Network Director

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This episode was produced by Anne Nguyen, Eujung Park, and Ashley Tam, hosted by Anne Nguyen, and graphic by Callista Wu and Claire Sun.

Time Stamps:

00:00 Introduction to Women in Medicine Conversations: Abbey Zhu from KAN-WIN
00:55 Introduction to Abbey Zhu and KAN-WIN
02:21 Unique Challenges for AANHPI Survivors of Violence When Seeking Support
06:11 How to Start Conversations with the Community
11:32 Creating a Safe Space for Patients
15:18 Recommended Trainings to Learn Trauma-Informed Care
17:55 Misconceptions About Trauma and Its Impact On Patients’ Health
21:19 Policies to Improve Trauma-Informed Care
24:42 How to Connect with KAN-WIN
25:47 Wrap Up 

Full Transcript:

00:00 Introduction to Women in Medicine Conversations: Abbey Zhu from KAN-WIN

Anne: Welcome everyone to a new 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 Anne Nguyen and I am the Women in Medicine Director at APAMSA. I’ll be your host for today. Today we’ll be meeting with Abbey Zhu from KAN-WIN as part of our Women in Medicine Series in the APAMSA Podcast. In this podcast, we dive into topics ranging from experiences as an Asian American Native Hawaiian Pacific Islander (AANHPI) woman in medicine, to broader topics like women’s health advocacy. Abby will be sharing with us today about KAN-WIN’s mission and their work in working with domestic violence survivors and other survivors of violence within the AANHPI community. 

00:55 Introduction to Abbey Zhu and KAN-WIN

Anne: Hey everyone. So we’re here today with Abbey from KAN-WIN. Abby, could you go ahead and introduce yourself first and a little bit about KAN-WIN?

Abbey: Yes. Hello, my name is Abbey. My pronouns are she/they and I’m the community engagement team lead at KAN-WIN. And KAN-WIN is a culturally specific nonprofit organization based in the Chicagoland area, serving Asian immigrant and Asian American survivors of gender-based violence. So what that looks like is we serve survivors of domestic violence, dating violence, sexual violence, and we have direct services available for them. So that includes legal advocacy, counseling, general wraparound case management, but we also have a super robust community engagement and outreach and education team. So we’re doing both the immediate crisis intervention work, but also trying to lay the foundations for a lot of community and social change so that hopefully we can equip all community members,

regardless of whether or not they’re working for a domestic violence agency with the skills, knowledge, and confidence to be able to support and advocate with survivors of domestic violence.

Anne: Thank you for sharing about KAN-WIN’s mission. It sounds like you all do a lot of great work within the community, especially with different multifaceted approaches, like you were saying.

02:21 Unique Challenges for AANHPI Survivors of Violence When Seeking Support

Anne: I was wondering if you could share with us some unique challenges that Asian American, Native Hawaiian Pacific Islander survivors of trauma and violence face when seeking medical or psychological support, especially because KAN-WIN has such a strong, culturally responsive focus.

Abbey: Yeah, I forgot to mention this during the intro, but at KAN-WIN, our staff speak Korean, Mongolian, and Mandarin Chinese, and we were actually founded by Korean Advocates in 1990. So this is our 35th year anniversary of serving clients in the Chicagoland area. But related to that, right, because we’re doing both the direct service work and doing the community outreach and education work, just getting a general pulse on how the community’s doing, kind of what victim-blaming attitudes they might be internalizing, and then also just the fears that survivors themselves might face in like coming forward, asking us for help, even identifying as a survivor. I think especially in a lot of immigrant communities, a lot of our communities are very tight-knit, right? We depend a lot on each other because obviously the United States is not an incredibly welcoming space for immigrants, an incredibly welcoming space for people of color. It’s so beautiful, the ways that we’re able to build these strong communities, but at the same time, because of how tight-knit they might be, there’s a really strong fear of gossip, or there might be a really strong fear of folks stepping, “stepping out of line,” and so there might be a lot of silencing or shame in identifying as a survivor of domestic violence. I think one of the most prominent issues that KAN-WIN has been addressing since our founding is even identifying or naming something as violence. When people immigrate to the US, after they get to the US, there’s so much structural, systemic, and also interpersonal violence that people might feel like they have to normalize or be okay with to literally just survive. So I think the biggest challenge is what someone might perceive as normal, actually naming it as violence and being like, “This isn’t okay.” And I think for a lot of people, too, they might have grown up in families where there wasn’t mutual respect between parents or there might have been power dynamics between parents or power dynamic between parents and children. And when there is a power dynamic, then violence might be seen as justified, right? So I think our biggest challenge has been going out into communities, doing a lot of education around healthy relationships, not just like, “How do you identify domestic violence?” but like, “How do you actually build a healthy relationship with the person you’re dating, the person you’re married to, parents and children?” And how do we talk about things like consent not just in the terms of like sex and dating, but also between family members and trying to change the norms around how we are in relationship with each other, especially while dating or within the family, and really, really pushing for that like, norms change at the community level, not only so that we build those healthy communities and families and relationships that we want to see everywhere, but also so if someone does experience violence, that they’re able to identify it, name it, and not have any fear around disclosing to people.

Anne: Yeah. Yeah, I think that because this is such a sensitive topic, a lot of the time you want to make sure that you cultivate a safe space for that person to come forward themselves and be willing to put themselves forward in a way that, like at their own pace, everything like that.

So I think like you were saying big issues are like just starting the conversation in the first place and then getting a sense of what that person even thinks is normal or what they’re like potentially minimizing in their lives.

06:11 How to Start Conversations with the Community 

Anne: I was wondering for KAN-WIN, because you were talking about education and community outreach for y’all, how do you guys get people to be receptive to your efforts, or how do you start these conversations in the first place?

Abbey: Yeah, that’s such a good question. And I think it’s something we continue to try to figure out. I mean, at KAN-WIN, we have a multilingual advocacy team as well as community engagement team. So we work together, but we’re also separate departments. You can think of us as separate but partner departments. And for our multilingual advocacy program, they are people who are bilingual, so fluent in an Asian language and also fluent in English. And they explicitly do education and outreach to immigrant communities where people might not be speaking English as their first language. So we have a Mandarin Chinese speaking advocate, a Korean speaking advocate who also does a lot of targeted outreach to Korean faith communities, so Korean Christian communities, and then we also have a Mongolian advocate.

And I think it helps so much, obviously to be able to do things in language, so much of our values are also embodied in our language and that– being able to have someone who can translate and interpret so skillfully is really important. And then also I think, depending on like what generation immigrant you might be, that also is going to change your lived experience, your values, and the way that you move through the world. So I think having that team is so, so helpful because they’re generally targeting older folks, first generation folks, people who don’t speak English as their first language, and really just laying the groundwork for, okay, like, hey, like a lot of the things that you’ve experienced in life are really, really messed up. Like, a lot of them can change and can be different, especially for future generations. And on the community engagement team, we’re mostly English speaking, we have a youth and young adult organizer who explicitly does education and outreach to Asian American high school students. We focus on college students, and then also like professional to professional training, like certification training, sexual harassment training, bystander intervention, etc. But what we’ve been trying to do is try to also do more, just like intergenerational dialogue. So actually, this past February, our youth and young adult organizer, our faith advocate, our Korean speaking faith advocate, and then also members of our direct service team did a whole month of workshops and programming with Korean churches. So they did workshops on teen dating violence because February is teen dating violence awareness month. And they did workshops just for the parents specifically, just like what they should know about teen dating violence, how to support their children, how to maybe identify as well. And then for the teens themselves, our youth and young adult organizer and an art therapist on staff did workshops around boundaries, consent, basically how to maintain healthy relationships. Think about healthy relationships, both within the context of family but also dating. And an art therapy workshop that kind of also helps facilitate, ‘How do I want to set up boundaries? What kind of boundaries do I want to enforce’, etc, etc. And they also created a brochure so that parents and children could have a dialogue with each other. And so this very targeted intergenerational outreach I think was super well received. I mean it’s something that parents will always be worried about. They don’t want their children to be facing violence right. Then for children, empowering them to be able to keep themselves safe and then also set the foundations for the types of relationships that they want to have was so, so helpful. And I think like we want to keep being able to do that into the future because I think parenting workshops have been super helpful, especially among first gen immigrants, people who don’t speak English as their first language and our multilingual advocates have done consent and parenting workshops so often. And we want to be able to keep developing that and keep creating conversations between generations, just that we can like really clearly emphasize that there are folks in the community who are thinking about this who recognize that mental health is a really big issue, that creating healthy relationships is really difficult within immigrant families. And how do we start doing that, start saying like, some of these things that might have been seen as normal are actually not okay. And how do I know that other people also have my back and are going to support me and trying to create a different or better future for all of us.

Anne: I think that you brought up really great points about like the very targeted interventions because you know, this is– these are like issues that affect many people of like many different backgrounds within the same community. I like the work that you did with the Korean communities and things like that because it’s just you’re really utilizing something that is like a sense of a support system for people who are going through things and then by partnering with them, you know, you can create a much stronger and safe space for people to talk about things.

11:32 Creating a Safe Space for Patients 

Anne: I think for us as future health care providers that learning how to build and create the safe supportive space is something that we’re always keeping in mind when we talk to patients. I’m just wondering if you had any tips for how clinicians or health care providers can navigate these conversations about difficult topics like violence, especially maybe in terms of language so we can approach care without actually traumatizing or just kind of like accessing the situation when we meet patients who we think might be going through something.

Abbey: Oh, that’s such a good question. And like my first instinct to answer that question is just like to be curious about your patients to ask questions that might not just be directly related to their symptoms of where they’re coming in to seek care for, but genuinely being curious about

patients’ lives and getting the context for why this person came in, in the first place. And I think just having longer conversations with someone reveals so much, especially for domestic violence survivors or really anyone who is a survivor of like racialized violence or economic violence etc. Right? What, beyond like the medical care that can be provided, maybe I can refer someone to a social service organization that could provide economic financial assistance or housing assistance rental assistance, if someone’s worried about insurance or like paying for their health care, and giving them information about Medicaid or other affordable health care options in your city or in your state. I think with domestic violence. I’m sure I’m quite sure almost every state has their own version of what might be called “40 hour training”. And that’s basically just a really intensive training where you get trained on how to identify domestic violence, identify dynamics of domestic violence, how to support survivors, and basically also how to treat survivors in a– as much as possible trauma informed way. And I know the word trauma informed is such like an amorphous like bubbly word, like what does that actually mean? But to me it really just means recognizing and acknowledging that no one ever faces violence, whether it be domestic violence whether it be medical violence again like economic violence, racial violence etc. None of that happens in a vacuum, and like understanding on a deep level that the world that we live in is so unjust and so many different ways. And so when someone comes to me because they’ve experienced violence in some way or another, recognizing that it’s never just on the interpersonal level but there are so many reasons why that person experienced violence and why they’re here today, and like trying my best to be able to be able to understand the context in which the violence happened and not just like the manifest– maybe the physical manifestations of violence in the current moment. So I think just being curious, asking questions, and trying to get as much context as possible and then if you have the time, and you can get your workplace to pay for it because it’s usually so expensive, getting 40-hour-trained is super super helpful in just getting a deeper understanding of what domestic violence looks like and how to specifically support survivors.

Anne: Yeah, I think that, what you were saying about the training and figuring out the context it’s all so important and something that we need to keep in our minds constantly. Someone might not be coming to you to tell you their whole backstory but then if you kind of like make a space, elicit information, you can, you know, then gather that context and really help them to the fullest.

15:18 Recommended Trainings to Learn Trauma-Informed Care

Anne: I’m really interested in the 40-hour-training that you were talking about I was wondering if you could tell us more about that or other resources and training that you would recommend medical students and other clinicians within this– working with this community who want to improve their ability to provide trauma informed care.

Abbey: Yeah, so the 40 hour training is specific to Illinois. In Illinois, if you want to work with domestic violence survivors in a one-on-one setting so work at a domestic violence agency, volunteer for a hotline, volunteer for a shelter etc. So if you’re looking to get 40 hours of training first before you can start working with those survivors. Basically it’s just a law that’s like we want to make sure that folks working with survivors are not going to retraumatize survivors. In New York or in other states, yeah, quite confident that there are probably other training requirements for y’all, but generally domestic violence agencies or organizations will host 40-hour-trainings throughout the year, you can register for them. So some of them are all online some of them might be 20 hours of self paced learning 20 hours of in person training, but it is a really really great way to get really really in the weeds of just dynamics of domestic violence, legal options for survivors, medical options for survivors, and also like history of the anti-violence movement as well. So it’s really like kind of like foundational training for you to be able to expand your knowledge of how to support survivors of gender based violence, intimate partner violence.

In terms of other trainings I think really just any professional trainings that you can register for that deepen your knowledge of anti bias work, just anti racism, just any trainings where you can learn more deeply about the structures and systems of our world and how they impact people on the individual level and how that’s going to impact the way they show up when they come to a hospital or when they come to a clinic or when they come to the doctors. I think there are so many really amazing organizations who provide and do trainings on that, because, again, like we grow up in a world learning so many narratives about so many different people. And so there’s a lot of stuff for all of us to unlearn, because our brains are wired to think in very specific ways and we might not even be noticing, that we’re thinking or behaving and therefore acting in a way that is actually really harmful towards other people. So yeah, those are my recommendations. 

17:55 Misconceptions About Trauma and Its Impact On Patients’ Health

Anne: On that topic, then, what do you think are some common misconceptions about trauma and how it can impact patients health and well being just so we will know to look out for what we want to unlearn and things like that.

Abbey: Yeah, I think, in the context of domestic violence, the biggest misconception is that the only thing that counts as domestic violence is physical violence, so people might only be looking for physical signs of injury, whether that be bruises like choke marks around the neck broken

or whatever. But what we know as folks working in the anti-violence movement as people serving survivors of domestic violence is that domestic violence is so much more than that. It could look like sexual violence, including sexual assault, it could look like tampering with someone’s birth control forcing someone to have a child if they don’t want to have a child, it could look like emotional abuse, psychological abuse, financial abuse, not letting someone get a job, not letting someone have their own bank account, and like that doesn’t manifest physically

right but all of that trauma, even if it is like “psychological” is going to show up in the body in different ways. So a lot of our survivors might be like, “Oh, like, I’ve had chronic stomach pain for months”, and like that’s stomach pain obviously is a manifestation of like the abuse and violence that they’ve been enduring, but it shows up as this like body problem that might feel like, “where did this come from?” and also like, oh, at the same time like “that’s just a stomach ache”, right. But as y’all know, as medical professionals, as medical students, all of the violence, even if it isn’t physical, is going to show up in our bodies in different ways, whether that’s mental health difficulties or issues, whether it’s chronic pain, chronic stress, high blood pressure, headaches right? Thinking about that and then also thinking about how you never really, “completely heal” from trauma. It’s always going to stay in the body in some way or another might show up as PTSD again, might show up as chronic pain, but just like getting rid of the idea that like, things can be “fixable”, but rather empowering survivors giving them the tools, the empathy and the space to decide for themselves what they want their healing journeys to look like. And also being really honest with survivors. I think that’s something that we repeat over and over again is that we’re never going to over promise to survivors when we do legal advocacy right? Applying for a restraining order or order of protection– when we help clients apply, we’re not going to say like, “you will be able to get this for sure” right? We’re going to be like “hey we’re going to help you get this, it’s ultimately up to a judge”. And I feel like in medical context, it’s a similar thing of like “we’re going to do our best to address this and work through this together”. But again, right like there’s no guarantee that it’s going to be over or gone completely.

Anne: And so after sharing about that I do think that, like you were saying, it’s really easy for people to get caught up with these kind of “classic or typical expectations” of what like a survivor would look like. So just being like very open minded to know how people might come in with different experiences and then being honest with them I think would definitely help a lot in terms of you know how to catch people while they’re, you know, in a place where they might need help.

21:19 Policies to Improve Trauma-Informed Care

Anne: So I was also wondering if you could tell us if there are any policy or changes that you think would improve trauma informed care in medical settings as well.

Abbey: Good question. I think in an ideal world, and if there were enough resources and enough time because I know y’all are also so overworked. Every medical professional if not to get 40-hour-trained but at least to get basic domestic violence or intimate partner violence training so that they’re able to identify domestic violence survivors or if someone discloses to them, like, knows what they need to do to be able to refer that survivor to the resources or services that they might need. And then I also think just increase partnerships between domestic violence organizations and hospitals, or like medical groups. I know that there are a lot of domestic violence agencies in the Chicagoland area who have partnerships with certain hospital or medical groups in the Chicagoland area where those hospitals provide

reduced cost or just like no cost care to survivors if they were to come into the hospital requiring care after experiencing domestic violence. I also know that there are really strong referral networks so if a survivor, if someone comes into the emergency room after having experienced really severe physical domestic violence, a nurse has the knowledge and knows who to call, and can know how to speak to the survivor and ask, “Hey, like, do you want me to call a hotline with you?”. And then, since they have that like referral network and those partnerships with these DV organizations, then also medical staff know who to call. And I think also, this is more like a policy level unless on like an individual medical professional level but ensuring federally like nationwide that all people have affordable health care. And so that people aren’t afraid to ask for care. I think that is one of the biggest barriers as well like “Oh, how am I going to pay for this if I were to go in to ask for testing, screening, medication, etc”. And a big part of our advocates work at KAN-WIN too, is trying to find as much as possible, state or government assistance for our survivors because a lot of our limited English speakers or might be low income or don’t have a lot of financial independence because of the abuse that they’ve been enduring so short answer to all this is just more, more just policies for all people and then also stronger partnerships and collaborations between the medical field and domestic violence field.

Anne: Yes, I totally agree with all of that like just like the stronger partnerships like I mentioned before working within the community I think it’s so powerful, because you know like, if y’all like KAN-WIN have a great network with people that you know are seeing survivors with clients, then you know, having medical groups partner with you guys really just capitalizes on that sense of trust and can really more effectively like help you all with your mission and like approach people who are survivors of violence in a way that’s familiar to them, safer for them. And then, in addition like you were saying with the policies, especially the financial aspect that you were mentioning, I think that’s huge, just removing that burden kind of opens up a whole new world, or it makes it so that people aren’t afraid to ask for help if they need it.

24:42 How to Connect with KAN-WIN

Anne: And then, just kind of as a last question, I was wondering if you could let listeners know where they can hear more about KAN-WIN’s work. What are ways for them to get involved and any exciting kind of new services or programs that you guys are doing.

Abbey: Yeah, so best way to stay updated on our work is to follow our Instagram. Our handle is @KANWINChicago, all one word, no spaces or underscores, and our website is KANWIN.org And you can subscribe to our newsletter there, our website also regularly updates like news and updates. So, great way to stay updated on the work we’re doing. 

25:47 Wrap Up 

Anne: Great, thank you so much for speaking with me today, sharing with us, you know more information about how to interact with survivors of violence, especially the tips on trauma informed care and culturally responsive methods. I think this was a great conversation, I learned a lot, I hope that the people listening learn a lot too. Yeah, thank you again so much for meeting with us and sharing today.

Abbey: Of course, thank you so much for having me and coordinating this, it was an honor.

Listen here:

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This episode was produced by Annie Nguyen and Ashley Tam, hosted by Tanvi Chitre and Mason Zhu, and graphic by Callista Wu and Claire Sun.

Time Stamps: 

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

1:16 Introduction to Drs. Grace Kajita, Indu Partha, and Sreekala Raghavan

3:15 Mastering Letters of Recommendation with Dr. Indu Partha

10:50 Telling Your Story Through ERAS Experiences with Dr. Sreekala Raghavan

23:26 Crafting a Personal Statement with Dr. Kajita

30:46 How Should I Approach the “Hometown” Section?

33:09 How to Use Program and Geographic Signalling

35:53 Virtual Open House Etiquette and Post-Event Follow-up

39:58 Potential Red Flags in Applications

44:18 Letters of Recommendation – What to Consider and How Many to Get

48:54 How to Find Virtual Open Houses for Internal Medicine Residency Programs

51:04 Should I Mention Subspecialty Interests in My Personal Statement? 

54:33 Event Outro

55:14 Closing

Full Transcript 

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

Annie: Welcome everyone to the 10th 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 here at APAMSA. I’ll be your host for today! 

In this special workshop episode, we’re joined by three incredible physicians—Dr. Grace Kajita, Dr. Indu Partha, and Dr. Sreekala Raghavan—to dive deep into the art and strategy behind crafting a standout personal statement and mastering the ERAS application.

Whether you’re prepping for residency applications yourself, or mentoring students who are, this episode is packed with invaluable advice, real-world insights, and actionable tips to help your story shine. From dos and don’ts to what program directors are really looking for, our panel covers it all with warmth, honesty, and unmatched expertise.

Today’s episode was moderated by Tanvi Chitre, a medical student at the California Health Sciences University and Mason Zhu, a medical student at the Georgetown University School of Medicine. Both are members of the 2024 Leadership Committee. 

1:16 Introduction to Drs. Grace Kajita, Indu Partha, and Sreekala Raghavan

Tanvi: Welcome to our Personal Statement workshop. We’re so glad to have you here. And, um, we’re really glad to have our three amazing speakers who will be answering all your questions and sharing all their knowledge about the residency process. And this workshop is brought to you by the National APAMSA Leadership Committee. So hope you enjoy! So our three speakers are Dr. Grace Kajita, Dr. Skreekala Raghavan, and Dr. Indu Partha. And they’ll be talking about different aspects of the residency application and also doing a Q&A with everyone at the end. Doctor Raghavan, if you wanted to introduce yourself. 

Dr. Raghavan: Yeah. Thanks so much. Um. I’m Skreekala Raghavan, I am an associate program director for internal medicine residency at Mount Sinai Morningside in West, which is in New York. I’m excited to be here and joining you guys today. 

Tanvi: Thank you for having– for coming. And Dr. Partha.

Dr. Partha: Hi, everybody. I’m Indu Partha. I am also an associate program director for our internal medicine residency program here in Tucson at the University of Arizona College of Medicine. I’m super excited to be here, and I’m thankful to the organizers for putting on this event. 

Tanvi: Great. We’re so glad to have you. And finally, Dr. Kajita. 

Dr. Kajita: Sorry I had a little trouble unmuting there. Hi, everyone. It’s nice to meet you all. I’m Grace Kajita. I am the program director for the internal medicine residency program at Montefiore Medical Center, specifically the Wakefield Track. And for those of you who don’t know where we are, we are actually in the Bronx, New York. Thanks so much. 

Tanvi: Perfect. Thank you all. So this, um, is the little snapshot of what we’ll talk about in this presentation. We’ll cover letter of recommendations, experiences, and the personal statement. And then lastly is the Q&A. 

3:15 Mastering Letters of Recommendation with Dr. Indu Partha

Tanvi: So we’ll start off with Dr. Partha for the letters and rec. 

Dr. Partha: All right. Thank you so much Tanvi and Mason and Reanna for the invitation. And I’m super excited to talk to you guys about letters of recommendation, I think. Um, a couple of things I’d like to go over is when to ask for these recommendations. Um, who to ask for the recommendations and what to ask them, um, to actually do for you. So I think one of the hardest things for any student is just the anxiety that is related to asking somebody for a letter of recommendation, and I wish there was a way I could tell you that, you know, this is an easy thing. I think depending on different people’s personalities, um, and their interactions with their faculty and attendings, um, it can be easier for some, harder for others. But I want to reassure all of you guys that from a faculty standpoint, we all recognize when it is, um, time for applications to be turned in, we understand and know that our students are going to need letters of recommendation, um, from us. I think those of us in internal medicine especially, is one of the core clerkships are quite, um, used to having students approach us. So I don’t think you need to worry that this is a shocker to an attending that you’re going to be asking, and so at least feel a little bit reassured in that, you know, why is it important to ask the right people and make an effort to get a good letter of recommendation is, truthfully, you really want it to be a personal and non generic letter. Um, yes, letter writers are doing a lot of letter writing during application season. Um, but there are ways and I’ll go over some of those tips that I can offer you to help you create a more– personalized letter for yourself. Because in this day and age of AI, I think more and more letter writers are incorporating AI to help them write these letters. So what is it that we, as the folks asking for letters, can do to help improve our success? One of the biggest things, though, I would advise you all, is be mindful of who you’re asking for a letter. Um, make sure that this is someone who has seen you, you know, perform your best. You want to set yourself up for success, and it’s totally appropriate when you’re first meeting an attending on a on a clerkship that you know you need a letter from is just a straight up at the end of your first day to say, you know, “doctor so-and-so, I would really like to get a letter of recommendation from you at the end of this week because I’m applying for residency and XYZ– what would you recommend or what would you like to see for you to feel comfortable writing me a very strong letter of recommendation?” Um, and that’s going to be a clear ask. You kind of want to make it, um, apparent to your writer that you’re going to ask for a letter. You want them to know what you know. If you’re applying into internal medicine or surgery or what type of residency program you’re applying to. And once you take that next step and reach out with a letter in follow up. You can most certainly be a little prescriptive on what your hopes are of what they would like, what you would like them to focus on. For instance, you might have one attending who really saw you at your best in your interactions with patients, in your clinical care. You might have another attending who you’ve done research with, who can really speak to your scientific prowess, and another one, perhaps, who you did some type of procedural elective with, who can speak to your technical skills. So it’s perfectly okay and appropriate to ask each letter writer to focus on perhaps a different aspect of your skill set to highlight for your future programs to review. So, you know, you’ve settled with doctor So-and-so that they’re going to be willing to write you a letter, so when you write them a formal request via email, it’s helpful to be ready with all the information that they would need from you. And this is that kind of helpful information. You want to send your CV. You want to send a personal statement so they understand all that you have done already, what your personal statement and your ideology is. I know you guys will be getting some good tips here on what to include in that personal statement. Um, what I tell my students to include or residents when they’re applying for fellowship is, um, do you have evaluations that are from other rotations, from other classes that speak to how well you’ve done? All of that information can help show your letter writer what a well-rounded student you are. And I would include all of those. I would be very clear on what your deadline is. I would I need this letter to be submitted to ERAS by whatever my tip would be to put that deadline a week or so before your actual deadline, so you’re not scrambling towards the end. Um, perhaps ask them if it would be okay for you to send them periodic reminders. A lot of letter writers truly want to do right by their students, but just are so busy that they would actually appreciate getting some, um, reminders. And lastly, I would encourage you to provide some answers to some questions that I’ll review over to help you, um, personalize your letter. If I could get the next slide. I didn’t want to over text this, so I’m going to read these off, and you guys, if you feel like this could be of help and, you know, note them down. Um, I want to credit Dr. Kimberly Manning for, um, this idea. I’ve used it a lot for my letters that I’ve written, and it’s really helped me, uh, create some personalized letters. What I would do is when you write to your letter writers, you can tell them, you know, my mentor suggested I provide you some of these answers to help you in your letter writing to make it easier for you. Um, and the questions I have for my students answer is: “what are your strongest attributes and what are you most proud about yourself? Um, What have you done that could set you apart from other applicants? How would your peers or teammates describe you? What would you want to make sure the programs know about you and your candidacy? And then this is an optional one – what hardships, um, if you’re open to sharing, have you experienced that might cause you to be misunderstood? Again, totally optional and different students have different experiences. And lastly, three words you would like to see in your letter in support of your candidacy.” Um, if you provide answers to this and send it to different letter writers, just a reminder, please change your answers for each letter writer so they’re not all writing the same letter for you. But I have found utilizing my students answers to be very helpful for me personalizing their letters. Um, my last thing I would say is this isn’t the time to be humble. Utilize impactful words and language and be clear about what you’re proud of and what you have done. Um, this isn’t the time to, uh, sort of downplay your skill set, because this is your chance for your letter writers to advocate on your behalf. Thank you very much. 

Tanvi: Thank you so much, Doctor Partha, for all of that. 

10:50 Telling Your Story Through ERAS Experiences with Dr. Sreekala Raghavan

Tanvi: Next we have experiences from Doctor Raghavan. 

Dr. Raghavan: Thanks so much again. Thank you for having me here. This is you know, the section about experiences in ERAS has changed over the last number of years. And so I think the way that programs have been using this section has evolved over time. And so I anticipate a lot more questions will come up than just what I’ve answered here. But what I’m really going to talk about. Um, before the Q&A at the end is what should you really include in your experiences? What should you consider leaving out? Um, and in that ERAS section, what are the most meaningful experiences mean, and how do you select which ones they’re going to be? And then what– you know, what are really– what are what’s really being sought, uh, in that impactful experiences session, which is different than most meaningful. So, you know, you can probably guess that they’re looking for different experiences that you’ve had in, uh, in the ERAS- in this ERAS section, and that includes a bunch of pre-selected categories that you can select through, uh, the ERAS application itself. I’ve kind of highlighted some of them and combined some of them a little bit here, but a lot of them are the activities that you’ve taken on potentially as clubs or extracurriculars while you’ve been to medical school. Um, a lot of folks talk about the work that they’ve done. As it’s become increasingly popular to take time between medical school and residency, and some folks may have worked as a scribe or done their certification to be an EMT and worked as, uh, as an EMT, even customer service roles and and roles that are not directly related to medicine and the medical field are, you know, can highlight a lot of really amazing things about you, characteristics that you have or skills that you’ve built while doing that job. Um, and so these are kind of the, the larger areas that you want to talk about. Some particular things for– I’m not sure exactly sure who is in the audience– so just to point out, uh, for folks who either took a lot of time off between, um, college and med school or you’ve had a little bit of a, um, like you don’t have a standard 4 year timeline for medical school, you want to be sure to use your experiences to really build in the timeline. So this very often applies to folks who are going to medical school outside the US and uh, and coming to do residency in the US, where they may have graduated medical school some time ago also, and have some years, um, in between. So if they’ve done clinical experiences in the US as observerships or, um, any externships, hh, they should definitely list– you should definitely list all those experiences because as a, you know, on the program side, what I really want to know is what’s been happening during all of this time in between and what how are you learning and growing and changing and then kind of beyond that, um, what you’re really using this section to do is to highlight who you are. What are you passionate about? Um, you know why medicine, right? So you’re going to talk about why your particular field, why you went into medicine in general, um, in your personal statement. But this is where you kind of highlight all the activities that led up to that, the kind of evidence behind all the, uh, the larger statements that you make in your, in your personal statement. And when I’m reviewing experiences, I really want to know what you’re passionate about. So then, you know, you’ve done quite a lot of things, I’m sure, over, over the last number of years. So how do you decide which are the ones that you’re going to include? You can only include ten, and you can only mark three of those ten as your most meaningful experiences. So I would you know, when you’re really thinking about which those ten are, you want to highlight things that highlight that passion, right. And you want to choose things where you’ve really shown some sort of a commitment. You certainly want some if you have had leadership positions, for example, these folks, lovely folks who are running this workshop today as part of APAMSA leadership. So highlighting that, um, type of, uh, work that you’re doing through– or service that you’re doing rather– um, through your activities is really, uh, a way to, to separate yourself, right, to, to show how unique you are, uh, in your application. Hobbies? Also, I don’t have it as a separate section here, but hobbies do fall into this experiences section. Sometimes, uh, hobbies or work or significant activities, especially for medicine before your life in medicine, um, matter. So if you were, um, like a concert violinist for a bunch of years before you really got to this point, it highlights a lot about who you are– dedication, um, different skills that you build, um, potentially around problem solving, around dependability. Um, and so all of those characteristics that you want to show, if you want to show that those are the things that you’re strong in. And these activities can help you to highlight that. Um, this is not a CV. Uh, and so just to remember that, uh, you really want to pick these, these things that highlight exactly what– what helps you stand out from the, uh, larger pool of applicants. So then how do you move into selecting your most meaningful three? Answering those questions that, um, that I mentioned a little bit earlier, like: “Who are you? What are you most passionate about? And which were the activities that helped you grow the most?” That’s also really, um, impactful when I read it. Not impactful in the ‘Most Impactful’ on the experience that I’ll talk about a little bit later. But, um, when I’m reading an application and I see that, uh, somebody has a clear theme in the things that they’ve found to be meaningful, that they’ve really grown a lot, um, participating in particular activities. It helps me feel out whether this is somebody who’s going to thrive in my residency program environment or, um, not maybe enjoy taking care of the particular population that we take care of, um, or not, or want to focus on some of the additional opportunities that exist within my program. So I’m really looking, not just for somebody who qualifies kind of on paper as like a top student. I’m looking for somebody who really wants to train with me and wants to be in the environment that my residents are in. They’re going to have a great time and learn a ton of medicine and be great at the end of it. So those are, you know, the showing your growth through your meaningful experiences, I think is a really great way to highlight who you are and how you fit in your particular, um, learning environment. 

Dr. Raghavan: So what do you not want to include? Um, this is not a place to list and to have an exhaustive list of every single thing you’ve ever done. Um, some of the questions that often come up are, should I include things I’ve done in college? Yeah. I mean, if you did something for four years in college, you showed a real commitment to it. You had a leadership position in it, or you did something for a while between, um, between college and medical school. These are all things that you can include. So just the actual timing of it. Like the number of I mean, the year in which you started doing something is not or determines if it’s a really old activity. But if you volunteered for someone or something for three months in your freshman year of college, that does not go in your experiences section because it doesn’t really speak to who you are now as you apply for residency. Looking into like something that you participated in at one time, if that one thing was, you know, something that was really, really meaningful to you because it challenged you in a particular way and you grew, you could make a case for including something like that. But typically you want to– you want to show that you were really passionate about something and that it made an impact on you. This is not a place to list your abstracts and your manuscripts. There’s a separate research session for that, but that question does come up quite a lot when you list your research experiences, what you’re listing is what you learned through participating in research, not the abstract that came out of it, not the manuscript that came out of it, but what were you working on? What was your role? And so that was one of the other things not to include– if you really don’t remember what you did in a particular activity, it probably didn’t mean so much to you. So don’t put that down there. You will, you know, anything on your ERAS application is fair game in your interview. And so if you put down something that you’re not prepared to talk about, um, interviewers can be surprised and feel like, oh, even though you highlighted this was one of your 10 activities and you can’t really talk about it, they’ll question the veracity of the statement also. And so you don’t want to get caught out on that. And then again, not just that you don’t remember your role, but that you can’t describe the activity or the experience in detail because when questions about experiences come up, it’s often, you know, “what did you learn from that experience? How did you grow? What challenges did you face?” And you need to be able to describe all of those things to be able to to really show your passion and show how you stand above the crowd. And then finally, you don’t want to overlap everything with your personal statement or with the content that you go over, uh, typically with your student advisor that goes in your medical student performance evaluation or your MSPE. If they’re all exactly perfectly aligned, you just have a lot of repetition in your, uh, in your application. So you want to, you know, use this as an opportunity, this section as an opportunity to highlight other things about your commitments. 

Dr. Raghavan: And so then the final question that really comes up about, um, about this section is that there is a separate question about impactful experiences. So meaningful is the meaningful experiences that you highlight, which are three of your ten experiences are the things that you know you really want to show that you are passionate about. Impactful experiences, not everybody will necessarily have to answer to know, what the question is really asking is whether you had any real obstacles during, you know, during medical school or potentially at a time before medical school kind of leading into your career as you start. Um, and so if there was something that really impacted your journey and maybe made, uh, made that distance traveled greater if there. You know, very commonly we see, uh, personal illness stories in this, uh, in this section, you may see, um, other kind of, uh, socioeconomic difficulties of getting into, um, a particular track or into medicine, um, listed in, uh, in the Impactful experiences section. But, uh, by and large, most students are not actually filling out this, um, this section because you don’t– this is not a standard section that we expect to see something in. This is a way to explain something that may have affected your– your path as you were on, you know, on your way to where we meet you, um, and that you had to overcome. And so it helps, uh, it helps us to see who you are a little bit differently, and how you arrived at the place that you are at and understand, you know, what hardships you really had to, had to kind of go through. Um, and then just to remember that you don’t have to explicitly state that your impactful experience, uh, had, you know, had something to do with your meaningful experiences. But if you overcame a particular challenge and then you volunteered for a foundation that helps folks, um, overcome such a challenge, or you have a leadership position and something like that, it’s clear to kind of see that, um, as a full circle without having to necessarily, uh, list it out in your application. 

Tanvi: Thank you so much for that comprehensive look on how to figure out what, um, experiences to include. 

23:26 Crafting a Personal Statement with Dr. Kajita

Tanvi: Um, finally, we have Doctor Kajita with the personal statement. 

Dr. Kajita: So I am super lucky because I’m following two really excellent speakers who really have said so much about what makes the foundation of a personal state. And you’re going to see a lot of themes repeated in what I’m about to say. The personal statement for some reason has, at least in my experience, turned into this somewhat painful exercise that everyone leaves until the very end just before they submit their application. Because it feels big. And I want to let you know that you don’t need to do that. You can start it right away. You can work on it in bits. It doesn’t have to be painful, you just want to get started. The second thing I want to say about it, that I’ve learned in my experience, from talking to people who are applying largely for fellowship, that I think people feel that there’s some sort of way that you can read the mind of the person who’s going to be reading your personal statement and sort of craft something for that person. Note that this is a personal statement. This is about you. And honestly, all of us who are reading a personal statement really just want to know about you and know about what you care about and know why you’re here. So don’t feel that there is an absolute formula or that you’re trying to quote “game the system”. Write your personal statement about yourself using many of the tips that have already been discussed. And so when I say make it personal, do all the things that Dr. Raghavan just said about what you want to include and keep it simple. You really don’t need to include everything about your life, as long as it’s all really about you and in your voice. One of the things that we tend to do is we tend to be a little bit modest. Please give yourself credit for what you’ve done. You’ve made it this far. You are all really impressive people. Be proud of that. Share that. We want to, we want to know about that. And when giving yourself credit. This is not about itemizing all of your accomplishments. This is about really saying something about yourself, particularly maybe what you’ve been proud of, what has brought you to medicine. Don’t repeat your your CV. And because you want this to be in your own voice, do not. Please do not use ChatGPT or AI. This is a whole new frontier. They’re probably going to be better rules about how to use it in the future. It’s okay if it doesn’t sound like classic literature. This is you again. Be honest and don’t stretch things to make it sound more impressive, because that’s how– so the Olympics are on. You can say, I played soccer in college, but you don’t have to turn it into. I was on the Olympic stage, right, because someone’s going to ask you about it, right? Only include stuff that you can really talk about. It’s okay. On the same note, to not have too much stuff in there. This is about quality stuff. Okay. It doesn’t have to be two pages. In fact, you want to keep it one page. You want to keep it tight. You want someone to read it. For typos and proofreading and for how it’s phrased right? If your reader is a friend, maybe it can be honest with you and faculty and say, this is kind of boring, you’re kind of trying too hard. That’s okay. That’s why you’re going to give yourself time at the beginning, because it’s like crafting any good, any good essay. It’s going to take multiple rewrites, but don’t be intimidated by it. You can all do it. You all done statements like this before. 

Dr. Kajita: Now some people have some questions about how to format your personal statement. What do I start with? Is there any one way to do it? There really isn’t. I usually tell people. Um, you can start with an anecdote if you like, but we are always– thank you for your advancing the slide. Um, and that’s often what people do, and to a point where it’s almost become a formula, but it can be a positive. It’s a good way to start. Maybe that’s not where you end up, but the classic to the point that as readers, we sometimes kind of all, um, laugh or in a kind way, mind you? Oh, this is familiar. We know where this is going. Phil and the family member had a heart attack. Ended up in the emergency room. You did CPR on the field? They- they survived. And this is why you want to become a doctor? Okay, that’s great, but it’s not necessary. Some of you have never had this kind of crisis. You may have other reasons. Do you not feel that you have to fit things into a formula. Similarly, I get asked this a lot and I see it done well sometimes and not so well. Think about whether or not you want to start your essay with a quote from Doctor William Osler, because it’s a medical quote– don’t do it to impress us. Do your quote if it’s something that really means a lot to you, okay. And the quote doesn’t have to be a famous person, but we’re also used to seeing the quote that my grandfather said, fill in the blank. That you should become a doctor. Okay. You don’t need to do that either. Okay. It means a lot to you, and you can tell a story. Which includes things about why you are the right person for this particular residency. Go ahead. Okay. The reason why I say maybe or maybe not on this slide is because I put it out there and then have someone look at it and see if it seems genuine. Okay? Because this again, it’s about you. Please do not recycle your med school applications. Okay? I see people do this, and you’re already so much more impressive by the fact that you’ve gotten into med school and you’ve done all of these things. You’re not the same person. Not just in accomplishments, but in your insights and your personality. You’ve grown. Please don’t recycle the old application. Finally, some people have asked, well, I really want to stand out. I want to do something different. People try to do things like write essays in iambic pentameter. One wrote an essay about, um, going to Shake Shack. Okay, this is a real essay. Okay. It was a remarkably successful essay, but that doesn’t mean that it’s the best essay for you. It might be entertaining, but it might not be what the program director is looking for you. Remember, this is a representation of you, and we’re not looking for fireworks– were looking for you. So please, if you are an amazing writer, you have a talent for it, go ahead. You know, this is one of those things that you want to include in your experiences or really makes you stand out. Be my guest. But it’s not necessary. Use good judgment about these things. And always, always. A lot of people want to help you succeed, and we are a friendly audience, so please, please don’t be afraid to share your work before you submit it. And that’s all I have to say. 

Tanvi: Thank you so much. Um, the personal statement is always a huge obstacle to overcome in these applications, so your advice is very helpful. 

30:46 How Should I Approach the “Hometown” Section?

Tanvi: Um, next we have some FAQs. Um, first, what to write for hometown. Um, if anyone wants to address that. 

Dr. Partha: I might just speak up only because, um, I think between me, Doctor Kajita and Doctor Raghavan, I am from a program in a relatively smaller town and a less populous state. So the only advice here I would have is, you know, we don’t need ten different hometowns of every place you have ever lived. However, where this can be somewhat useful for programs like mine and Tucson where yes, we do kind of look through and see what an Arizona connection might be because, you know, we want applicants who are really serious about coming here is if you did not go to undergrad or medical school in a particular state or location, that’s a bit smaller, but you do have some connection, like maybe you did live here, you know, between birth and sixth grade, I, I think that can be helpful to signal to a program in a smaller location that, hey, I actually do have some connection to Arizona. So me living in Iowa right now, applying to Tucson isn’t as crazy as it might look. Even though I went to undergrad in Michigan and medical school in Chicago, and I grew up in Iowa, that’s where my permanent address is. So sometimes the hometown, if it’s a legitimate connection to a place, might be a great way to sort of slide in a little bit of an indication to a program in a less popular location or city or state that you do, in fact, have a, uh, a connection, a personal connection to that place. 

Dr. Kajita: So if I could add a comment to that. People have lots of options. You can fill in more than one hometown. But going back to the whole issue of is it meaningful? Remember, if someone’s going to ask you about your hometown potentially. So make sure it really is a substantial connection to that town, and not just the two months you spent there on vacation with your family because you want to impress someone. 

33:09 How to Use Program and Geographic Signalling

Tanvi: Um, next, is it useful to apply to many more programs than number of signals you have as an applicant? Um, and geographic versus program signaling. Thoughts? 

Dr. Raghavan: I think this. Um, so all three of us happen to be from internal medicine. Um, and so the I think the answer to this question really varies based on the specialty that you’re applying into, um, in internal medicine, it’s typical to apply to many more programs than the number of signals that you have. Um, most folks are applying pretty broadly, you know, whether that’s in a particular geographic region or not, or if they’re just applying widely around the country. That’s um, that’s very normal in internal medicine, in other, um, in some really competitive fields. Uh, a lot of programs actually, uh, do look really mainly at the folks who have signaled them. So I know in dermatology this is a significant, um, way that folks try to limit the number of applications that they’re reviewing. Um, and so a lot of dermatology programs, especially in very populous cities, um, do use the signals as a way to essentially say, these are the folks that I’m going to really review first. Um, they may continue to review after, um, but if they fill their number of interview slots with folks that have signaled them, those are going to be folks that are really getting that preference in a, in a very competitive field. Um, and then geographic versus program signaling again in very, very competitive, uh, fields. I think program signaling really carries the strength over geographic signaling. Whereas, um, in fields like pediatrics, family medicine, internal medicine, um, there are or kind of larger number of programs, um, geographic signaling carries a significant amount of weight, because if there are a large number of programs in a particular field, in a particular, uh, area, you may not be able to signal all of the programs in that area, even if you’re very interested in living in that particular area. And so programs that have, uh, or specialties that have a lot of programs in a particular, um, area may use geographic signaling even maybe preferentially over program signaling. Um, and then finally, the competitiveness, I guess, of the actual program itself also determines, to some degree, the answers.

35:53 Virtual Open House Etiquette and Post-Event Follow-up

Tanvi: Okay. Thank you for that. And finally, um, what is good etiquette for attending virtual open houses? Maybe doctor Kajita, if you wanted to take that one. 

Dr. Kajita: Sure. And I’m sure the people will have some opinions on this. I think the main thing is that you are present, that you are courteous to not just the faculty, but your colleagues. I found that at some open houses, it it turns into a little bit of a competition to impress. Just if you have a question, ask. And certainly, um, collaborate with the– your co-participants because you’re going to be seeing a lot of each other on the interview trail. It’s important that you can start some of these relationships now. Um, do all of the appropriate things that you do on a zoom call and all of those things in terms of muting and not muting, not having a lot of noise in the background, those kinds of things that you would do in any type of meeting. I’m not sure what specifically this question was addressing Reanna. I think you were the one who brought it up. Is there anything in particular that we can answer for you? 

Reanna: I was curious more along the lines of like, reaching out to programs after you attended an open house, or what’s the etiquette there? Because I know contacting programs, you don’t want to contact them too much, but if something’s meaningful. Like how do you approach that?

Dr. Kajita: Okay, that’s a great question. Um, my answer to that is I, I don’t mind at all, and I appreciate a short thank you. Um, however, I would prefer that once you thank me. Thank you, thank you. That, you know, you don’t need to continually send more thank yous. I’m interested in this. I like this so much about your program. A simple thank you is more than enough for me. And I’m curious as to what the other faculty think. 

Dr. Partha: Yeah, I would agree. And I would say, etiquette wise. Um, the thing to remember is, granted, there might be a lot of people on line, but, um. You can be remembered both for being positive and for being negative. You know, some of the residents who are online definitely give feedback. Oh, this one student was really, you know, whatever XYZ either positive or negative. So if you’re really serious about a program and are showing up to the open house, I would say bring your A game, know about the program, be a little bit ready with some really good specific questions to indicate, hey, I’ve really looked at your website and know about your program. Um, and those are ways to kind of set yourself up a little bit so that, um, if like a chief resident is online, there’s no faculty, that chief might say, oh, there was, you know, a student named Reanna. She really seemed very interested and super excited and polite and, um, you know, we’d love to have her versus, oh, gosh, there was this one student who all they were concerned about is how many vacation days they’re going to get. And what’s the days off? Um, and so just realizing that what you’re saying can often really help or sometimes, unfortunately, um, be negative for you. 

Dr. Raghavan: I also want to highlight that it’s a little bit of a first-date situation and you are also assessing the program. Right? This is usually your slightly more extended way to hang out with some of the house staff or people currently in the program and get a sense of if these are people you want to spend a lot of hours in somewhat stressful situations with. And you want to– certainly you don’t want your questions to focus on the schedule and vacations, that’s usually included on the website or materials on your recruitment day, but really get to know what connects people in the program and showing that level of interest, so showing that you know a lot about the program for sure but showing a level of extra interest of what would it really be like to be in this program also can get noticed as a passion for that program.

39:58 Potential Red Flags in Applications

Tanvi: Okay, perfect, so last we have about 15 minutes left and we will do the Q&A session now. I think Mason and Reanna have been combining all the questions together so if you want to tell us the first couple questions.

Mason: Sure, I will bring those questions up. Thank you all of submitting your questions, we may not get to all of them but we will try to prioritize the ones that apply to most of the people. We got a question, I think it goes along the lines of what not to do that Dr. Raghavan mentioned about some of the open house etiquette, but for application reviewers, what are some of the common red flags that you will see on someone’s personal statement or their ERAS application overall?

Dr. Raghavan: I’m just going to say that if there is something that makes you stand out in a particular way, like you had to repeat something or you know there’s going to be a statement about something that is not the most positive in your MSPE which typically, medical schools now allow you to see even if you can’t edit– that should be explained somewhere. A red flag for me is not that actual thing, the repetition of a clerkship or something like that, the red flag is not knowing what happened and potentially– as a reviewer, I think, maybe the student didn’t realize this was significant and didn’t use it as a learning opportunity. But I want to see that there was reflection about it, that particular experience. 

Mason: All right. Thank you. Dr. Kajita or Doctor Partha, anything to add? 

Dr. Partha: I would definitely, um, emphasize what Dr. Raghavan mentioned. Yeah, you definitely want to see an explanation. And I don’t know that this would be a red flag, but perhaps something. Um, I think both to what? Uh, Dr. Raghavan and Kajita reviewed over what is meaningful experiences. If you know, someone just has a list of volunteer activities and they’re each just one day for two hours, and that’s what fills their application. Um, again, like I said, not a red flag, but perhaps, you know, this person might be stretching for experiences and working on quantity over quality, so it might just dilute the competitiveness of an application.

Dr. Kajita: I would agree with both those. And the only other thing which isn’t obvious is having a lot of mistakes right? On your– on your application. If you, you know, it’s a it’s an important thing to you. And if it feels like maybe you’re not paying attention or you’re not as careful as we would hope you would be if there were a lot of typos, grammatical errors, spelling errors. You spelled your own name incorrectly. I’ve seen that before. I would worry a little bit about that. So just. That’s an easy one. Just be careful. 

Dr. Raghavan: The one random thing and I feel kind of silly saying this, but, um, see what your picture is saying about you? Like, is it a just a nice– nobody is looking for an expensive fancy picture, but, you know, do you have a nice expression on your face? Is your hair combed and are you looking put together? Um, for the most part we see great pictures. But every so often we do see pictures that kind of grab our attention. And that might not be really the way you want to grab a reviewer’s attention is by a picture that’s kind of, um, standing out for being a little too dramatic, or somebody just threw something on and and took a picture. 

Mason: Great, great. Thank you. It sounds like, you know, be forthcoming, be honest with your application. And also double, triple check your your work. 

44:18 Letters of Recommendation – What to Consider and How Many to Get

Mason: And we received another question, a couple questions regarding the letters of recommendation. Uh, one of the questions was just asking, what type of letter writer– what type of letter writers are recommended? Uh, if you have a research mentor versus clinical versus your clerkship director, and kind of what’s the recommended number of letters to get. 

Dr. Partha: I mean, most oftentimes you’ll need three letters of recommendation. One of them might be your, you know, chair letter from your department, different schools. What have different people? Um, writing that letter in our, um, institution, it’s our IM clerkship director, and it’s co-signed by the the chair. Um, I would say most certainly you want somebody who’s going to be in, in your field that you are applying to. So if you are applying to surgery, you need a surgeon. If you’re applying to medicine, you need someone in medicine. Um, you definitely want to look for people who are going to be able to write a good quality letter, not someone that was, oh, they’re super well known in their field, but I worked with them for two days. Um, so for the sake of that, you don’t want somebody to give you, like, a one paragraph meaningless letter just because they’re a star in the field. So you really want to look for, um, quality letters and then from the specialty that you are applying to. And if you don’t have all the letters from that specialty, usually it’s going to be helpful to have, you know, folks who’ve had more of your core clerkship experiences who have spent a little bit more time with you. Um, but if you’re really passionate about research and that’s what your career is, um, going ahead towards, obviously I would definitely have your research mentor letter speaking to your skill set there. 

46:13 Letters of Recommendation for Sub-I Rotations and Visiting Students

Mason: Great. Thanks. And, you know, just to piggyback off that question, someone else asked. Kind of relating to quality of letters for fourth year med students who are doing sub-Is and they’re rotating at your institution. If they don’t feel like they’re getting a lot of time with the PDs. Um, should they still try to ask the PD, or should they try to focus their attention and ask the attending that they spent more time with? 

Dr. Kajita: I tend to be a fan of the person who knows you better. I mean, a PD letter– PD is also just so you know, they’re cautious, right? Because you know, they know sometimes that their letters carry some weight. And so unfortunately sometimes those letters hopefully the PD would be frank about saying that, you know, I think someone else might write you a better letter, but the person who knows you and has seen what you can do in your sub-I in an actual clinical setting, that’s great. I think for myself, if it’s a strong, um, faculty letter from your sub-internship.

Dr. Raghavan: I think that’s great. I would say the other part of that, and I agree with Dr. Kajita completely, is that in certain specialties that are smaller, a lot of folks will really a lot of the faculty will know each other from around the country because they network at conferences. And, you know, they’ve spent a bunch of time in that area of expertise. And so if they see a letter from someone that they know, even peripherally, they may reach out to that person and, and ask like, oh, what was it really like to work with this, this candidate that I’m really interested in? Um, and if the response is like, well, I got asked for this letter, I didn’t really know the person that well, um, that’s not so great. And it’s much better to have a letter from somebody who’s going to really, you know, stand in your corner and talk about why you’re the right candidate. 

Dr. Partha: I might just add two for the student to double check what the culture is in that program. Because I know for us, like our PD does not write letters for visiting sub I’s. I mean, she will write them if she’s there attending, but if they’re rotating, you know, with me she’s not going to write a letter. So, um, versus students thinking that’s the culture and what they need to do, they should kind of check ahead of time what’s traditionally done or expected, but completely agree with Dr. Kajita and Dr. Raghavan, to ask the person you’ve worked with, not the person who has the higher job title. 

48:54 How to Find Virtual Open Houses for Internal Medicine Residency Programs

Mason: Great. Thank you. Um, you know, we have three of you amazing PDS and APDs and, um, you’re all in the internal medicine, uh, area. So we have a couple questions that are a little more tailored to the IM residency. Uh, we had a question asking what the best way to find the virtual open houses for IM programs. 

Dr. Raghavan: So there might be kind of different definitions of this, because there are the kind of meet and greets when you’ve applied for a program. So that’s going to come directly from the program and be highlighted to you. Um, otherwise, you know, different programs that have virtual open houses for larger groups of folks in a particular area from a particular background or, um, particular set of interests. Um, those will usually come out through interest groups, advertising to interest groups, or advertising to student advisors, or sort of through your medical school. Um, I know at Mount Sinai where I am, the way that, um, the programs really have a kind of pre, uh, before we’re– we’re able to see, um, IRAs before you guys finish, uh, submitting all your ERAS applications our virtual open houses are advertised to medical schools around the country to their to advertise to their students, um, so that they can join and see what our programs are all about. And we usually do kind of a combined, uh, virtual open house across specialties. And then we break out into breakout groups so that folks can meet those in their specialty. 

Mason: I just did a quick search on Google and it seems like, you know, for internal medicine programs, they might be specific to the school. So, um, you might, you know, uh, you know, might have some luck finding the specific programs you’re interested in and then seeing if they have an open house. Um, I know some specialties, like anesthesiology they have and like a central hub that lists all the open houses. So I would think that might also be helpful as well. 

51:04 Should I Mention Subspecialty Interests in My Personal Statement? 

Mason: Um, another question for kind of internal medicine, but also subspecialty related in your ERAS or personal statement, should you include your interest about these subspecialties? For example, if you have a passion in, uh, cardiology or any of the other subspecialties. 

Dr. Kajita: I’ll take the first crack at this one. Um, I think that that there are there are a group of people who know from day one what they want to be, and that’s great. And there are people who don’t know or think they know and change their minds. So when I read a personal– certain personal statements for residency and they come in wanting to do cardiology and then they change their mind, that’s okay. I think the more important thing is, is it a coherent personal statement that talks about them and why they want to do cardiology particularly? Right. 50% of them who come to me change their minds, but I don’t– the personal statement was still great. So, um, I think that some people worry that they will be pegged in a way that, oh, we don’t have those kinds of we can’t support that particular interest, or we have too many people who want to become this particular thing. So, uh, but you don’t know if this is a program you’re interested in, think about that as well. What is this program like? You also want to think about when you write your personal statement. In some ways, that may also help you think about which programs you’re most interested in and how you rank them, because sometimes that also helps to define what your future career goals are. So I would say there’s no sorry, I’m so ambivalent about everything, but there’s no hard and fast rule about that as long as it’s honest and it’s you. 

Dr. Raghavan: I will note that sometimes programs use, um, specialty interest information to, um, like, if they have resident buddies that they pair you up with after the match. So when those kinds of shared interests to say, hey, you know, I’ve got a second year who’s also interested in cardiology, I’ll help you out. And so if you’re really, you know, very interested in that sort of match up, um, and it makes a difference to you and how you transition into residency, it could be helpful. But then there are definitely programs, probably not the majority of PDS that I know. Certainly when I was doing my own recruitment as a PD I didn’t use specialties to say like, I’m not going to, you know, rank this many people who want to go into cardiology or GI or something. Um, but there are definitely programs that do use that, um, that type of criteria where they want to have a mix of folks in their class. Somebody wants to go to pulmonology and someone going to allergy and not a class that’s like split into GI, cards, and heme onc. 

Dr. Partha: Let’s keep in mind that when you interview on that personal statement, your program does not want to hear all about you being a future cardiologist. But first, why you’re going to be an amazing internal medicine resident for them. So just watch how you sell yourself, because that could be off-putting. If your whole interview is about your passion for cardiology when you’re not applying for a fellowship at that moment. 

54:33 Event Outro

Mason: All right. Thank you very much. Um, it looks like we’re about to approach the 9:00 mark eastern time. Um, so that’ll be our last question. But, um, you know, first of all, we want to thank Dr. Kajita, Dr. Raghavan and Dr. Partha for coming and speaking about the IRAs and personal statement and really helping us neurotic third and fourth year med students and aspiring physicians kind of, um, get their bearings. Um, I believe, uh, our panelists have also agreed to share their emails or contact information. So, you know, if you have any lingering questions or interests, you can feel free to reach out to them as well. 

55:14 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! 

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

Time Stamps: 

00:00 Introduction to Women in Medicine Conversations: Dr. Avani Patel

00:28 Introduction to Dr. Avani Patel

03:28 Why Medicine?

05:44 Growing Up Asian Indian American in Mississippi

08:35 Work-Life Harmony

12:03 Health Equity Leadership & Cultural Competence in Mississippi

20:07 Sitting in Discomfort & Determining Your Boundaries

28:30 What Good Mentorship Looks Like

32:35 Reflections & Career Advice for Your Past Self

Full Transcript:

00:00 Introduction to Women in Medicine Conversations: Dr. Avani Patel

Anne: Hi everyone, this is our Women in Medicine series in the APAMSA Podcast where we dive into topics ranging from experiences as an Asian-American Native Hawaiian Pacific Islander woman in medicine,to topics like women’s health advocacy. Join us for these insightful conversations. For today’s podcast, we’ll be speaking with Dr. Avani Patel, who is a board-certified psychiatrist and community leader in her home state, Mississippi. Let’s welcome Dr. Patel. 

00:28 Introduction to Dr. Avani Patel

Anne: Dr. Patel, I’m very glad that you’re here with us today to share your insights about medicine and also your career and being a woman in medicine. Just as an intro question, could you start us off and tell us a little bit about yourself and also about your journey in medicine?

Dr. Avani Patel: Absolutely. Thank you so much for having me on the podcast. I’m so excited. So, I’m actually a concierge and sports psychiatrist, and I founded my own private practice called Mississippi Psychiatry and Wellness in my home state of Mississippi. I graduated from residency from the University of Mississippi Medical Center. And I actually also received my doctorate of medicine MD degree from there as well. In addition, I have a master’s in healthcare administration with emphasis on executive level leadership. So I thought I wanted to be a CEO, maybe a CMO of a hospital system, and I got that toward the end of my medical school training as well. I’ve done some additional training in sports psychiatry, I know that’s a new emerging field that people are excited about. I’m always happy to nerd out about that on another episode if it’s of interest. And so I was awarded that by the International Society of Sports Psychiatry. And so, a lot of my passion areas and the work that I do is in health equity, some consult liaison psychiatry, sports psychiatry, private practice, how to start a private practice, and what concierge care looks like, and then administrative leadership. And in terms of some of my leadership positions, which I think would be really helpful, especially as we go through training, there’s so much you can do and so much opportunity. I think it’s helpful to kind of know a little bit of that history. I actually served on my Mississippi State Medical Association Board of Trustees for six years as a medical student, as a resident. I was the first resident physician to serve on the American Medical Association Foundation Board of Directors, and I was actually invited to serve a second term. I was very involved with AMA as a medical student with some section related roles, as well as the resident fellow section. And I was actually the Vice Chair of our Committee on Business and Economics. And then now, currently with AMA, I’m on the Women’s Physicians Section Governing Council as the Young Physicians Section Representative. In addition, I completed three non-clinical fellowships throughout residency. And so, I did two in leadership and one in health equity, and I continued to serve in some of these roles, even from my specialty side of things. So I served a year on the American Psychiatric Association Board of Trustees and I was actually the Chair of the Leadership Fellowship through the American Psychiatric Association. And I also am the Senior Laughlin Fellow selected amongst my cohort, which is one of the highest honors you can receive as a trainee in the field of psychiatry through the American College of Psychiatrists. So I’ve done quite a bit of stuff from the leadership realm and as a trainee and really looking forward to continue that journey now that I’m early career. 

03:28 Why Medicine?

Anne: That’s great. It sounds like you have a lot of accomplishments and it’s really amazing that you’re– you’ve been really dedicated to staying and then helping out in the Mississippi area, as well as such a national scale for medicine as well. Could you tell us a little bit more about how your identity as a woman, and in addition your cultural background as someone who’s Asian American, and how that’s shaped your practice currently and also your journey in medicine?

Dr. Avani Patel: Absolutely. Thank you for that question. I think it’s so important to be proud of where we come from. And I’ll tell you, growing up in the state of Mississippi I wasn’t always proud. And in fact, I wanted to hide my background, because I felt like it wouldn’t be accepted and it wouldn’t allow me to grow in leadership. And so I’m actually Asian Indian American. So both of my parents are Indian and immigrated from India. I’m Gujarati by background specifically, my last name Patel kind of gives that away. So I was born in the United States, so I was born in Alabama and I was raised in Mississippi. I’ve spent most of my life here and my dream was always to be able to help people. So when my grandfather passed, he asked that I pursue a career in a way that I can help people and make a meaningful difference the way that he did. He was a farmer, but spent a lot of his life’s work in philanthropy. And so for me, I loved medicine and it just seemed like not only could I have the American dream, but I could do something really special and helping people in an area that I’m really interested in. And so I was the first in my family, in my immediate family, to go to college in the United States, medical school, and become a physician. And then my younger sister ended up following in the footsteps, but she’s now a plastic surgery resident, and my younger brother is now wrapping up his final year of medical school as well. So all of us decided to pursue a career in medicine, but different specialties.

Anne: That’s so cute. It’s like a little family business. Very adorable. Everyone was inspired in the same way, that’s very cute! Thank you for sharing.

Dr. Avani Patel: Yeah, even though we’re all different. Yeah.

Anne: Yeah, it’s like, you guys all have different niches, but kind of like the same goal in the end, which is so nice. 

05:44 Growing Up Asian Indian American in Mississippi

Anne: So throughout like your career, how do you feel that you’ve been able to balance your personal life, relationships, and also advancing your career in terms of career development during your training and also now that you’re established in your practice?

Dr. Avani Patel: Yeah, so I realized there is a part of the last question that I feel like I didn’t get to answer and something I kind of wanted to bring up and then I’ll move into this question because I think they kind of go together. So during the last question, you know, I think my background really inspired me because I realized where I grew up, you were either, you know, white or black, but nothing in between. And so in fact, you– I faced a lot more adversity being in the other category, if you will. And that was really interesting because I worried about, will I be able to get enough experience to go into medical school? You know I come from a humble background and humble family background, am I going to be able to have the resources? And throughout this time, I realized as I experienced adversity, I never want to treat people in the ways that I’ve been treated, my family’s been treated. And I think that’s something I’m really proud of that I see across the board with those of Asian heritage and background, is that we really are– do a great job, I think, of being able to overcome adversity, developing resilience, and grit. But it’s hard. It’s hard and we often don’t always check our mental health in that process. But fortunately, I use that to drive me to want to do more, to want to do better, and to also never treat people in the way that I wouldn’t want to be treated. 

And so that’s actually what inspired me to pursue the Health Equity Fellowship because the majority of the patient population of Mississippi, we actually have the highest black minority population in the country. And so if 80% of my patients identified as a minority, how was I gonna be able to do a good job of treating them? And so that’s how a lot of my background shaped, I think, who I am and the way that I practice, because I’m very down to earth, and I think that’s really important to remember that we’re all human at the end of the day. And it really allowed me to be able to speak to people in a way that I think is more personable. And that’s something that I encourage everybody to always keep about yourself. The more personable you are, the more you’re gonna be able to relate to your patients. And you know, it’s interesting because when we’re treating patients, there’s a lot of formulaic black and white understanding of the physiology, and in psychiatry. there’s a lot of gray. And what I realized is, when you really look at the data, sometimes what we’re not accounting for, and the thing we can’t measure is the rapport that we have with people. And so I think that’s something, that’s a really important point and a special point, and having that identity, that cultural background, and being ‘othered’, has really allowed me to progress forward in a way where I never want anyone else to feel othered in my interactions with them as a physician. So that’s something that’s really important to me. 

08:35 Work-Life Harmony

Dr. Avani Patel: Now in terms of kind of how to balance it all, I don’t like to say work-life balance. And it’s a phrase I’ve used before, but now I look at work-life harmony. Because the reality is that we’re never truly going to feel balanced. Nothing is ever going to be 50/50. And we have to be comfortable with that idea. But what’s important is feeling fulfilled when we’re achieving that harmony. So it might be that we are working more and we’re going to through different stages of our training in our life where that’s going to happen. In medical school, you are consumed with clinicals and absorbing all of this information and processing it. And sometimes it leaves little time for personal life. And in that process, I think the people who really care about you tend to stick around. And so, I say that people often go through our lives in seasons. And it’s okay if they go through life in seasons because they were meant to teach you something in that season. But guess what, there’s another season to experience. And so, I often say when we experience loss, or we experience the winds, it’s important to experience all of it. And that’s, I think, the really special part of being human. Otherwise, we would all end up being real life ChatGPT AI robots. And so in that process, you know, we understand that medicine is a very unique field. There’s a lot of sacrifice that’s made through this. But it’s important to choose yourself sometimes. And so throughout medical school, I’ll tell you one of the things that I never compromised on, and maybe I would have been a dermatologist or plastic surgeon or something at this point, was sleep. I love it, I love sleep. And so I said, you know, I know I’ve got exams, but I’m better off sleeping and just taking the L and making a guess, than I am continuing to push myself. And those are the ways that I found work-life harmony. And then even in residency, one of the things I prioritize– so for me, I’m not married, I don’t have kids, it’s something I definitely desire, and I say if it’s something you want, don’t give up on it. But if it’s something you don’t want, it’s absolutely okay. One of the hardest things is to be honest with ourselves, I think, whenever we’re dealing with these life things, because our career is so structured for us, right? Like we have a pathway that’s, that’s laid out for us. We know we have to go to medical school. We know we have to go to residency, maybe even fellowship. And then we kind of choose the next step in our career, whether it’s to be employed or go out on our own. There are steps that we go through in stages, but our personal life is not necessarily always laid out in that same fashion. And so in that process, I think we learn some adaptability, we learn flexibility, we learn that harmony between work-life is going to look different for everyone. And so, I always prioritize family, friends, and then travel, because travel makes me happy, and some of the extracurriculars. So because I wasn’t really responsible of having to take care of another human, or fur baby, or anything, it allowed for more time to be able to pursue some of these leadership activities that really gave me a lot of joy and made me more motivated to be a better medical student, resident, and now a physician today.

Anne: That’s great advice. I think, like you were saying, in the end, it’s really good for us to understand that, you know, we’re humans, our patients are humans. So then it’s good to be more forgiving, more understanding of anything that’s up and down and that way we can kind of be more resilient, and take better care of ourselves and other people too. 

12:03 Health Equity Leadership & Cultural Competence in Mississippi

Anne: I know you spoke to your Health Equity Fellowship before, and I actually find that really interesting, that’s not something I know a lot about and I don’t think I know a lot of people who’ve done like, a Health Equity Fellowship before. So I was just wondering if you could speak to like what that was like, how you kind of got into it, what you did during that fellowship, and then how you apply that now for caring for your patients in a culturally competent, health equity-minded way, especially in Mississippi, where you could potentially have less exposure to diverse populations.

Dr. Avani Patel: Yeah, absolutely. I think that’s such a great question. So the fellowship, I will tell you which one I did, and I actually encourage everybody, when you feel you’re in the right stage to do, it’s actually meant for attending physicians. However, I was the first resident physician to pursue this. And I’m glad I did because those skill sets really helped me throughout my training. However, if I could go back, I may have waited until I was early career, because then you’re going to be in positions where you can make a more significant change on a system level sometimes, which we often don’t get an opportunity to do in training, only because we’re learning how to be doctors and take care of people and there’s a lot more, I think, pressure, as well as bureaucracy that we’re going to have to deal with. It’s very different from whenever you’re out and you kind of get to make choices in terms of what level of leadership and ownership do you want, which had actually played a huge role into why I didn’t end up going employed. Because I wanted to have a level of autonomy and a voice to be able to take care of people the way that I want, advocate in the way that I want, and also be able to set a standard for, you know, speakerships, educating, teaching, all of those things without having to go through the red tape. So I did the American Medical Association Satcher Health Leadership Institute Medical Justice and Advocacy Fellowship. I know that’s a mouthful, but all of that basically translates into a Health Equity Fellowship because it actually was born out of the Center for Health Equity at the AMA. And throughout that time, what I– what my goal was initially is that I noticed is that again, because 80% of my population identified as a minority, yet I live in a very red state, there are sometimes a bit of a mismatch in communication, as well as a distrust of the healthcare system and the physicians who are providing that care.

And I’ll actually recount a story from when I was a medical student, where I was in my third year of medical school, or maybe second year, I was going through clinicals, learning how to do a lung exam for the first time, and I wanted to hear rales. And so, I had a patient who was in her 90s, and I remember being with a colleague, who was a Caucasian male, and she said that my colleague could listen to her lungs, but I could not. And that was the first time in a long time where I thought, ‘what do I do?’ I mean, this, and she said, “Your kind is not welcome here.” And that was very hard for me. But I was in adrenaline mode and so, I realized in that moment, you know, I was basically damage controlling, where I said “Look, I understand how you may feel about me. I’m not looking to change your opinion. However, this is really important for me to listen to you because this may be able to help me save lives in the future.” And eventually, you know, through some disconcerted looks and some silent moments and pauses, she allowed me to listen to her. When I walked out of that room, I broke down. I didn’t realize how much how it had affected me, and it was sad to me that here we were in 20-, you know, -18 or 2017, and we’re still having to have these conversations and deal with this. And I don’t know– I didn’t know that’s how I would react and I wouldn’t want that for other people. But in that moment I realized I never want to be the person to put somebody else in that position, which is why I wanted to educate myself. 

And so that’s what really inspired me to pursue the Health Equity Fellowship, because there’s a lot of pain that I think that comes from that, and that was also very traumatic because it reminded me a lot of what I had gone through growing up in a very rural area in the South. So interestingly, I thought whenever I’m finished with training, I will leave Mississippi and I will never look back. But I realized that if everyone like me leaves, how will we ever experience change? How will we ever get to take care of people in the way that they deserve if we’re not willing to give back in these areas? But I also think it’s really important to take care of ourselves and our mental health care. So it depends on where you’re at in your journey with resilience and grit. I knew in my mind that I was not going to be able to change what she had been taught for the last 95 years. I really don’t think it was about me. It was about the values she had been taught. So when you’re able to compartmentalize and depersonalize it, it’s not to say that it makes it okay, but it allowed for me to realize that this wasn’t about me. And how can I contribute in society and be an advocate, so that my patients would never have that feeling the way that I did. And so, that’s something that I really wanted to be better versed on, particularly with some of the health equity related terminology. 

So something I didn’t realize that was actually a focus was actually understanding cultural differences and stigmas around mental health, which was helpful. And so, for me and the population I treat, they identify as black, and much of the stigma around it is praying it away. And even for me, you know, my cultural background, mental health was not really a thing, and there was a lot of pressure I received when I said– I thought I was gonna be an anesthesiologist, and then I changed my mind and decided to be a psychiatrist, and the reaction was, “So you went to medical school to do what? Out of all the things you could have done, that’s what you want to do?” And there was a lot of pressure. And even from mentors who were non-Asian, who said to me, “If you become a psychiatrist, no one’s ever going to respect you.” And I thought to myself, the best thing you can ever say to me is that I can’t do something, and I’m going to prove you wrong, and I’m going to show you that you can. And so, I’ve always found that mental health care is my passion because I really enjoy the ability of being able to understand people, relate to them even if I come from a different background, and communicate how we can heal. And I’m able to do that in a variety of ways, through therapy, through medication management. And it’s grey. You get to be creative and I’m very much a creative. So I get to use all these various modalities to really help people heal, which is pretty special. And I thought to myself, if I can save a life when someone can otherwise take it by choice? That’s something really special. And if I can make people feel like they’re understood, no matter what background they come from, then I’ve done something very special here. I’ve cracked the code, right? That’s all we really want. We all want to feel understood. We all want to achieve success in what we have envisioned for ourselves that success is. But that’s what’s interesting, is that success looks really different for everybody. And there are certain barriers, depending on what your background and what your gender may be. I have very much experienced all of those things. But it’s also important to kind of learn the system and learn how to navigate that system to be able to be in those places then to create change.

Anne: I really do agree with you that psychiatry is such an intimate specialty where you can really personalize the care that you give people, and you can also like, really get to know them as well. And then I can totally see how like a Health Equity Fellowship would better prepare you to have these deep meaningful conversations with people and then encourage them to take care of themselves and then be a part of that healing process with them. 

20:07 Sitting in Discomfort & Determining Your Boundaries

Anne: Just to build off of that story that you shared, I know a lot of medical students have trouble sometimes standing up for themselves when they’re going through clinicals and things like that, of maybe confusion of how to interact with patients or with other people and with the medical student hierarchy and everything during their training. I was just wondering if you’ve had any other strategies that have helped you advocate for yourself in these professional settings.

Dr. Avani Patel: Absolutely. One of the most, hard things to understand is that medicine still has a very traditional view of things in terms of a hierarchy system. And we know that as medical students, we tend to be at the bottom of the totem pole. However, I do think that the landscape is changing and medical students do have a lot more power than they think they have. But one of the things I caution people is to use it judiciously. Because sometimes we’re going to be an uncomfortable situations that we’re meant to experience. And it’s not ever nice to experience them, it’s not fair to experience them, but part of life is that it’s not going to be nice or fair. And so being able to gauge how we’re going to react to those things and handle those things are really important. 

And so, the advice that I share is the same advice that I share to patients because I think it stands the test of time and it’s something I do today. When something has hurt us or when something feels uncomfortable or when we feel like something is unfair. We often– it’s human nature to have a knee-jerk reaction of some sort, and that’s typically related to our personality. Right? We go in fight or flight mode and we’re like, okay, how do I do this? And for some people, their fight or flight mode, depending on what their cultural background is, is to remain timid, quiet, and just blend into the wall and just move on. For others, it might be addressing it right then, right there, right now, and I’m not sure that either method is really the method that’s going to help us solve the issue. So I would say taking time and being able to reflect on what happened is really important. Because we’re not in a state where we’re able to really, I think, address what’s going on. And being able to sit with something is very important. And so one of the things I recommend, and this is something I’ve gotten better with over time, and as I’ve gotten older, is, I like to sometimes write it down and have it be tangible and let me see what the situation is. Like how I felt about it, what happened, and keep in mind we’re always going to come in with a biased lens because it’s our version of the story, right? And then I need to, I like to sit with it. Because if you’re angry or if you have these feelings of discomfort. It’s gonna come across in the way that we respond. And so it might still be too emotional for us before we can address it. And so being able to sit with it, taking a look at it, asking people that you trust, whether it’s family, whether it’s mentors– I’ve done that where I’ve called mentors and I’ve said, “Hey, I experienced this, and I’m not really sure how to respond, but I know that it really upset me, I’m really emotional, and I want to make sure I’m doing this level headed.” And I can always refer back to my notes of how I’ve described the situation, how I feel and how I would want to respond. and then asking the question, “How should I respond?” Right? So that way, we’re always having a different perspective, which is important and it allows us to grow. So what we’re doing is we’re then wiring our brains on how to respond in a way that’s leadership driven, right, that’s evidence driven, and that’s a little bit less emotional because we now have perspective outside of ourselves from people who we deem to be leaders if that’s where we want to go. And that way, we’re also not feeling gaslighted, right? We want to make sure we have people who are on our team because this is gonna come up, this is gonna happen throughout our lifetime in a variety of settings, personally, professionally. 

And I think that’s the best way to be able to advocate for yourself is having mentorship and being able to take a step back when we’re less reactive. Um, so that way we’re able to make the best decision moving forward. Because one of the things I see often is I see people who die on every hill. And guess what? The people who don’t get listened to, who then get dismissed are the people who die on every hill. And it’s not that I’m not inspired by their passion and the fact that they’re standing up for themselves and advocating for themselves, but there’s strategy involved. It’s all about timing, place, and strategy. And that’s the way that you grow in leadership. And so the most successful people you’ll notice, it really doesn’t have as much to do with their level of intelligence. It has everything to do with their level of discipline and strategy. And that’s includes our own emotional regulation and control. And one of the things that I think humans do a really bad job of, that I think, that it’s important, is being able to sit in some discomfort. Because it’s important for us to get used to feelings of discomfort, but also understanding where the lines are in terms of what our boundaries are. So those are two different things, right? Being able to set boundaries and then being able to sit in discomfort. Because our boundaries drive how we advocate for ourselves moving forward, and having outside perspective of those with more experience, like a mentor or a family member who’s had a little bit more life experience on them, can really help us determine where we want our boundaries to live and where we want our areas of discomfort to be.

Anne: Yeah, I really like that idea, like what you were saying about that balance between boundaries and discomfort. I know for me, personally, like any type of discomfort makes me freak out a little bit. I kind of– I want to act on it. But like you were saying, you know, taking a step back, so I can understand myself, having other people give their input, so I can then again understand myself and the experience better. It kind of serves you in the end because then you just have a deeper understanding, a better plan of how to move forward instead of just acting on something and having to deal with the consequences of that. Yeah, I love the idea of sitting in your discomfort for a little bit. I think, it is uncomfortable, but it’s–.

Dr. Avani Patel: Right?

Anne: But being able to sit with it makes you more resilient too.

Dr. Avani Patel: It does, and I think it not only helps you in your professional life, but personal life too, right? One of my favorite examples is using a romantic example. Let’s say there’s someone you really like, and you’re like, okay, what do they think of me? It’s like we’re overthinking, we’re overanalyzing, it’s making us uncomfortable, but because we want something to happen now, sometimes that can be kind of suffocating. And so for the person on the other end, what’s the natural human inclination? It’s to take a step back because you’re like whoa, whoa, whoa, wait a minute. We’re really reactive, like, this is a lot. This is really overwhelming, this is feeling smothering. Well, it’s the same way in professional areas and conflict. And so the people you notice handle conflict really well are the ones who are willing to take a step back and are basically, kind of like, microdosing themselves and being able to sit with discomfort. And it’s something that I’ve learned, and the trick I’ve learned over time, and has actually allowed me to be not only more effective as a leader, but more respected in the rooms that I’m in. 

Anne: That makes a lot of sense, there’s always something to learn from discomfort, because there’s something to resolve at that point. This is a really great idea that we can all kind of incorporate into our training as early on as possible, so like we just get better at handling difficult situations because it’s going to happen for us, especially in medicine. 

Dr. Avani Patel: You know, and it allows us to connect with people too, right? So part of being human is we are required and we need social interaction and social connection. Like the US Surgeon General in 2023 put out a report about the loneliness epidemic. And he didn’t just mean personally, he meant all facets of our lives. And so, that’s professionally too. That’s why I’m a big, big, big proponent of mentorship and seeking out mentorship, and not only locally, nationally, in whatever circles of life that you’re in, because there’s many different types of mentors we can have, whether in medicine, outside of medicine, in the community, I think it’s really important. Because it allows us to get better at testing our patience, building our resilience, again sitting in that level of discomfort, but also strategy planning so we can grow in leadership and advocate for ourselves in the same token.

28:30 What Good Mentorship Looks Like

Anne: On that note, what do you think makes a good mentor? Because as medical students, we’re always seeking mentors, looking for people to make professional networks with, but I think it’s difficult to establish these relationships sometimes.

Dr. Avani Patel: It can be because everyone’s so busy, right? And we go back to the idea of work-life harmony. But I do think there are people who love to pay it forward because they’ve received mentorship, they understand the value of mentorship, and those are the types of mentors that you’d want anyway. The people who don’t really value what mentorship can do or mentor-mentee relationship are probably not going to be the people who would make great mentors anyway, in my opinion. And so, I feel that one of the most important things is understanding that mentorship is a two way street. But as a mentee, we’re probably going to be putting in more of the legwork. And that’s just the truth of the matter because our mentors are likely going to be very busy. So one of the things that allows me to have many mentors and great mentorship relationships is that I’m consistent. I will always reach out, I will always check in, not only just for advice, but personally as well. And I think having that established relationship, even if it’s just an exchange of a message or two, is really important because it reminds the person in your life, they’re very important to you. Not only from a mentor capacity, but professionally and personally as well, that this is a relationship that you really, really value and someone who makes you feel safe. 

Now, there’s a caveat with it. Because if you have a mentor who basically encourages you to do every single thing that you want to do, to react in every single way that you want to react, are they really mentoring, right? So again, I think I seek a mentor who makes me uncomfortable sometimes, who will challenge me and say, “I’m just offering you a different perspective. What if you responded or reacted in this way?” The ones who say, “So I’m not saying you have to do it, but I’m offering it to you and I would support you no matter what, because I care about you and you’re my mentee.” So I’ve had some mentors who have given me some tough love, who have made me uncomfortable and sit in discomfort. But that’s really important because it’s been great for my growth. And then I have also had mentors who I realized in the end, weren’t really invested in me. Because all it was, was a feel good for them, in the sense of, okay, I’m doing this, I’m paying it forward, except I wasn’t really growing or learning from that relationship. And you need to have both. And I’ve even had mentors that I would say are no longer mentors, because I think it also shows you kind of, who’s on your team, who you’re looking to grow with. And they give you examples as you get to know people, right? We get to know people and we have ideas of them on the surface because everybody puts their best face forward. But sometimes over time, the more you get to know them, the more you realize they may not be the right fit for you. Or they’re teaching you something and that– there are things that they do that you know you don’t want to do moving forward or you don’t feel would be an accurate representation of who you are, the way you want to pursue your career, whether professionally, personally, any of those things. And so, mentors can come in a variety of ways, kind of like friendship, and I think nurturing that is important, understanding that you’re gonna put in more legwork is important, and that not every single person has to be your mentor. And it’s also okay to end a mentor-mentee relationship if you feel like it’s not serving you. 

Anne: That’s really good advice. I feel that for me, when I am trying to find a mentor, sometimes I really focus on this, like, perfect fit, they have to do everything exactly, like I want to do, have the same goals, the exact career that I want to achieve. But I feel that, you know, based on what you were saying, we can really have mentors that serve us in different aspects of our career. Like they can provide me with advice on this, or this mentor can make me feel a little more challenged, a little more, sit in discomfort like you were saying. And these are all things that can help us grow, which is I think a really, like a great way to approach mentorship is to reach out to people and then be open to different types of mentor experiences. Thank you for that. 

32:35 Reflections & Career Advice for Your Past Self

Anne: I think for our last question, this is gonna be a little bit of like a reflection for you. So if you could go back and give your younger self one piece of career advice, what would it be?

Dr. Avani Patel: I love this question for many reasons. The first reason is because it’s such a challenging question to answer. Because we’re all gonna be so different as we reflect on our younger selves. And there’s not a one size fits all answer for it. But one of the things that I think would be applicable to everybody, is to understand that you shouldn’t apologize for being you. Because you wouldn’t be here if it weren’t for you being you. And yes, you’re going to make mistakes. Yes, you’re going to do things and say things that you regret. Yes, you’re going to wish, “Oh, I should have studied instead of going to dinner with my friends.” And there’s always going to be a what if? Or should I have? Or should I not have? But it all comes together perfectly in my opinion because it makes you who you are. You become the person that you’re meant to be and I’m a firm believer in that. Whether you are someone who is spiritual, religious, not religious. I firmly believe that it always ends up working out in the way that it’s supposed to. And so as you experience adversity, as you experience biases in the field, which I have experienced many, age, race, gender. Just remember that you are always meant to be in the place that you’re supposed to be in, and you’re meant to have these experiences, whether they’re joyous, whether they’re uncomfortable, we are all gonna experience the hills and valleys. And so, even though sometimes it’s hard to see light at the end of the tunnel, it’s there, and never apologize for being you and try to be as patient with yourself throughout the process and enjoy as much of it as you can. Because it is fleeting and you realize how fast life moves. And it’s wild to think that just yesterday, I say yesterday, but this is 13 years in the making. I remember thinking in college, I finally get a chance to live out my dream. I get a chance to be a physician. And now I’m in my first year of practice, I serve in a multitude of roles, which I actually didn’t mention and may be helpful. So not only do I have my private practice, but I’m also a behavioral health medical director for a managed care entity. And so what I got hired on for is to build out our behavioral health coverage plan for our Medicaid population. And I’m the youngest in the country. In addition, I also contract my time to two rehabs. So I work with the post-incarcerated homeless Medicaid population, which I really really enjoy because it’s particularly challenging as you’re doing dual diagnosis work, and then my private practice is more catered toward a higher socioeconomic status population. And I did this because when I was in training, I was actually seeing, or funneled, a lot of our quote on quote VIP patients, and I realized I worked really well with high achieving individuals, but they also have their own unique challenges to recovery. And so I really get the full spectrum of individuals that I get a chance to treat. And I never thought I would have done this and I never thought I would really be the person that I am today. But I realized I wouldn’t be the person I am today if I didn’t get to experience all of the highs and lows in life. And there are things that we’re always gonna want and desire, and more is always going to be more, because that’s what we’re taught, it’s human nature. But if I could go back, I would say, enjoy all of the highs and lows. Be patient with yourself. Don’t apologize for who you are. And that’s the beautiful part of life. I think that’s the lesson we’re meant to learn.

Anne: Thank you, that’s a nice note to end our conversation today, a message of self-love and trust in ourselves, trust in our abilities, trust in our careers, which I think is very important for all of us because as a medical student, we’re on this very long path. It’s easy to get burnt out. So easy to kind of start losing our steam as we’re looking ahead. But in the end, like you were saying, I think just taking care of ourselves, trusting ourselves, and then knowing that we’ll– we’ll get to our end destination. And even if that destination is a little different than what we expected, sometimes it’s still like a very great journey.

Dr. Avani Patel: Think about it, you were chosen on this path. There are so many people who would kill to be in your position, but you were chosen to be on this path. We are the top 1% of the population. And that’s a pretty special thing. It doesn’t feel like it or doesn’t seem like it. But as you reflect and look at things on a larger scale, people are going to trust you with things they don’t even trust their spouse with, their children with. And that’s a pretty– I mean those are some big shoes to fill right? But that’s also why we do the grind because there’s something in us that realizes we want to do something bigger than ourselves and what’s outside of ourselves and I think medicine allows us that pathway.

Anne: That’s so nice to hear from someone who’s like been through been through it all. I think that it’s very inspiring to hear, especially knowing that for me I have a long journey ahead. I think it’s great to hear something that you would tell basically yourself at my point in my career too. 

Dr. Avani Patel: Absolutely, I really enjoyed it. I– for everyone who listens, just understand, I see you, I hear you. It’s such a psychiatrist thing to say, but it’s so true because the journey is worth it. And the thing is, is that we can’t predict life, right? That’s one of the cool things is that we get to experience it, not predict it. And there’s a lot of fear around that, but I think there’s also a lot of excitement in what the unknown is because then we hold the cards. It’s up to us in terms of what our next play is going to be.