doing a lot of the analysis. I do a lot of mentoring of the people I have, helping them write their grants, helping them write their papers. I do some experiments every now and then, especially if I’m onboard new undergraduates. And a lot of meetings, like to facilitate collaborations, to facilitate clinical care of the clinical programs I’m involved in, some meetings for fun, like academic talks and, clinical talks and things like I’ve come to the point where I feel like I have a pretty good balance of the things that I enjoy.

3:57 Why Neurocritical Care?

Annie: So this balance and having your hands in a bunch of different places sounds really exciting because you get some of the clinical input as well as some of the maybe less exciting administrative stuff, and then you have all your scientific endeavors. Was this structure something that attracted you to this specific line of work, or what was it that attracted you to neuro critical care? 

Dr. Singhal: I would say that, really for me, and it might be different for different people that you ask. But for me, I was really driven by the content more than anything else. I didn’t think so much about what my life would be like, and if I had thought more about what my life would be like, I think I would have been wrong, because I wouldn’t have exactly known how either clinical care would evolve or labs would evolve as well, or differently as they have. But I was really just content driven, you know, for better or for worse. I just really enjoyed working in the intense environment of the ICU. I really like thinking about the brain. I mean, ever since I was a kid and my mom was in college while I was a kid, bringing home psychology textbooks, like the stuff about the brain just always kind of fascinated me, and I’ve just always been drawn to it. And in college, that was cultivated in med it was just the, the content, the teamwork, talking with patients, helping patients deal with devastating brain injuries, helping families come to terms.

5:16 Evolution of the Practice of Neurocritical Care

Annie: How do you feel like the field of neuro critical care has changed the course of your practice? Where do you see it going?

Dr. Singhal: Neurocritical care in particular, is an example of a field that’s pretty young compared to other, more established fields. And because it’s so young, it’s practiced differently at different places. And in terms of practice, I don’t mean the actual content, I just mean kind of like what the structure of your day is. For some neuro critical care it’s very embedded within neurosurgery. And, you know, you’re really, really hand in hand with the neurosurgeons a lot. And in some programs, it’s a little bit more like you’re practicing neurology in the ICU– how we practice it here’s a little bit of we do some stroke work and some neurosurgical work and some more straight up neurology, sort of a good mix. You know, when I was inspired to go into neuro critical care is when I was in medical school at Penn. But the way that the unit is set up there is kind of very different from the way that it’s set up here. One thing that’s evolved in ICUs, not just neuro ICU, but other ICUs the strong contributions NPs and PAs to the critical care practice, so it really allow for these larger– for you to practice in larger units, taking care of more patients with more staff, but still sort of being able to do a good job because you have really well physician extenders to some, to some degree. So I think the practice has changed in many ways. And it’s different in many ways because of just depending on what institution you’re at.

6:48 Neurocritical Care at UCSF 

Annie: Are there certain things about the division at UCSF that really drew you in, aside from being able to do research? 

Dr. Singhal: I think being able to do the research is a big part of it. At a lot of places around the country, when you’re practicing something technically intense as, like, surgical specialties or practically intensive, as many medical specialties are, the program really benefits from having clinicians that are really focused on the clinical. But at places like UCSF or academically focused places, we just have an abundance of intensivist and neuro intensivists. Look at the whole state California or look at all the non big cities in California, and maybe there’s like one or 2 or 3 neuro intensivist in those cities, Fresno or, Reno or upstate California, there’s very few, but then you look at the big cities, the big academic centers we have like a dozen, just here at UCSF and, if you include the whole Bay Area we have so many, so it really gives us the time that we need to, know, devote to clinical care, but then also to extend the capabilities of clinical care with research. 

7:51 The Various Roles of a Modern Physician

Annie: For those who are interested in neuro critical care, do you believe that research is an experience that is essential for their training? Or are there other skills and experiences that would be very helpful?

Dr. Singhal: Nowadays, in most fields of medicine, I don’t know if research is essential anymore because there’s so many roles for physicians, so many useful roles physicians can play, and research is just one of them. Even at places like UCSF, research is not, necessarily required for some specific job descriptions. Historically, places like UCSF and academic centers really benefit from having researchers around, and a lot of patients come to places like UCSF because of the research capabilities and the history of that. There’s just sort of no end to the, to the need that physicians could fill. There are so many skills that amazing administrators and leaders, clinical leaders have that researchers just don’t have the training and maybe don’t want to cultivate the skills necessary to do that. And having specialized administrators that can really put together excellent clinical programs is a skill unto itself. Education is another forefront where academic centers don’t necessarily need you to focus on research and over the last five years, there’s a late but growing recognition that just because you’re a physician doesn’t mean you’re a teacher. Places like UCSF and probably others have really invested a lot of time and money into teaching educations, teaching physicians how to be educators as opposed to just sort of handing them students and saying, you know, somebody taught you, so now you can teach they’re actually giving people training in how to be a good teacher. And then even within research, right, it’s not just basic science or clinical research, but is epidemiology, public health. There’s almost different niches to fill if you’re a physician.

9:44 -Omics Research in Medicine

Annie: So on the note of research, there was a question in the chat from Reanna about transcriptomics and genomics research in the neuro critical care setting. So any thoughts on that? 

Dr. Singhal: One of the best examples the medicine field has for precision medicine is oncology. Oncology really had amazing progress in treating so many different types of cancers over the last 15 years and brought new things, new therapies to market for very specific cancers and have the promise to do so more. And not maybe not every field is going to benefit as much precision knowledge about the disease, but it can’t hurt. And I think we’re just at the surface of understanding the contributions of -omics like genomics or transcriptomics or proteomics other new -omics that people keep coming up with, and other omics that are that we don’t even know about, you know. And how that’s related to a specific patient’s disease. A lot of people say that progress in clinical research is slow because it takes evidence so long to accumulate about a treatment for example, in the in the world of stroke, one of the newest treatments since 2015 is something called embolectomy, where you can actually go in with a catheter and remove the blood clot if a patient has a specific kind of a stroke. And it makes such intuitive sense that this procedure would work because you’re taking out the blood clot and now they have restored blood flow. But there’s actually a kind of a long history of this procedure actually causing more harm than good when the devices were early and, even when the devices were, it wasn’t clear which patients would benefit from it, but then the science of radiology using specific radiology scans, you could define which population would benefit more from the procedure versus less. And it had to do with how much viable brain tissue they had. So that type of precision radiology really helped stroke advance. And similarly I think that type of precision-omics can help a lot of different fields advance, including neuro critical care. There’s so many controversies in neuro critical care that haven’t necessarily been answered by what people thought would be, definitive clinical trials. And the opportunity to have additional biomarkers from -omics that might really help specify the patient populations that benefit from a treatment or don’t benefit from a treatment. 

12:11 Recommended Experiences to Pursue Neurocritical Care

Annie: So the generation of all these I agree, is very interesting. Sifting through all that data and finding these biomarkers is the next frontier, but there’s definitely a lot to sort. Are there specific skills or experiences that you would recommend for those who are interested in neuro critical care to pursue? 

Dr. Singhal: Most places now have a neuro critical care rotation. Certainly having that rotation under your belt helps a lot. If you want to go into any critical care field, the rotation that actually helped me the most as a med student was anesthesia. Spending a month in anesthesia was the most helpful thing I can think of in medical school. Maybe just for one reason, it just really made you comfortable with more critical situations. If you ask the most intensivists what the scariest things are for them, by far and away airway issues and spending a month on anesthesia is by no means enough time to become an expert on airway, but at least it gives you some knowledge of like what you would need to know to help take care of patients airways when those crises come up. So anesthesia was a super helpful rotation for many reasons. The background that you get from neurology is obviously helpful. But then, you know, more specifically, putting that together in the critical care.

13:22 How to Find Mentors  

Annie: You mentioned earlier that there are undergrads that you’ve mentored before, and it does sound like mentorship is very important to you. Do you have any advice on how to approach mentors in neuro critical care or the best way to find mentors? 

Dr. Singhal: Yeah, that’s a hard question. sometimes you find a kind of by accident. You know, you just, come across someone in a clinical setting or a non-clinical setting and, you know, sort of clicks that, they’ve gone down the path that you want to go down and you want to learn from them, and they seem to be open to it. And that’s always those organic types cultivated relationships are sometimes always the most rewarding. But sometimes you’re not going to run across that by accident, and you have to kind of go out searching for it. You know, the power of a cold email when they’re not ignoring that tells you something about, someone’s openness to mentoring because a cold email might be the best way to put you in touch with someone who you truly feel like you could learn from. I would suggest that that email talk about what your interests are moving and just see if you can set up an initial meeting and talk more. What really comes through in the students that we take on often, are less the experiences they’ve had and more, you know, what they can commit.

14:33 How to Stay Grounded

Annie: You mentioned that this is a very intense, uh, specialty to pursue. Are there certain things that you did during your training to really maintain, like a strong sense of grounding, or what were the things that you relied on to kind of get you through it? 

Dr. Singhal: Oh, that’s a sort of a multiple fold question. I was the type of person and maybe still and just kind of put my head down and do the work as efficiently as possible, and then, you know, go live my life. So on one it’s nice to silo the work and the non-work. There’s nothing that’s going to recharge you as much as leaving your place of work. But on the other hand while you’re in training, you’re working so many and there’s always pressure to work more hours, it’s difficult to, like, totally silo it, and it’s difficult to step away from it. It’s difficult to know when to say “no” to those things. It is important to, set up some sort of boundaries, although it doesn’t have to be perfect silos. It’s important to also, while you’re going through to not forget what motivated you in the first place. I interview a lot of students as they’re applying for medical school and I’m always so impressed with everything they’ve accomplished and everything they want to accomplish. And then I work with a lot of students on the wards, and sometimes you can tell the students on the wards are beat down and have forgotten the things that motivated them to go into medicine in the first place. So not forgetting the things you’re motivated and knowing when to say no or when to go home and then knowing what recharges you, is important. The things that might recharge you that’s different for and that’s changed for me from time to time as well. 

16:09 Having a Partner in Medicine

Annie: So having a support system definitely sounds very critical for you. You had mentioned that you or we know that you have a partner in medicine. Can you tell us a little bit more about how this played out for you, or what kind of support this provided you? 

Dr. Singhal: Yeah, yeah. I mean, we, we’re like the super dorky couple we met at a neuroscience conference. We met at– my wife and I met at Society for Neuroscience in 2006 and, uh, she was already matched to come out to San Francisco. We started dating when we were both in Philadelphia and training, and then she was already matched to come out here in 2009. And then I remember meeting with one of my mentors, uh, Steven Galetta, who’s at NYU and was at Penn before, and he has this thick New York accent that I’m not going to try to imitate. But he said, “you know, if you’re serious about the girl, go to San Francisco”. So I, I came out and did in a way, sub-I in San Francisco. Um, and, and loved it out here. Um, so it was, you know, sort of amazing and also serendipitous that we were able to go through residency, kind of at the same, go through fellowship at the same time, faculty at the same time, and although we’re both in neurology, my wife does pediatrics and she does epilepsy and she does education. Our department is 300 people. So it’s not it’s not like we really overlap in space or subject matter, but there’s sort of enough overlap in our universe that, it’s great. It’s great to have a partner in that. It can also, at some points in time, be too much to have a partner that’s in the exact same, you know, field as you. I think from the beginning of our relationship that we’ve always really not talked about medicine that much. Like, I think we both have this unspoken rule of, you know, there’s other things going on. and that’s naturally happened as we’ve had kids, you know, we have an 11 year old, a 9 year old, and a 4 year old where, like most parents, 80% of what we talk about is the kids at this point. 

18:03 Maintaining Relationships and Friendships While in Medicine

Annie: What advice would you give to other physicians who are trying to manage their careers alongside supporting their spouse, who is also in medicine? 

Dr. Singhal: Maybe even though I have a lot more years on you guys, um, you know, maintaining any kind of relationship, whether it’s a marriage or a friendship or whatever it might be, it’s like a lot of work, right? You know, being a– being a son or daughter, you always have to put in work into maintaining that relationship. And, and there are times when you’re just going to have to apologize because you are going to have a lot of other demands on you. And sometimes you just have no choice, you chose this path where I’m going to be a resident and working eighty hours a week for four years. And, uh, it it just happens to be that in, you know, March, I have to work, you know, 80 plus hours a week, and I just don’t have time to hang out with my brother or hang out, go see my parents or, you know, hang out with my spouse as much. And, and the people in your life, in some ways have to accept that you have to apologize for it and offer, you know, support in times that you can or make small, uh, bits for bits of support in the ways that you can when you don’t have time. Um, Yeah, for better or for worse, going down the path of residency will sacrifice the time that you have for other things, and the people that are going to be closest to you are going to understand that. But some people may not. 

19:37 The Role of Research in Work-Life Balance

Annie: So setting realistic expectations, knowing what to expect and taking accountability. Those are definitely very helpful pieces of advice. Oh, we have a question on the same note from Reanna. Do you want to unmute? 

Reanna: How do you manage kids during your training and or career? And how do you ensure your present for your family? And then finally, do you feel like the aspect of research helps your work life balance? 

Dr. Singhal: I think research definitely helps. I’ll go with the last one first. I feel like research definitely helps the work life balance. That, you know, the thing about having kids is that it’s unpredictable when they’re going to need extra help or, you know, parents around or not. And, um, especially when they’re young, it’s just a lot of, like, brute force parenting where you have to be there for them, like when they’re infants and they’re sick and they can’t go to school. And, so it’s so unpredictable to have a little kid and research is predictable in that it’s never an emergency. So it’s the more time you have carved out for research or flexible time. That’s not patient care, the easier it is to manage your work life balance. 

20:45  How to Be Present for Your Family

Dr. Singhal: Um, Um, how can you be present for your family? Yeah, I, I think for me, that’s evolved over time. Like being an intensivist is both good and bad for the family. It’s good because, uh, what’s considered an academic workload for an intensivist or even a full time intensivist is not actually working every single week of the year. You know, like most hospitalist jobs are like 22 weeks out of the year, 20 weeks out of the year. Um, so you’re actually fairly available, right? As long as it’s not one of those 20 weeks out of the year, you’re pretty available the rest of the time to have flexible work life balance. But then you have to have arrangements on those weeks where you’re not present at all or like you may be totally ransacked even when you are home because of phone calls or having to look at images on the– on your EMR because people are sick and need your help. So how can you ensure that your present for your family, um, that evolves over time. Uh, when your kids are young, uh, when your kids are young, they’re going to need you more, and you may have to cut down your clinical workload. Um, or you may have to change your job a bit. I mean, one thing, I actually transitioned my job in 2022 to be less at the county hospital and more at the VA hospital, uh, because at that point, we had a third kid and I was going to have more responsibility at home. So kind of signed up for a five year, you know, period of time to be more at the VA and less at the county. Um, so that’s, that’s been great. You know, instead of working like 8 to 12 weekends a year, I’m only working like, you know, 3 or 4 weekends a year. So, you know, that’s a huge difference when it comes to like going to soccer games and being with your family. So, so even within one institution, you can cultivate your job, uh, such that, you know, I was at UCSF this whole time, but I just kind of focused more on one hospital, less on the other. Um, know, hopefully if you’re in a good spot, hopefully this flexibility in how you can structure your job. And then managing kids during training, I think that’s the hardest, actually, because you really don’t have much flexible time in training. Um, I don’t know how my co-residents, we had our kids at the end of our training, uh, so it didn’t impact us. But my co-residents who had kids, like, I just don’t know how they did it. It’s ,it’s really hard. Like, you– need you need help. You can’t do it on your own. Uh, whether that help is family or somehow paid or a combination. Um, I would say it would be expecting too much. I think having a kid in training, it’s definitely possible, people do it. Um, I don’t think people can get it done without help, though. 

23:39 Taking Care of Yourself

Annie: Fantastic insights. Thank you so much. So far we’ve covered balancing clinical care and research. Now we’ve talked about being a spouse and also being a parent. Um, the last thing is how you’ve managed to take care of yourself in all of this. Um, because you definitely can’t take care of others if you’re not sustaining, you know, your own well-being and everything. So are there certain things that have, you know, kind of helped keep you sane or are the things that you rely on? 

Dr. Singhal: As a kid and in college, um, I never really thought about, like, health or wellness that much. And that’s because I was already doing it without knowing it, probably like I was already super, you know, I was super into sports. I was always, like, playing a sport. Always. Um. You know, we’ve kind of signing up for different teams and staying super active, uh, you know, socially with friend circles and things. And then as you get deeper into your career or professional life, you kind of forget how important those things are to you. Or maybe you never realized how important those things are to you. And it’s like, well, well, I’m just, you know, I’m not going to really have time to play in that soccer league this year or I’m not going to worry about going for a run, you know, today. But, um, when those things are missing from my life, um, because life gets busy, uh, definitely, you know, realize that those are the things that recharge me, you know, like staying active. Um, not forgetting about social engagements with friends and, you know, you know, hosting dinner parties or going out with friends. And, and then it’s like, yeah, as things have evolved, it’s, you know, more like hanging out with my kids, taking them to the beach, uh, watching their basketball games, things like that. Um, those those so, yeah, in some ways, you got to kind of think about, okay, what are the things that really made me happy when I was younger? Am I still doing those things, or did they drop out of my life for some reason, and should I go back to them or not? So yeah, for me. You know, playing sports. Watching sports. Definitely. 

25:44 Intramural Sports and Friends Outside of Medicine

Annie: Can you tell us a little bit more about how you found little pockets or people or groups for these sports when you were transitioning from different areas? 

Dr. Singhal: Yeah, yeah, yeah, definitely. In my um, most cities have, you know, have different ways to like, meet up for, for leagues or gyms, I would say like joining gyms and joining, you know, joining sports leagues that you find online. You know, those are ways that my friend circle grew, I think, during training, um, serendipitously came across a lot of friends that weren’t in medicine. And that was also really, uh, an important part of staying grounded is having a lot of friends and outside of medicine as well. Kind of forgot about that when I said that earlier. Yeah. I had I had roommates who weren’t in medicine and that, um, expanded my friend circle to a much larger friend circle outside of medicine. And that kind of helps remind you of what life is like outside of medicine. 

26:43 Taking Vacation Time and Traveling

Annie: Always good to have those reminders for sure. Uh, one thing that you had mentioned, um, when we talked previously was traveling. So that was something that you have tried to make time for. Are there specific destinations that are your favorites, or how has travel changed now with your kids? 

Dr. Singhal: Yeah, yeah. I think, um, traveling is actually, you know, for friends I have outside of medicine, it can be hard to find time to travel because there’s there’s always, like, something going on in high pressure fields. And the good thing about medicine is that often, you know, you can, because because the culture has evolved, you can take two weeks off. Or if you don’t take that two weeks off, people are like, you know, why aren’t you using your time? And especially now a lot of places, you know, you can’t just keep accumulating vacation. You have to use it. Um, you know, UCSF we get four weeks off. So we’re pretty good about using that whole four weeks. Um, yeah, when you don’t have kids, that’s great because you can just travel off season and go to amazing places. And that’s what I highly recommend. During residency, traveling was great because it was just me and my wife, and we could go off season and, you know, take advantage of cheap flights. Um, so we had amazing trips before we had kids. As we had kids, we had less amazing but also fun, but also fun trips that were more local. Although this summer we did our first, um, trip to Spain with three kids. So we’re still trying to we’re still we still have the travel bug and trying to pass it on to them. Um, so totally possible to travel with kids. Um, you just got to work your way there and your parenting patience and skills. 

Annie: Do you have any tips for that? Specifically traveling with kids, especially when quite young.

Dr. Singhal: Yeah, yeah. Hard to give a blanket tip because every kid is different. But I will say that when the kid when kids are from like eight months to two, it’s just so hard to travel with kids, even though it’s free for this, even though it’s free for them to travel. It’s like, oh my gosh, short plane flight, much better than a long plane flight. And yeah, I saw someone put in the chat– to bring an extra person. Yeah, I think it’s all hands on deck sometimes. But once they get to iPad age, then, uh, they are happy to, they’re happy to watch the iPad for three hours when you usually, when I usually limit their screen time to much, much less than that. Mhm. Okay. Pro parenting tip right there. Yeah. 

29:20 What Would You Have Done Differently?

Annie: Um, as we come to a close, we just have some general questions to end with.  Um, are there any things that you would have done differently in your medical journey if you could go back in time? 

Dr. Singhal: I probably didn’t, um, really confront my weaknesses as much, and I might still not, um, you know, I know that one of my main weaknesses is not asking for help when I need it. Um, not asking for mentorship when I need it. Not. Uh, getting the collaborations. Not spending the time on cultivating collaboration, and instead just putting my head down and doing the work. I think I know those are my weaknesses. And, um, if I maybe really appreciated it, um, some of those things earlier. I think, you know, especially in the research world, I would have, you know, I could have maybe set myself up for better success or better collaborations. Uh, earlier. The general piece of advice surrounding that is, yeah, I think, you know, reflect hard about, you know, what your weaknesses might be, what your blind spots might be. And, you know, really, really try to face it head on. Like and critically. It’s hard. And I still don’t know if I do it correctly, but that would be one piece of advice. And then yeah, things that I would– 

Annie: I think you were saying that there’s always so many opportunities that you can pursue, and, uh, saying no can also be really hard. Um, have there been certain things that you’ve tried that have made saying no a little bit easier?

Dr. Singhal: No, I still struggle with saying no. 

Annie: Totally real life journey then. Okay. 

31:02 Taking Advantage of Free Time Before Residency

Dr. Singhal: But yeah, yeah. You know how to say no. Um, know, you want to say no as positively as possible when you do have to say no. Um, and then you just also have to realise that some things you can’t say no to. There’s a lot of unwritten curriculum in moving up the ladder in a hierarchical place like academia. And sometimes if you say no to the wrong thing, you know, they may not ask you again. Um, so, yeah, there is yeah, that’s talked about a lot now, but it wasn’t before. But yeah, there’s a lot of unwritten curricula in academia. Most important advice is, um, yeah, really enjoy that free time that you have before internship. It’s not the last free time you’ll ever have because residency is more humane now, but also has vacation. But it’s still a really, just nice part time in your life to really, like, just sit. Kind of sit back on your laurels a little bit and enjoy everything you’ve accomplished. Um, without much responsibility. In my fourth year, I got so much out of going abroad in the Spring, um, had an opportunity to to practice medicine in Botswana and South Africa and like, learned so much independence from that, that carried over to internship. Like, I think I was a mediocre MS3 and I was like a decent MS4. But then I became like a really good intern. And I think a lot of it was because I spent like two months abroad at the end of my fourth year, which was like super fun, but also like, just really increased my confidence clinically. 

32:45 Closing: What is One Thing that Brought You Joy Today?

Annie:  That’s an incredible experience. Wish we could learn more about that! Um, but the one thing we always love to end on with each of our speakers in this series, um, has been focusing on one good thing that happened today, kind of what you were saying. It’s really important to step back to enjoy this whole process, um, and to really be grateful for each day. So is there one thing that has happened today that you’ve been very excited about, or one thing that brought you a lot of joy? 

Dr. Singhal: Today was an interesting day of reflection for me because of this phone call, but also because I had, um, a meeting with another mentee. Um, so, yeah, it was kind of like a good chance to step back and, you know, think about, uh, and also I had a conversation with the premed person as well. So I had, like, uh, a lot of self-reflection about, uh, how far I’ve come the last few years so that, you know, that’s kind of, you know, a similar point where many fourth year med students are as well. 

Annie: I think it’s encouraging to hear that this self-reflection is something that has to happen at every stage. It never stops. You’re always learning, always growing. Perfect. Any last thoughts that you would want to share? That’s all that we have for today. 

Dr. Singhal: No. Yeah. Thanks for all the great questions.

Annie: And that’s our latest installment in the Ask Me Anything Series! If you have a specific physician or speciality you’d love to hear from, let us know! You can reach us at professionaldev@apamsa.org. We hope you enjoyed today’s episode as much as we did and don’t forget to tune in next time. Thanks everyone!

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This episode was produced by James Chua and Ashley Tam, hosted by James Chua, and graphic by Callista Wu and Claire Sun.

Timestamps:

00:00 Introduction to White Coats & Rice: An APAMSA Podcast

00:24 Introduction to Donna Tran

02:40 Doctor Who and Drag Queens

07:57 Getting Involved in Health Policy

13:11 The Inspiration for Medicine and Advocacy Work

16:35 Why Psychiatry?

20:39 Learning About and Joining APAMSA

25:04 Donna’s APAMSA Legacy

30:32 Debunking Misconceptions of the Medical Field and School

37:07 This Or That? Questions

41:20 Advice for Pre-Health and Medical Students

00:00 Introduction to White Coats & Rice: An APAMSA Podcast

James: Welcome everyone to the fourth episode of the APAMSA podcast. From roundtable discussions of current health topics to recaps of our panels with distinguished leaders in the healthcare field, to even meeting current student leaders within the organization, this is White Coats and Rice. My name is James Chua, second year medical student at Tour University, Nevada, and the current fundraising director here at APAMSA. And I’ll be your host for today. 

00:24 Introduction to Donna Tran

James: On today’s episode. We’re very excited to welcome our first APAMSA alumni guest, Dr. Donna Tran, an inspiring leader in medicine, health policy, and the AANHPI community. A proud daughter of Vietnamese immigrants and a native of San Jose, California, Donna’s journey to medicine refelcts a deep commitment to service, advocacy, and innovation. Donna completed her undergraduate studies at UC Davis, post-bacc program at CSU East Bay, and earned her medical degree at Michigan State University College of Human Medicine. Additionally, she also earned her Master’s of Public Health from Johns Hopkins University. Her impressive career spans public health and federal policy work, including internships with both the US Senate and House of Representatives, as well as a collaboration with President Biden’s Advisory Commission on Asian Americans, Native Hawaiians, and Pacific Islanders. Donna has also served as an appointed commissioner for the City of San Jose’s Senior Citizens Commission. From 2021 to 2023, Donna served as the national president of APAMSA, leaving a lasting legacy through her tireless dedication to amplifying AANHPI voices and creating opportunities for community engagement. Now, a PGY-1 intern, she continues to advocate for health equity and cultural competency in medicine. Outside of her professional achievements, Donna is a proud dog mother to a French bulldog named Boba Princess, seeks to reach new heights not only in medicine, but also with climbing and bouldering, and is a culinary expert, which is distinguished by a Yelp Elite Black Badge. Without further ado, join us as we explore Donna’s incredible journey in medicine, her insights on leadership, and the unique passions that shape her inspiring story. Donna, welcome to the podcast. How are you doing today?

Donna: I’m doing well thank you, just enjoying the last bit of sunlight during Winter.

James: Yeah, absolutely. And a lot of that came from your many bios on the APAMSA website. Yeah, so if it sounds familiar, that’s where it was all taken from 

Donna: I’m very complimented, thank you.

02:40 Doctor Who and Drag Queens

James: No, we are just so like, we are so excited to have you as our first alumni. Like your story is just so interesting. And I imagine that there are plenty of doctors that have inspired you throughout your time and probably have made you the doctor that you are today. I can probably think of like Dr. B Li or Dr. Jhemon Lee, just to name a few. But there is one doctor I’m very interested to know, like how they have inspired you and that is Doctor Who.

Donna: Oh, oh my gosh, I’m flabbergasted right now. Yes. Doctor Who. I actually got into it because my cousin and my brother started watching the 10th Doctor, David Tennant, back when he first came out in the early 2010s. I’ve heard of Doctor Who. I was like, “Oh, this is some weird British sci-fi thing.” Then they’re like, “Oh yeah, just watch an episode with us.” Then I just got totally hooked. So this was before med school. I actually went to Silicon Valley’s Comic Con and David Tennant was here in San Jose area and I had to pay like $100 to get like a picture taken with him and his autograph. And I told him this was like when I was applying to med school I was like oh yeah I’m like going to medical school like Doctor Who was like you know your characters inspired me so much into becoming like, kind of doctor I wanted to be. And he like, perked up and he’s like, “Oh, brilliant”. And I was like, oh, my god, it was the best moment of my life. So yeah, so I met him in person. He’s amazing. He’s really nice. Like, even though, you know, like 1000 fans are like, going through and taking pictures with him, but he is still my all-time favorite doctor. Doctor Who is still going on now. Give it a watch. Yes, it’s a huge time investment, but I just think it teaches me so much about character in such a good sci-fi sense versus Game of Thrones, which I also love, but it’s like very messed up. So I feel like it’s at least more like nerdy hopeful positive. So yeah, I still watch Doctor Who and I love it so much.

James: Have you? So you still keep up with the most recent seasons of Doctor Who then, ya?

Donna: Yeah. Yes. I know the most recent one was Ncuti, the black doctor, and I haven’t seen the whole thing yet. I know there was a Christmas special that just came out so I have to catch up. But I’ve like caught up like like with the ninth doctor, 10th, and then 11th is Matt Smith, which I think most people know by association of his face. And then you have the 12th doctor, which is an old dude, 13th was a woman, I think her name was Jodie Whitaker. And the 14th now is Ncuti.

James: I think the 12 doctor is Peter Capaldi, right?

Donna: Thank you. Yes, Peter Capaldi. Thank you. Yeah.

James: I’m somewhat familiar with Doctor Who. I remember back in my younger years when I used to be on Tumblr, I would always see Doctor Who content all the time. 

Donna: Oh memes! Memes upon memes!

James: But I really, it’s so, you know, warming, especially for me, personally, as like a queer person to see like how inclusive Doctor Who can be. And especially, that’s why I was curious if you’re keeping up with the latest season because to my knowledge they have not only drag queen but non-binary actor Jinkx Monsoon is one of the um… 

Donna: Oh I love Jinkx! Yes. Yes. I haven’t, no I haven’t seen their episode yet but I also used to watch RuPaul’s Drag Race and I definitely did watch Jinkx Monsoon’s season. But don’t quote me on anything. I just don’t remember anymore but I do know some of the drag queens, they’re amazing.

James: Yeah, of course. And I feel like, that is such an important thing, like the sense of inclusivity. And I also watched a lot of drag race. I think one of my personal biggest accomplishments prior to me joining APAMSA, and I think it sor of led to like why I work towards serving the communities that I do, you know? But um, back in the day when I was at, uh, my undergraduate university, it was the University of San Diego and to our listeners or to you, if you didn’t know, that is a private Catholic institution.

Donna: Oh- I did not, isn’t that the party school?

James: No, that’s San Diego State University.

Donna: Oh, state, thank you. Okay, got it.

James: Yeah, I get that a lot. It’s either, oh, you went to UC San Diego, and I’m like, no, that’s the La Jolla School, and then they’ll be like the party school. But in any case, what I’ve been meaning to say is that, back when I was an undergrad, one of the things that really ruffled a lot of feathers was we hosted a drag show on campus, you know, to amplify queer voices and we would always invite drag queens to host the show, you know? And one of the amazing queens we got to bring through to host the show was Bob the Drag Queen before she won her season. 

Donna: Stop! You met Bob? What?! That’s amazing!

James: They wore the dress they made from the first episode of their season.

Donna: They’re a legend. Yeah. Even I know Bob. Yep. 

07:57 Getting Involved in Health Policy

James: Yeah. But one of the things that I think is particularly special about Bob the Drag Queen that you parallel is how politically involved they are. You know, and I would love to hear more before we dive deep into your journey through medicine. Like what inspired you to do so much policy work? I feel like they’re – for at least for me, so I don’t want to speak for everybody. But I find that there is such an overlap between medicine and policy. But for a lot of folks, they don’t know how to, you know, if they have a passion for both legislation and medicine, how to incorporate the two. And so to see how much you’ve done, like it’s so inspiring and so how did you get started on that? 

Donna: Yeah. So this is going to sound funny. But I used to be like not interested in politics at all. I used to be borderline apolitical prior to med school. I knew that there were elections. I knew Obama won and Bush won before. But I just didn’t, and I don’t know if that’s like an age thing, but when I was younger, I was just very so much in my bubble. And I didn’t know exactly what the three branches of government did years ago and I think medicine comes hand in hand with being involved in the community and advocacy. Like, it’s difficult to remain in that bubble as you progress through your medical journey without opening a few eyes and a few doors. And the reason why I say that is because I knew in med school I – I was obviously happy with the clinical training we getting, that’s what med school does, it pumps you up as a doctor, but I was not happy with what I was taught in terms of population health, in terms of how we can help communities, what does that system look like you know, that’s, you know, beyond your school. And so I actually chatted with the California Surgeon General Dr. Diana Ramos a few months ago, and she told me a really good quote that I still remember to this day. She said that “80% of healthcare happens outside the four walls of your exam room.” And I 100% believe that. And the reason is because if you have patients who can’t afford medications, who can’t afford treatments, who have a very poor diet, they’re in a food desert, right? All of those things contribute to them coming back to see you all the time in the hospital right? Readmission rates are high, etc. And so for me, I wanted to get that experience. And so I wanted to get an MPH and that’s when I started getting a little bit more like learning about politics and about like advocacy, and it really didn’t click for me until I was like in that scene. So when I went to Hopkins, it’s in Baltimore, which is literally across from DC. And really just a geo-like political landscape and opportunities that were there. I was like, you know, I should toss my hat in the ring and like apply for these internships and see where I land. And so I think and I say this to a lot of people all the time, like, “Yes, I’ve had a long CV, but I have probably three times the number of applications and twice the number of rejections.” So nine out of 10 things I apply for, I get rejected from. And that one thing that I applied for and that I did get, I try to learn something from that, or I stick with it and I try to be really good at it. And so for me, wanting to be in that advocacy scene, one, you need to place yourself where the action is. You can’t just say like “I want to learn about this, but I’m just going to sit here and, and read, read”. Reading is great to get knowledge, but if you’re not out there being in, you know, positions of power or getting leadership experiences, it’s not going to help you and it’s not going to help anyone else. And so I think during my APAMSA term, and even now, trying to create a physician organization for Asian Americans, I still have the same mindset. Is to give opportunities, to raise awareness so people can be leaders themselves. So thats the first part, and then I think the second part is just not giving up. And why I say that is because I actually was City Commissioner, like you mentioned when I was actually a med student. I was a fourth year med student and I was a City Commissioner. Not that I Googled who else was, but I would probably soundly say not a lot of people did that, their fourth year med school and I just applied for it. I applied for it on the city of San Jose’s commission board website. It looks like a website from the 90s. I wasn’t even sure if my application was going to some black hole and then my council member called me and said, “Hey congrats, we’re going to appoint you as City Commissioner” and I was just a med student. So never feel like, you know, you can’t do something based on the level of where you’re at, you can do anything at any time. And so those are probably like the two things that I’ve learned on my journey so far in terms of like marrying medicine and advocacy.

13:11 The Inspiration for Medicine and Advocacy Work

James: Truly we don’t have the cameras on right now, but my mouth is a gape. That is so like inspiring to hear. Wow. Would you say your journey in policy work has closely paralleled your career, like the beginnings of your medical journey? Like, so in other words, I’m asking like, how, where did your journey in medicine begin, you know, and how closely did that tie to policy work? If there even is an overlap in the genesis of the Donna Tran medical journey.

Donna: Oddly, I would actually say actually the medical journey began a lot earlier than my advocacy political journey. And that’s because, you know, years ago, my father, my whole family is like OG immigrants. I was born here but they came over like during the Vietnam War. And my dad, long story short, had a brain tumor, was very like, anti feelings, anti mental health, and that just took a toll on our family. And I live in, we’re from San Jose, California, where there’s like a huge number of Asian Americans in general, and just, they just could not find an Asian therapist. It was actually very shocking. Even today if you look at like the AAMC workforce data. There’s, you know, from last year to this year, last year’s Asian physician workforce was 18% and this year was 19%. And sometimes those numbers just don’t make any sense for certain communities that have such a high number of Chinese Americans or Hmong Americans, and there are not enough physicians to serve them. And I’m like literally in Silicon Valley. So I can’t even imagine what a physician desert it is in some areas across America. And so in general, I would say that kind of kick started off my journey in exploring medicine and how I can help families in those areas and similar situations. And then after that, I think the political and advocacy work came a lot later, ’cause I was just like, focused on getting into med school, doing well on my MCAT. When you look at people’s CVs, you’re like, “Oh, wow, they did a lot of things.” I don’t know. At least on my end. I was like very like like one step minded. I was like I gotta get to like post-bacc I gotta get to medical school and then now I’m in residency. And I didn’t believe it like previously but when I would ask leaders the same question like oh, how did you get involved? Or you know how did you get all these opportunities there like number one answer was serendipity and I just would not believe them. But now I get it, I totally get it. You know, you have, like I said, you have to put yourself in places and situations and try to like figure it out like what you’re really passionate about and then just kind of take each experience as it comes along and learn for that. So the advocacy part, I’m still trying to figure it out now. Um, and it’s more advocacy than political. I don’t have any desires right now to run for office. Um, I worked with politicians and it’s, it’s a lot, it’s a lot of hard work. So if you want to run for office, I’m more than happy to help run your campaign. But I’m very happy with doing legislative stuff on my end. 

16:35 Why Psychiatry?

James: Yeah, absolutely. And so something I want to dive a little bit more deeper into and it’s another reason why I look up to you as a role model, but you were touching, talking about earlier about mental health, especially amongst like immigrants, Asian immigrants. It’s not discussed as much as it should be. And you know, and that unfortunately trickles down to our generation, you know, as first generation American, Asian Americans, you know. Did that – That must have played a major role in you choosing psychiatry. So I’m ask- so what I’m asking is, at what point did you realize, like, you know, psychiatry is the one for me? How did your upbringing or how did your background like sort of lend to that? 

Donna: Yeah, so I would say, um you know every so every med student uh is going to go through third year rotations, psych is one of them. When I went through my psychiatry rotation it was the best ever. One, because a lot of things that we helped patients with were very personal and intimate, and medicine is already intimate enough, but to explain this further, when I was in my surgery rotation which is– people think are like polar opposites, right, surgery versus psychiatry. When I was in my surgery rotation they were like in awe. They were like, “oh, you’re interested in psychiatry, we’ve had some we’ve read some psychiatry colleagues actually become psychiatrists and we were trying to figure out like the correlation between them and what we kind of figured out was that with surgery, you’re basically cutting into a person right like you’re sticking their hand into their abdomen. That’s as pretty physically intimate as you can get. Right? Like you’re literally cutting into a patient and sewing them up. For psychiatry, you’re basically doing that, but you’re dissecting their mind. And you’re figuring out their traumas, like what it is that they really think, what drives them as a human being. A lot of my co-interns really like this philosophical view on psychiatry as well. It’s more of a narrative medicine. And so I think that, you know, after going through all of my rotations, like, this is the one for me. I want to figure people out. I want to figure out how to help them, because you know like there’s a pill you know for diabetes and yes there are pills for depression and stuff like that. But if you ask any psychiatrist, no one is going to give you a straight answer on exactly how to fix depression. There is no definitive or numerical answer, right? Versus like diabetes, you have a hemoglobin A1C, like either you have diabetes or you don’t, right? Pretty easy. With depression or like schizophrenia the other psychiatry like um, diseases and disorders, it’s not that straightforward. And so I kind of like that complexity, and I find that incredibly rewarding. And a lot of public health is a lot of public mental health as well. Behavioral things that people can do to increase not only their mental health but also their physical health too. And so I think that right now, in the past few years, since the pandemic started in 2020, mental health has kind of exploded on the scene. You know, everyone’s just now paying attention to it a lot more than it used to be and telehealth is basically rising in the ranks. And so just you know, having followed along this past like four years, I think, it’s been really interesting to see how psychiatry evolved as a field and also in the landscape of medicine. So I’m very interested to see in this upcoming administration, how psychiatry medicine is going to be impacted by this different you know presidency this different congress right it’s going to be completely Republican run, and seeing like what that does to medicine and our population health in general?

20:39 Learning About and Joining APAMSA

James: Yeah, absolutely. That is um…I there’s so much. Yeah. I can’t even imagine how. Cuz we don’t really think about the environmental factors and how they impact, you know, our mental health. Environment, meaning like anything not like out of our control. Man, that is a very wild thought to ponder, you know? And so you talk about how your third year rotation is when it clicked for you for psychiatry. If we rewind just a little bit more, was it your first or second year that you joined APAMSA? 

Donna: Oh, joining APAMSA was actually a wild, another wild story. So, I don’t know. I always laugh at this because I don’t know if it makes me a good president or a bad president before, but before like med school, I didn’t really know APAMSA existed. Like, when I got to med school, I was like, “Oh, it was probably like some Asian med student organization,” and that’s when I found APAMSA. But literally like did not exist until like med school. So I like first semester of med school we had some really nice upperclassmen, second years. I think they went to the 2018, 2019? Like that National Conference. It was in person, it was pre-COVID in person. And they were like, hey, we need some like regional director who wants to run and like, no one was running because it was the Midwest. Like, no, there was like one, not enough like representation, which was sad, but also two like, I’m telling you, like people, like, for some reason, like, don’t want to run for positions or don’t want to have these experiences. It’s wild for me. So me and a couple of my classmates ran for RD, regional director positions, and we got it because no one else ran for it. And so that was my first way into like being involved with APAMSA. And then luckily, for me, someone, another national board member was unable to finish out their year as Committee Outreach Director. And so I was the very last person to actually hold two national director positions at the same time. And I thought it was going to be like crazy. I’m a very yes-hype woman. So I was like, oh, yeah, totally. Like I’m happy to help out. But it turned out okay. I think because of those two experiences simultaneously, I got to talk to different branches, different people in APAMSA and I loved it. Then I ran for EVP and then President and the rest was kind of history. But yeah, I started very early on and stayed involved because I think the people that you meet, the friends that you meet, they’re still my friends now. Like I literally text them like almost every week. So if APAMSA is a wonderful organization, I think I’m preaching to the choir here, but and everyone truly wants to make a difference, you know? And I think that that’s what really drives people to be in APAMSA and to stay together. 

James: Yeah, absolutely. I think in my own experience, since I’m now only I’m barely about to have one year of APAMSA national board under my belt, I will say for anybody that is interested like, to our listeners who may be interested in running for the national board. If you do decide to pursue this opportunity, it will really change your life, but it is what you put into it, you know? You could just let this just be a residency builder for med school or to get into residency. But like, so far, all of my favorite memories have been the ones where I created events or I collaborated with others and made everything a united effort. You know, this, for example, like I mentioned this in the introduction, like I’m just the Fundraising Director. You wouldn’t expect–

Donna: You’re not JUST the fundraising director. You’re our fundraiser, you’re THE fundraising director. Yeah. 

James: True, true, true. But you wouldn’t necessarily expect the Fundraising Director to be the host of the APAMSA Podcast, you know? But it’s about taking your unique skills and sharing it with the organization and allowing you to flourish in the most beautiful kinds of ways, you know? 

Donna: Yeah, I agree. Absolutely. 

25:04 Donna’s APAMSA Legacy

James: And so in your case, you know, since you’ve served, like you’ve worn so many hats, you’ve done so many things for the organization, looking back, what are some of the things you are most proud of during your time in APAMSA?

Donna: Yeah, I think what I’m most proud of was, I found my purpose and I stood by it and I still stand by it, it’s actually my purpose. And I think from that very cemented purpose came like, you know, multiple initiatives that I wanted to start and are still in effect today. And so, you know, my, I think that everyone, they have the potential to be a leader. And it really just takes a little bit of awareness, a little bit of opportunity and some magic. And I think that everyone can find a place within our healthcare system within this world to be able to enact the changes that they want to. So I don’t think, you know, APAMSA being on national board or executive board is like this exclusive elite club. It absolutely is not. Everyone came from somewhere and I’m very humbled by that belief that I hold every single time. I don’t think anyone is too big or too small for a task. I like still make PowerPoint excels, right. Like, I don’t have a secretary doing that for me. But really, like leaders just start out, you know, doing things that they want to help solve problems and help the community with. And so because of that belief that I had, I really tried to instill that into my national board during the two years. And so there were some things that I wanted to implement that would sustain the organization for a very long time and be able to carry on you know these like legacy aspects of that that would help future students as well. And so one being give you an example was membership dues. We were the student medical student organization to not like have membership dues. And I think in part was because we’re a newer organization we started around 1994. And so, you know, you know, a lot behind many years behind you know, SNMA or LMSA, but that’s totally fine right come in existence when we come, but at the same time, we were also struggling to keep afloat, to be able to do all these initiatives and support our students with grants, scholarships, etc. So one was implementing dues. And the second thing was creating more opportunities and structure within national board to be able to pipeline just, you know, student members who want to explore the national board and come into these positions of leadership. For example, when I just started into my presidency, we actually created the diversity branch. You would think that it was here forever but it was not. It is like maybe five years old. It’s not that old. Same with advocacy. Advocacy just came into existence right before I got into the National Board. It was like probably within like 10 years old or something like that. So Diversity branch was created, we created also multiple committees nationally standardized National Committees for the Diversity branch. So in addition, like created like the Leadership position Director, Women’s Director position, and created those like corresponding committees as well. So all these things is to increase participation, engagement, and I just really wanted to nail in that you know, this isn’t like a me position, this is a we position. I cannot run everything by myself as president during that time, no matter how much you think you can, but it needs to be a team effort. And so I think that me trying to instill those values and seeing some of those initiatives still be in existence today, it still makes me very proud. So good job guys. I’m not doing any of those work anymore. You all are. But you know, just being able to recognize that, you know … in a place temporarily and how much good we can do is really reflected on what you can leave behind that’s sustainable and that is positive. And so every though I’m a resident now like I still always come back because the APAMSA so was so much fun and it was so meaningful that I think that you know, it was really such a rewarding experience for me. 

James: Absolutely. I mean you truly do have such a long-lasting legacy at APAMSA. I think something that inspires me so much about the work you’ve done and so much of the national board and past presidents and everybody, all of the alumni, is that like, what you guys have done is truly like. You found APAMSA in a away and then you left it in a better state than what you got.

Donna: We tried.

James: And so that’s, I feel like if somebody is ever interested in joining this org, that’s what should be motivating them to do more than what their position entails. What can you do to keep growing and create that sustainable change. Yeah, but yeah, man, you inspire me so much. I can’t wait to– our elections are in 3 months.

Donna: You’ll somehow someway you’ll get there time will fly. Next thing you know, you’re graduating and you’re going to be a psychiatrist yourself.

30:32 Debunking Misconceptions of the Medical Field and School

James: One can only hope, yeah. But in that case, so, since we’re talking about the future, to some degree, I think you now being a PGY-1 at Stanford. That’s huge. I feel like something that we as medical students and we as, like, you know, not doctors yet, there are a lot of misconceptions we have about what’s to come, whether it’s even just about medical school or residency or about being a doctor 101, you know, one of the first personal huge misconceptions I had about medicine that I hear from my mentors, you know. It’s not all fun where it’s all treating patients all the time. Like, what I’ve been told is that there’s a lot of paperwork, like, more than you can possibly imagine, you know? And so, in that theme, what are some common misconceptions about the medical field or medical school in general that you think requires some clarification or something that you would like to enlighten our listeners on?

Donna: Ya, so I agree with what you said. And I’ll just kind of integrate and echo a bit of what I also said earlier. Like you said, I think the biggest misconception is that you go through all the schooling and, you know, we expect to come out and feel like, you know, Gray’s Anatomy is doctor. Right. Like that’s totally not how it works. Not even with that level of trauma. I like when I was in medical school, I really took that time for granted. Because it was really hard, right? Like you dig your nose into the books. And you’re like, okay, once I learn all this information, I spit it out, I take STEP1, STEP2, I go to residency, you know, I’ll just like magically know everything. And the whole system will make sense. Speaking as a PGY-1, that’s not the case, but probably physicians who are veterans even, you know with years of experience under their belt, they could probably still tell you that like the system still doesn’t make any sense even though you’ve been out of med school for so many years. And so I guess but you know misconceptions, the biggest misconception I had in medical school was that I thought going through medical school and graduating would give me this magic wand to feel better about myself and about my job and career in medicine. And that’s just not the case. So if you’re waiting to feel better magically at some point, sometime – it’s kind of parallel with adulting right? Like there’s no adulthood ceremony even though you know 18 is like the legal age and then 21 you can drink, right? You graduate undergrad. But there’s no like– you know, oh, at 25 now you’re magically an adult because you can actually rent a car. I think it’s like 24, 25 or something. And then at 26, you’re off your parents like insurer, health insurance right? There’s no magical ceremony that will graduate you into adulthood, that will graduate you into doctorhood and make you feel better at all. And so I think that that cognitive dissonance between your expectations and the reality of medicine in this world is very jarring. I think medical students and doctors live in our bubbles a lot of the time. And that’s why with like, you know, white ivory tower schools, you know staying in academia, like, there’s even a problem with physicians like talking to their patients, like half the time, like, we say these all these huge– jargon. And these patients are looking at you and they’re like ‘uh-huh’. Like we can’t even like communicate with our patients sometimes. And I think that’s a reflection on our own notions as a physician community. And in thinking that once I go through these like rites of passages, right, pre-med, med, you know, residency, attending, then life’s gonna be a hundred times better. And it just doesn’t. And so what I say is that, you know, during along this journey, you should just try to experience the journey for itself and find meaning for what you’re doing right now. If you’re always thinking about like the next step or having to achieve the next step, then I’ll be happy or then I’ll be successful, then you’re never going to feel fully whole and fully happy until you’re on your deathbed, right? And even then, people still have regrets right before they die. So I think being a doctor is a very cautious choice, like, about what you want to do and about the realities of it. And so, you know, I know it’s hard not to pigeonhole yourself into thinking about the next step, or about this perfect system that’ll magically appear to you on a red carpet once you graduate med school, but it’s not reality. If you look at data and research just in general, like that’s like, you know, physicians are twice, I think, yeah, two times at a higher risk for depression and mental health distress than the general population. And there’s a reason why, right? So yeah, I would say that’s the biggest shocker that I have learned throughout my years. I’m still learning now, right, and it’s hard for me to take my own advice. So hopefully, like, if someone out there is listening, than you can take a step back and just really reflect on your journey as you are showing up right now. There’s no other expectations for you than for you to just be yourself right now.

James: That is very wise, Donna. I think especially something that a lot of, for example, maybe our younger viewers or the listeners can relate to is that like, speaking on my own behalf, I remember I always looked at my parents and thought, wow, they really know, like, they have everything under control. 

Donna: No, they don’t. No, absolutely not. 

37:07 This Or That? Questions

James: Exactly. No, they don’t. You know, and I’m like, I remember thinking when I was 21, it’s like, oh maybe when I’m finally in med school or when I’m done with – I’ll feel like more under control, more grounded. But no, it’s literally just take everything one day at a time, you know? So thank you. Thank you for sharing that. That is definitely something that needed to be expanded upon. That is wow. Thank you, Donna. In any case, we’re coming to a close for this next episode of the APAMSA Podcast, and on a more lighthearted note to get to know you better on a more personal level with a couple of This-OR-That questions. So It’s simply an A or B, choose one, just let your heart decide.

Donna: Alright lets go.  

James: Awesome. City or beach?

Donna: Beach, sorry guys.

James: Cats or dogs?

Donna: Dogs, I have one next to me.

James: Boba Princess? Princess Boba? Text or call?

Donna: Like what I prefer? Or– see I’m overthinking it. Text, I’m terrible, I’m a millennial, we just text we don’t want to call

James: Black or white?

Donna: Black

James: Morning or night?

Donna: Night owl

James: Summer or winter?

Donna: Summer, I was also born in July so, Summer forever.

James: Breakfast or dinner?

Donna: I’m a dinner girl.

James: Would you rather have the power to be invisible or the power to read minds.

Donna: As a psychiatrist, 100% read minds. Well I guess that would make my job too easy I wouldn’t even have to talk to the patient, I would just be like “I know what you’re thinking” and bam, bam bam. That’s it. But also if there’s a way to shut it off that would be nice. Like selectively using my powers.

James: Ya this is supposed to be a rapid fire segment but I do have but I do have to say I remember one of the things that um, psychiatry during my psychiatry didactic block, there was this like exercise that our professor had us do where we were all talking basically at like max volume, you know, and we were assigned to like, try to remember a list or something. And basically by the end of it, like we could not hear our own voice, our own thoughts based off like, over everybody else. And it was supposed to mimic like, you know, hallucinations or, you know, people who suffer from that. I was like, if you have the ability to read minds and experience what our patients are experiencing, that would be pretty wild, you know? But in any case, would you rather have a hundred thousand to spend on yourself or a million you can only spend on others? 

Donna: Oh, a million to spend on others, cause then, I don’t know, I’ll just ask my mom to just buy me stuff. I don’t know. I’m joking.

James: And then we have two more. One of these is, I will only ask of you to cater specifically towards our special alumni guests. Indoor or outdoor climb? 

Donna: Oh indoor. I’m sorry, I’m a weenie, I don’t know how to outdoor climb yet. I know, I wanna learn. It’s on my list to do.

James: If you ever find yourself back in Vegas I will take you to Red Rock.

Donna: That’s classic rite of passage right there.

James: Exactly. And then finally would you rather retake STEP1 or retake the MCAT?

Donna: Oh 100% STEP1 100%. So I, so I used to teach MCAT as well but MCAT just doesn’t it doesn’t make sense like the O-chem, the physics, I did not care about it. Also, I think MCAT is more miserable because you can retake it multiple times. Whereas for, I mean, there is a passing score-ish, but like with STEP1 you just need to take it and pass. So I’d rather do that versus MCAT, you have to retake it multiple times if you don’t, if you aren’t happy with your score. I feel like that just messes people up. ‘Cause how many times did you remember hearing your friends say, oh yeah, retake the MCAT again. That is like years of your life. I feel like that’s more hellish than just taking STEP one once and then passing it.

James:  Absolutely. I have not taken step one yet, but I will eventually.

Donna: It’s pass or fail. You’re going to pass. You’re going to pass. Like, it’s going to happen. You’re only going to take it once and then you’re done. Whereas MCAT, it’s like, I’ve never used O-chem again, just FYI. I’m very starched, like advocate against O-chem. Just not using it. Yeah. 

41:20 Advice for Pre-Health and Medical Students

James: Nice. Well, in that case, that brings us to the end of our This-or-That segment. Thank you for your candid and thoughtful responses. As we wrap up, we love to close out our one-on-one series by seeking advice from our incredible guests. I know you provided a lot of wisdom with our misconception question, but I would still like to ask anyways, if you have anything else that you would like to share, is there any piece of wisdom or advice you’d like to share with somebody navigating the journey of medical school slash medicine? 

Donna: Absolutely. So I would have to confess that this is not my original thought, and I don’t even think it was this person’s original thought that said it, probably honestly came from Nike marketing. So I actually saw Mr. John Chu, who’s the director of Wicked and also Crazy Rich Asians up in SF. He’s doing a fireside chat talk with Aquafina. It was super awesome just seeing them like chatting on stage and talking about their lives and the creative arts of film. A really like great breather from medicine. And he was asked a lot of these questions as well and advice for people, etc. And I remember distinctly the moment, he was telling us that he was teaching a class at USC and he was sitting at I think some like loading dock or something. And he was crying because he wasted five years of his life trying to make another breakthrough film after Steven Spielberg had discovered him very early on at film school. And he felt like he was wasting his life and not moving forward. And the breaking point was him, was that he just realized at some point he said you just have to go do it. Just do it. That’s it. Three simple words, just do it. And it’s like three words that’s on like a Nike logo, but I was just listening to a story and I was just like know what he’s right like if I don’t do what I want to do now, what I’m passionate about, then one, no one else is going to do it, and two, or someone else is going to do it. And I’d rather do it because it’s something that I’m passionate about. And so I think that that advice really kicked me off to continue wanting to start up the National Asian Physician Association, NAPA, with APAMSA. So really thanks to, you know Mr. John Chu, who’s the director of really famous movies, just giving really good advice. And it didn’t even come from like a doctor. It came from a director, a film director, right? He was just like, just do it. And I was like, you know what, you’re right, Mr. John Chu, I’m gonna go do it. So, yep. I hopefully, like, if anyone’s listening out there again, like, if there’s something you just want to do, just, just do it. If there’s any doubt in your mind and it’s not obviously illegal or bad for anybody, like just start doing it. You be surprised how far you can go even if it’s just a little bit a day at a time. And it’s going to take a day at a time. Nothing’s going to come, success doesn’t come overnight. It just really, it takes 10 years for success to come overnight. I don’t know if people’ve heard that saying before, but that really speaks to volume about preparation, opportunities, and persistence in regards to success.

James: Wow. That is an amazing piece of advice. And definitely, it’s something that I needed to hear, especially about, from our earlier offline conversation. But in any case, Donna, Dr. Tran, it’s truly been a pleasure getting to know you better. We are so grateful for the time you took out of your day to join us and share your story, and even more so, all the time you dedicated to being a leader in APAMSA. To all of our listeners, we hope you enjoyed this episode as much as we did. Don’t forget to tune in next time for more inspiring stories and insights. Take care.

Listen here:

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This episode was produced by James Chua and Ashley Tam, hosted by James Chua, and graphic by Callista Wu and Claire Sun.

Timestamps:

00:00 Introduction to White Coats & Rice: An APAMSA Podcast

00:26 Introduction to Ashley Tam

03:28 Baking Cantonese Pastries and Buns

07:41 Playing Genshin Impact

11:26 The Journey to Medicine

14:31 Choosing Pathology as a Specialty 

22:24 Clinical Skills in Pathology?

24:50 Why Did You Join APAMSA?

31:05 APAMSA Core Memory

33:21 2023 National Conference Theme

35:07 Wishes for APAMSA’s Future

37:18 Community Impact Week 2025

39:16 What Are You Looking Forward to in Your Medical Career?

41:46 This or That? Questions

45:14 Advice for Pre-Health and Medical Students

00:00 Introduction to White Coats & Rice: An APAMSA Podcast

James: Welcome everyone to the third episode of the Asian Pacific American Medical Student Association Podcast, from roundtable discussions of current health topics to recaps of our panels with distinguished leaders in the healthcare field, to even meeting current student leaders within the organization, this is White Coats and Rice. My name is James Chua, second year medical student at Touro University, Nevada, and the current Fundraising Director at APAMSA, and I’ll be your host for today.

00:26 Introduction to Ashley Tam

James: On today’s episode, we are thrilled to welcome Ashley Tam, an alumnus of Cornell University and current fourth-year medical student at Oregon Health and Science University. Hailing from Oregon, Ashley’s path to medicine is truly inspiring. As the daughter of Chinese immigrants, her upbringing was deeply influenced by the richness of Chinese culture and traditions. However, it wasn’t until her time at Cornell that she fully recognized the importance of her cultural identity and what it plays in her life. In 2020 she began her medical education at OHSU and by her second year, Ashley and her local APAMSA chapter hosted the National Conference at their school themed: Renewal: Out of the Flames, Into the Future. Ashley has worn many hats within APAMSA from National Conference Director to Co-Social Media Director, and now, Communications Vice President. Her dedication to the organization highlights her passion for amplifying AANHPI voices and fostering meaningful connections within the community. Beyond medicine, Ashley’s interests are as vibrant as her professional achievements. Whether exploring Teyvat and Genshin Impact where she boasts over 1300 days of active gameplay, watching anime, or being a proud dog mom to Goji, her spirited Shiba Inu, Ashley embraces life with enthusiasm. Without further ado, join us as we dive into Ashley’s journey, her unique perspectives on medicine, and the vibrant passions that shape her world. Ashley, welcome to the show. How are you doing today?

Ashley: I’m doing good. Thank you so much. That was a beautiful introduction. I love that.

James: Yeah, I said this in Vic’s as well, but a lot of the stuff is drawn from previous APAMSA bios, so if you don’t recognize that, then you know from I think 20–, year first National Conference.

Ashley: Yeah, that is triggering some memories for sure of like typing that up and submitting it.

James: Yeah, I remember for me, since this is my first year on the National Board, I had no idea what to write for my bio. And I think the example that was given was like, one, written in third person, two, it was very long, and so I was like, oh perfect, let me do something very similar. And then I took the time to read everybody else’s bios, and I was like, hmm, no one else took this approach.

Ashley: Yeah, I– like as Comms VP this year, I definitely go through, you know, everyone’s submissions when they submit their bios, because we need to get that prepared for our website and everything. And it’s really interesting to see the different approaches people have, like some people super, super long and some people like don’t include their hobbies and I reach out to them and I’m like ‘Hey, like what are some fun things you do outside of school?’ Um, so it’s fun to see people’s interpretations of you know, the prompt. 

03:28 Baking Cantonese Pastries and Buns

James: Yeah, absolutely. And speaking of hobbies, one thing that I did want the listeners to learn about you personally is that I remember when we were talking about or like preparing for the podcast, one of the things you mentioned is that you are a baker.

Ashley: Oh yeah. I mean, I’m not like an expert or anything like that.

James: Well in that case what do you think is your favorite thing to bake?

Ashley: Hm. I think, similar to a lot of people, it’s like my baking journey kind of started around the height of COVID because I was like at home. I had a scribing job, but you know, at that time, they were like, you should probably not come in. And so I was at home, my family’s at home, my sister is doing school from home and I’m like I have nothing to do right now because I’m basically waiting for med school to start. and I decided to bake because I don’t like cooking as much because I’m more of a recipes person, and I feel like baking sort of like scratches that itch for me because it’s like a little bit more scientific. You really need to measure things out. And so because we weren’t going out to buy things as much, I decided to make egg tarts. And like I went through like a couple iterations. I mean, not my own recipe, this is other peoples’ recipes. But like the way that I did the recipe, I feel like I messed up a couple times and it didn’t turn out the way I wanted to, but then I really got into baking egg tarts during COVID. Then I pineapple buns as well, and then like the Cantonese cocktail buns which are the like still a milk bread bun but then the inside has like a coconut filling. So I made that sort of in rotation for my family. I’m like, oh, our stock is running low so I’m going to make some more. ‘Cause also I’m a little bit bored so I’m just like keeping up our stock and everyone gained weight over that time because I was baking so prolifically. But those are my favorite things to bake because I never thought that I would, you know, be able to make that at home. It’s always something that we have to go out to the Cantonese bakeries to buy. So it was really cool to be able to sort of provide that for my family at that time.

James:  Absolutely. And I think like, for me personally, I’ve always also and I feel like this is applicable to many people in the science field how they prefer the science of baking to just cooking which I do both but I feel like cooking is a lot more about vibes than anything else. But yeah, when I was reading your description about like all the things you’ve made before, the three items you wanted to highlight. I actually last night and now that I’m finally on winter break. I finally have had the time to do the things that I’ve wanted to do. And one of those things on the top of my list, because when you’re a busy medical student, all you can really focus on is studying, right? One of the things on the top of my list was baking. And so the thing that I made most recently were Bolo Bao inspired. They were inspired cookies though. So it had like the topping of the bolo that makes it look like a pineapple. I guess. Or I…

Ashley: Yeah! Yeah, yeah. That’s awesome. Was it successful?

James: I’ll show you a picture and you can be the judge. Um, yeah, it, the base of the cookie was this like brown butter experience. So it was just like, it tasted just like a normal cookie. And so I’m like, now I’m actually right after this about to go to Dim Sum with friends. So I was gonna try like- gonna try like an actual pineapple bun and be like ‘how does actually compare?’ 

Ashley: Yeah. That’s awesome. You should, um when you go you should get the custard filled one. That’s always a fun one.

07:41 Playing Genshin Impact

James: Yeah, and so on a separate note though, something that I wanted to ask more about. So, over 1300 days of Genshin Impact. That’s, for the listeners, I think over four years if the math translates. 

Ashley: It is, yeah.

James: How did that start?

Ashley: That’s a… that’s a great question. I think the launch of the game started, it was in like October 2020. I sort of had my eye on it, but you know, I was in my first year of medical school, I was doing didactics. And I was like, well, I don’t think I have time to like commit to starting a new game. I never played any like Gacha games before, but it just like really interested me. And then, it wasn’t until I think February when we finished one of our blocks we had just taken finals and we had a week off afterwards. And I was like oh, maybe I’m ready now, to like start this game and we’ll see how it goes. And you know, I think I started playing around February of 2021 and like the rest is history. Like, I’ve really liked it when I first started and because I had that week long break I was playing it like a lot and so I got really invested in it when I first started. And then, uh, Genshin is just one of those games where, you know, if you want to be free-to-play you kind of have to invest the time to be able to get the characters that you want and to be able to progress through the game easier, and so ya, because I really liked it I was okay investing that time. And it was like fun to you know, “I have to do dailies, I have to do my weeklies” and then it just becomes part of my list of things to do, not in a bad way. But it’s like, fun to keep up and to be able to feel like I can look forward to the next update and feel like prepared for like the new characters that are going to drop. Like I’ve come very far. And I’m proud of it to some extent. I haven’t spent money on it– my own money. I have had friends who have given me some like a birthday gift or like a Christmas gift. Like here’s like an Apple gift card and like I appreciate it but I haven’t spent my own money so I feel a little bit proud of that.

James: I feel that. Yeah. I used to play Genshin Impact and I also took pride in the fact that I was also a free-to-play player. But then like, eventually it got to the point where I did not get the 5– I lost my 50/50.

Ashley: Ugh, the worst. I think I have, on the poor side of luck with Gacha pulls. It’s like, a little bit upsetting sometimes. But it is how it is, so like I ration my Primos a lot. So I’m like, “I’m going to like hold out and like skip this character” because I know there’s another character that I will want later. I feel like I have relatively good Primo management. And yah. It’s a lot of I guess, self control.

11:26 The Journey to Medicine

James: Yeah. Absolutely. And see the reason why I want to bring up these hobbies and I do this with all of our guests. It’s to sort of show how like, medical students are not simply just, we’re not glued to our textbooks at all times. We are people, we do take care of ourselves in all shapes or forms, whether it’s like baking like you do, gaming like you do, or traveling, like whatever it is that keeps you grounded, you know. And so, I think I’m now very interested, I think our listeners would love to know, how has your journey been to medicine? Like, where did it begin? How did it get to OHSU? Like wherever you want to start personally.

Ashley: Ooh, I think my mom like pulled this out of the storage closet really recently but in first grade there’s like this art thing that our teacher had us do. And it’s like a picture of us and like ‘when I grow up I want to be’, and I had written doctor. So I guess like that’s when it started. Why did I wanna be a doctor at that time? I have no idea. I don’t know who put that idea my head. Is it because I grew up in like, an immigrant Chinese family and, you know, the classics careers that they love their kids to have, it’s like a doctor or lawyer. Something cool like that. I don’t know. But I think when I decided that I really wanted to pursue medicine was just through science classes and being really interested in the human body and like anatomy and like how everything functions about anatomy and physiology was super cool because you’re like wow it makes like total sense like how this works in the body and then it triggers this. And then it’s just like the science of it just makes so much sense, like the logic, and I thought that was really cool. So I think I decided at that time that I really wanted to pursue a career in the human sciences. Um, and I think I always sort of had an interest also in like the molecular side of things, like similarly how the logic of the human body is super cool. Like, I thought the logic and processes of like cells on a molecular level is also super cool. And so I think that’s sort of what, that was like the foundation for me finding interest in pathology because pathology is kind of like a specialty that is very granular and you have to look at like – you know number one it’s very small you’re literally looking under a microscope but there’s a lot of details that go on in pathology. And my love for that probably stems from my love for like details of molecular biology and stuff like that.

14:31 Choosing Pathology as a Specialty 

James: Absolutely. And I actually, it’s interesting, because I would love to learn more about your journey to pathology because as far as I’m aware, you did, it was last year I think? The pathology fellowship, right? 

Ashley: Yes, yes. 

James: Yeah. So for me personally, like, I was actually very interested in pathology. There were only two specialties that I really, like, were leaning towards when I started medical school, leading up to medical school. One was psychiatry and then the other was pathology. And so… 

Ashley: Super different!

James: Very, extremely different. And I think, like, my interest in pathology, stemmed from like, I did a post-bac, they taught it so well there. I also worked in so many research labs and I like that setting, right? Yeah. But then by the time I actually started medical school, I found that the way they approached pathology at my own personal institution made me like lose my spark for it.

Ashley: Oh no!

James: But, it’s fine! I was also in cadaver lab and I realized I didn’t want to do like forensic pathology.

Ashley: Yeah that’s fair.

James: Yeah but maybe you can re-inspire me so could you please tell me and also our viewers more about your junior pathology, post-junior pathology fellowship and how that really – I’m guessing it really affirmed like what you wanted to do.

Ashley: Yeah. I think I came to my decision of specialty a little easier than other students in general, not specifically like just in pathology, but I had exposure to pathology in undergrad actually because I did some shadowing. And like you I had been in some research labs before and I thought like bench work was really cool. And I was thinking, oh, I know what a research lab looks like, what that setting is, like the bench work but I don’t know what goes on in hospital lab and then so I did like some Google searching and I was like, oh pathology, that’s something that exists. And then there’s pathologists that like run the lab, whatever that means. And so I ended up shadowing some pathologists at a hospital that was close to my undergrad campus. And I thought what did was super cool. At that time when I was shadowing I basically sat at the scope with them and they walked me through how they were looking at cases and making diagnoses. Like “oh, this is what I’m seeing on the slide or under the scope”. And they’re showing me like what all the different cells were what all the architecture was, and it was hard to follow along because I didn’t have a lot of histology background, like at all. But I just thought it was cool how they could look at something and make a diagnosis off of it. And that you can actually see what disease looks like under the scope. And then they also use a lot of other tests like there are stains and stuff. And I just thought that, that logic puzzle was super cool because they’re like “okay so if you know this stain is positive and this stain is negative then I can say like it’s probably this diagnosis”. And I thought that was the coolest thing.  And so I already had this. I was already like, inspired by pathology coming into med school. And so, you know, as a good med student, I tried to like, keep all the doors open and keep my mind open to everything that medicine had to offer. At my school I feel like when we had pathology lectures. When the pathologists came and gave us lectures, I was like super inspired by them because they were like super happy it seemed like they really liked what they were doing and they really liked the things that they were teaching. So that was a big plus. I mean, I already have like positive vibes about pathology but interacting with those pathologists I’m like “wow they’re super happy and super excited about what they do”. And eventually, I learned that there was this post-junior or sometimes post-sophomore pathology fellowship at OHSU. And there are, a handful of schools across the country that offer programs like this. But it’s like a completely optional thing, it’s not something you have to do if you want to pursue a pathology residency. There are plenty of people who don’t do that. And then, there are people who do a year in pathology but they go into other specialties. But it’s like, you know, maybe they have an interest in pathology, or they feel like they wanted to take more time to sort of think about what specialty they actually want to apply into and stuff like that. So people have a lot of reasons for doing it. I personally wanted to do it because I had heard from other people that it’s hard to get exposure to what the life of a pathologist is in med school because you know, it’s not a required rotation, there’s not that many elective rotations available to explore pathology and the fact that it’s just so different from the workflow of any of the other specialties. You can’t really get a sense of, a similar sense of what pathology is on a different rotation. So, and I was okay with adding another year, I know that can be a barrier, but I was like, you know what, I think I want to do this because I really want to know what pathology is all about. So I ended up doing that between my third and fourth year of school. And it was awesome because I– because it was between my third and fourth year of school, I had already finished all of my third year core rotations before starting. And so I had already gotten exposure to, you know, generally a lot of other specialties. And then that first month of orientation of my post-junior fellowship, I was like learning how to gross, I was learning how to use a microscope, learning how to write a report. And even in that first month when I wasn’t like really doing anything real. I was like sort of clumsily like trying to figure out like how to be a pathologist. That first month like sealed the deal for me. I was like, I’m definitely going to pathology. This is like so much more fun. I’m like coming away from those days so much more excited. I’m coming home like really wanting to tell my husband like what I did that day. And I felt so good about pathology, like all the other doors are for sure closed at this point. And then the rest of the year was just like super fun because I got to really just like learn what I wanted to do as like my future career. And I think the program was really cool because you essentially get to work like a PGY1 pathology resident. So you’re really integrated into the residents’ schedule, like you staff a service by yourself and sign out one-on-one with an attending. You’re not reporting to your other residents, you’re part of the team. And so it was, it was a really fun experience for sure. And it solidified my love for pathology and it also helped me learn so, so, so much.

22:24 Clinical Skills in Pathology?

James: Absolutely. I’m very interested to hear your thoughts, so one of the things that like, people really brought this up to me. And I feel like it also I feel like it applies to psych or psychiatry in that like, it’s sort of unfortunate that all of the clinical skills like the actual clinical skills like how to listen to heart sounds, it’s sort of like you don’t use it as much in pathology. So I’d love to know what are your thoughts on that?

Ashley: Of like learning clinical skills that I won’t use like as a pathologist?

James: Yeah!

Ashley: Um, I mean, I guess that’s just like the game of med school. Is like, doing a lot of things. or like learning a lot of things that you might not use but are important to explore all that medicine has to offer. I guess it’s just like, you know, a means to an end. So, I guess I never really thought about like “oh there’s all these things that I learned but then like I won’t use it. So I will probably lose the skill later on in life”. Um, but I feel like that’s just the nature of med school and like without having learned, you know, how to listen to heart sounds and stuff like, I wouldn’t have been able to get like that, that full experience of exploring other careers in medicine. So I think I’ll look at it with that perspective. 

James: Yeah, no, so it still was all very useful. Yeah, it’s a very positive outlook, and something I need to remind myself of instead of just saying like, “Oh, it’s all being wasted”.

Ashley: Yeah, yeah. I would agree. I guess I never really thought about that too much. But you know, like when you, when you start clinical rotations, like, maybe there will be something else that like, inspires you. And then it’ll open a door that you didn’t think could be open. So.

James: Absolutely. Yeah, well, we’ll see. I’ll circle back with you in eight months or so. 

Ashley: Yeah, I would love to hear. 

24:50 Why did you join APAMSA?

James: Yeah, and so that– I see like pathology and we’ve talked about your medical school career and the academic portion. But now I want to talk about the extracurricular stuff, and more specifically APAMSA. Let’s start with the beginning. Why did you even join APAMSA in the first place?

Ashley: You kind of touched on that a little bit in my intro. But you know, I didn’t find an Asian community that I, you know, could share. Or like peers. I didn’t find peers that I could really share my heritage with and cultural like nuances with until I got to college and I think it’s because Portland is not a super diverse city. And I did have Asian friends but I think like, my Asian-ness is something I only really appreciated with my family. And I think I never sought out to share that Asian-ness with my friends at that point. But then when I got to Cornell, like even my parents were like, “there’s like so many Asians here”. And they were super surprised about that. And I didn’t know what to expect, moving all the way to the other side of the country. But I actually found like a really large community of just like Asians and like I was actually able to speak Cantonese with with friends for the first time, outside of my family. And so I thought that was really cool. And I think that sort of unlocked something within me I’m like wow this is something that I didn’t realize I was missing but I really really like it. And so I came back to Portland and when I started med school I was like, I want to have that community again. I want to be able to have that community here in Portland. And also I guess I didn’t really interact too much with the Chinese community or the Asian community in Portland, and I thought it would be cool to serve that population here as well. Because I wasn’t really in touch with the community. And so that’s the first season why I joined like the OHSU chapter of APAMSA was to really find that community again and be able to do something with medicine with them. And then that was really fun. I really liked that, being able to have that community to lean on and depend on. But also to connect with outside of school. And then in terms of joining national board, OHSU had won the bid host National Conference. And National Conference directors aren’t elected they’re sort of like selected from the host school. And then so I had this opportunity to participate. And I was super nervous. I was like, you want me to like help run a national conference? That sounds crazy because I’m not really an event planner. I obviously had never planned an event to this scale before and I had a lot of doubts and insecurities and a big lack of confidence but my friends who were other national conference directors. They were like, you know, you should participate in this I think like you’d be a good addition to the team. I was like, okay, we’ll see. And so I became the National Conference Communications Director. And I had so I had so much fun doing that. I didn’t realize that, you know, using my brain like creatively and being like bit artsy. I’m like not a great artist but I do like doing some art. And being able to do that with the National Conference for APAMSA was actually really really fun. And I’m so glad that I had people to support me and give me that confidence boost where I couldn’t give to myself. So I’m super grateful for them pushing me to like get into this role and then you know by the end of the year I was like I want to keep doing more, I want to keep working on the national board, I want to keep working like artistically and creatively. And so I ran for social media director after the National Conference was over. And then, so, I kind of stayed on. And so that was super cool. And I’m really grateful that I have the opportunity to have this position because it’s super fun and I get to work on APAMSA, which, you know, has like the mission and the values that we all want to, that we all like are really behind. 

James: Yeah, absolutely. I can definitely relate to that. Because I think like when people ask me like, why are you so passionate about this organization? I always immediately connect it back to my personal statement. And talking about I want to serve the community I’m a part of. And I feel like there’s no other organization that really does it like APAMSA. 

Ashley: Agree.

31:05 APAMSA Core Memory

James: You know, and so looking back with this very like illustrious career in APAMSA is there one memory since your graduating right? Is there one memory that you’re going to be looking back at very fondly, like wow I did that you know with the rest of the National Board or like with your own efforts or however you want to answer it.

Ashley: Yeah, one core memory that will definitely always stay with me is on National Conference day. It was during the lunch period slash poster session period. All of my National Conference co-directors, we took group pictures in front of our photo booth area. And then I was like – everyone is out and about at that time. Everyone was gathered in the big atrium in the building so like lunch was set up there, the poster session was there. That’s sort of all the events that were going on at that time and so everyone was mingling about. And we were at the photo booth that was set up along the wall. And we’re like taking pictures and then as we’re taking pictures you can just see like the whole scene like everyone gathering, having fun, eating, talking to people about their posters and stuff. And I was like wow I’m so proud of us. And so proud of what were were able to do and to see a year’s worth of work culminate in one day. And to see people enjoy themselves and we’re also enjoying ourselves, yes there’s a little bit of stress, but it was like I felt so much pride in that moment. And like, I was almost tearing up. I was like, I can’t we’re taking pictures but like I felt like the tears I kind of like coming up because I was like just so proud of like what everyone was able to do and like we then took pictures with our committee members and stuff and yeah, I just felt like immense pride in that moment. And also just like I couldn’t believe that I was able to participate in something like this and to help bring something like this to life.

James: That is a really touching story. Are you attending the National Conference? This upcoming one?

Ashley: Yes! I bought my tickets and everything. 

33:21 2023 National Conference Theme

James: And so for our listeners, the next APAMSA National Conference will be hosted at Duke University School of Medicine in North Carolina from March 7 to 9. 2025. Yeah. Hope to see you guys there. But, I actually wanted to ask you one more question about your guys’s National Conference, and it was a little bit ago, but how did you choose your theme? Renewal: Out of the Flames, Into the Future.

Ashley: Oo, that’s an interesting question. I was not the brain behind it. I was sort of the Yes-Woman, I was like this sounds great! It was our National Conference Finance Director, Hannah Moon. She’s a resident now! But yeah, she, I think she came up with this idea. Her and our, actually I think she was the main one behind it. Yeah. And I was like, it sounds great. I love it. And you know, the, my like comms director brain was going and then I was like, oh, out of the flames, a phoenix would be a great logo design and so that’s sort of where I ran with that. But I was inspired by her for the theme and then that’s sort of where our national conference logo came from. 

35:07 Wishes for APAMSA’s Future

James: Gotcha. Yeah. And so on the topic of, you know, out of the flames into the future, now that your time, we cannot thank you enough for your time in APAMSA, but is there something that now that you’re graduating, moving forward onto residency soon enough. Is there something that you hope for, for APAMSA? Something you hope we do for the organization, some sort of change that you want to see, something related to the future of APAMSA, is what I’m asking

Ashley: That’s a great question. I think just like the growth of our organization. Like I think APAMSA offers so much to its members and like there’s so much support that APAMSA can give chapters to create, or host events, participate in health fairs, community screenings, and things like that. And I think those are super valuable experiences. And I would just love to make that available to like a lot of other chapters and so then they can like serve their communities in that way. I feel like APAMSA does a lot to serve the communities that all our chapters are in. And so just like seeing like the growth of our organization to more like more pre-health chapters because like there’s so many opportunities for mentorship. So I would love to see that. And just the growth of our organization so then, you know, we can inspire more students across the country, and then it can also just like serve those communities as well. So I’m like super excited to see that. Yeah.

James: Absolutely. I personally can’t wait as well to see APAMSA keep growing. And I’m sure like all of the hard work we as a national board have done this year will keep the momentum going for next year and so forth.

37:18 Community Impact Week 2025

Ashley: I’m excited for the event that you’re – that you’ve taken a big part in putting together. Your week of service.

James: Oh yes so for listeners let me make sure I get the date right, but what Ashley was referring to is Community Impact Week which happens from Sunday January 26th to Saturday February 1st, 2025. What she’s referring to specifically is that I wanted to create an event that sort of celebrated Lunar New Year through service, through philanthropy, through, you know, being there for the community. And so we’re, we invited every single medical school that is affiliated with APAMSA to volunteer during that week, to sort of show our presence in all of the local communities. Yeah. And so we’re going to be posting more about that as the days roll by. I’m sure by the time this episode is actually posted, it’ll be right around the corner. So I’m sure listeners will have a lot to see but yeah I’m very excited about that too. And I think on the topic of growth, um, in the topic of like how many members there are of APAMSA, like, I think the reason why I thought an event like this should occur is because like, there are over 180 chapters across nine regions of the United States. And I just felt like, even though we are all individual local chapters. It would be a nice opportunity for us to all come together in solidarity to do something for our AANHPI community. I think this really encompasses – also the importance of like, serving, like, of Lunar New Year, you know? It’s not just about celebration, you know, let’s get that good karma going right away. 

Ashley: Yeah, yeah. 

39:16 What Are You Looking Forward to in Your Medical Career?

James: Yeah, I’m very excited about that, but we have about one more month so that’s a little bit in the future. But I wanna talk about something a lot more in the future. And so with you graduating in 2025 and residency being right around the corner, there’s so much to look forward to in your career. You’re going to be a doctor in like less than six months, which is kind of wild. 

Ashley: Oh gosh, I know. That’s crazy. My grandma was just telling me yesterday. She was like I’m going to start calling you doctor, and I was like oh my god. This is crazy

James: What is something you’re especially looking forward to in your medical career? As a doctor i guess.

Ashley:  Um, I guess I from like a medical student standpoint right now. Something I’m looking forward to. It’s just like getting in to my career, like graduating residency and coming out. Most pathologists, I think, will do a fellowship as well. Like 90 something percent of people do a pathology fellowship so after fellowship I’m excited to just be like a competent pathology with the knowledge to be able to sign out cases independently, to be confident. I mean we’re going to be lifelong learners right? But we’re going to come out of training feeling like we can do things for real and not have to run things by someone. And of course there’s always like, you will come across things that are difficult or that you don’t know and will ask your peers. But I’m excited to do the work, to do the work and serve the people and to have the confidence to do that. I’m just like excited to get to that point. We’ve just been learning for so long, training for so long, I want to be the real deal. So that’s what I’m excited for at this point. 

James: Absolutely. And I’m, I know I speak, I can speak for all of APAMSA and all of your friends and colleagues. We are looking forward to you, for you and that very bright future ahead of you. 

Ashley: Thank you. 

41:46 This or That? Questions

James: Yeah, absolutely. And as we come to a close for the podcast. We have two more segments to go through. If you guys, if you took a listen to Vic’s podcast episode, we like to do a quick rapid fire of This or That questions just so we can get to know you a little bit better. Because we know you’re a gamer and you like anime and a baker. But this is just quirky questions, you know A or B, really fast. Are you ready?

Ashley: Yes

James: City or beach

Ashley: City

James: Cats or dogs

Ashley: Dogs

James: Text or call

Ashley: Text

James: Black or white

Ashley: Black

James: Morning or night

Ashley: Night

James: Summer or winter

Ashley: Winter. I feel like I’m a holidays kind of girl, so I feel like that’s when all the fun things happen for me.

James: Fair enough. Breakfast or dinner

Ashley: Dinner? I do like brunch but I feel like dinner options are greater.

James: Mm. Would you rather have the power to be invisible or the power to read minds?

Ashley: Be invisible.

James: Would you rather have $100,000 to spend on yourself or have $1,000,000 that you can spend on others?

Ashley: $1,000,000 to spend on others. There was like this quote I heard that was like “why do I need something” or, “why do I need to have something that I only need to use tomorrow when someone could have that if they could use it today?” So I feel like that’s really stuck with me. 

James: And finally as we are all medical students, would you rather retake STEP1 or retake the MCAT?

Ashley: This is probably controversial but I think I would take STEP1? It’s a longer exam, there’s so much more material that goes on behind it, but like, I feel like in didactics I was able to keep up with board studying and anki through didactics to the point where when I got to STEP1 like after doing practice questions and stuff I went into it feeling pretty chill. And I remember going into the MCAT feeling not chill at all. So I already have the potential to be chill going into STEP1 so I feel like I have the ability to get back there if I needed to.

James: Yeah, absolutely. And I don’t think that’s that outlandish of an answer. Unfortunately, since we’ve only asked this of two people, you and Vic, Vic said that her medical school didn’t require her to take the MCAT. So… 

Ashley: Beautiful. 

James: Yeah. I will keep you posted as we keep asking more and more guests of the pod which one is the more popular exam.

Ashley: I’m excited to keep listening. 

45:14 Piece of Advice for Students

James: Well, in that case, that wraps up our This or That segment. We appreciate your candid honesty. To end all of our one-on-one series for White Coats and Rice, I always like to end it seeking out advice. So Ashley, what is one piece of advice you would like to offer someone in their medical school journey, whether they’re pre-med or someone who’s right in the middle of their didactics or rotations? You know, what is one piece of advice?

Ashley: I would say my piece of advice is to allow yourself to invest in the things that make you happy and fill your cup. I feel like it’s super important if you have hobbies that you really enjoy to really take the time to enjoy those hobbies and do them. I feel like it’s really important to have that outlet and something outside of school and the daily grind. But then in terms of like school related extracurriculars, I think it’s important for people to– like it’s ok to invest more time into an extracurricular that you really like and not as much into something that doesn’t fill your cup as much, that doesn’t inspire you and excite you. Like for example if you really like mentoring and tutoring and you don’t like doing research as much, I feel like it’s okay to spend more time doing tutoring and mentoring. You don’t have to do that research if you don’t want to. I feel like it’s easy to fall into the trap as a student who is reaching for that next step, that next milestone, it’s easy to feel pressure to do everything under the sun to try to get yourself to that next point. And ya, just give yourself grace and allow yourself to do the things you like to do because there’s a lot of required things that we have to do in school, whether it’s– you know you have to do a didactics block or you have to do a core rotation and you’re not going to like everything. It’s impossible to like everything that you’re exposed to in medical school. If you do, then great but I feel like that’s not the case for most people. So because there are all these requirements and the schedule is really tough and you’re always working, I feel like it’s important when you do those extracurriculars to be doing something that still can inspire you and can keep your love for medicine alive and keep pushing you towards that next step. And it’s totally possible to build your CV and to do something you like at the same time have that overlap and be the same thing. I think that’s something that I’ve sort of worked on and I know– I’m sure other people feel the same way. So just know that, I think it’s ok to invest your time into something that you like to do.

James: That was sweet. In any case, thank you, Ashley. It has been such a pleasure getting to know you better. We hope that you keep your cup filled as the rigors of residency are around the corner. We’re so appreciate of you taking the time out of your day to share your story with all of us. To all our listeners we hope you enjoyed this episode as much as we did. Don’t forget to tune in next time and regardless of what time you’re listening to this episode, happy holidays and take care!