Advice to Trainees

In this month’s episode of Lab Medicine Rounds, Justin Kreuter, M.D., interviews Nidhi Kataria, M.B.B.S., and Thane Kubik, M.D., M.S., for a deep dive into optimizing the residency experience. 

Episode Transcript

(00:00):
(bright staccato music)
- This is "Lab MedicineRounds," a curated podcast
for physicians, laboratoryprofessionals, and students.
I'm your host, Justin Kreuter,
a transfusion medicine pathologist
and Assistant Professorof Laboratory Medicine
and Pathology at Mayo Clinic.
Today we're rounding with twotransfusion medicine fellows

(00:23):
that we have here at Mayo Clinic,
Dr. Nidhi Kataria and Dr.Thane Kubik, to dive in
to talk about how to optimizethat residency experience.
Thanks for joining us today.
- Thanks for having us.- Thank you for having us.
- Absolutely.
So I really am alwaysimpressed by you guys

(00:44):
how you, throughout this academic year,
you see residents come through
and rotate through transfusion medicine,
which can be a verychallenging environment.
And I'm kind of curious, you know,
what information perspectivedo you think is important
for residents to understandabout where to put their focus,

(01:06):
their energy during residency training?
- Sounds good. That's a great question.
So we know pathology residency is, like,
a demanding journey in itself.
And like anything else, basics come first.
So getting your basics right,
getting your fundamentals right
is the first thing to start on.

(01:27):
So when you're in a pathology residency,
what your fundamentalsare, you need to know
how to grasp specimens properly.
You need to preview cases.
Preview cases, as many cases as possible.
That's what my seniors used to tell me
and that's what I feellike helped me a lot,
both in terms of practicingpathology and even for the both.

(01:48):
So those are the basic skillsthat you need to acquire
and even for the clinical, like,
need to understand thedifferent diagnostic entities
or like, how do we come forthe patient care decisions.
If you don't have your fundamentals right,
you would not be able toget to the proper decision.
That is the first and foremost thing

(02:09):
to start your residency with.
And that just doesn'tend in the beginning.
Like, you have to keepthis practice going.
(Nidhi laughing)(Thane humming)
Another thing I feellike, which is important
along with doing your hard work,
to that is doing yourlearning, is research,
which is another important aspect

(02:31):
of pathology residency training.
Whether it is just for, like,
your own CV and your own interests,
but you also needresearch to build your CV
for fellowship applications,to get a job in the future.
So you need some kind ofresearch, and how do you do that?

(02:51):
Like, you get into residency,you may have some experience,
but, like, when I got into residency,
I didn't have experience with research.
I had to ask my seniors.
I went to my program director.
I did a residency training in India too,
and I went to my programdirector and I was like,
I wanna get involved in research projects,

(03:13):
but I don't know where to start from.
And I was like plain and straight.
- Wow. You give me so much.
Let me put a pin in the research topic.
Let me circle back tothat in a little bit.
I really wanna kind ofdive into, you know,
your highlight of kind of thefundamentals and the basics.
And one thing I'm curiousabout is, you know,

(03:36):
how to approach this with,you know, learners, you know,
junior residents that are,you know, just coming on
or just coming on to clinicalpathology rotations now.
I imagine that for anatomic pathology,
maybe that's an easier thingto define or put your finger on
because you could thinkof like, okay, histology,

(03:58):
I need to really have a goodunderstanding of histology
and be able to identify my cell types,
be able to identify the architecture.
But I could see maybethat being a struggle
in the clinical pathology world
where maybe the fundamentalsis like, clinical medicine,

(04:18):
(Justin laughing)
which can almost get beyondwhat I can get my arms around.
Do you guys have thoughts on, like,
what does the fundamentalsin clinical pathology
rotation look like?
- Yeah, I mean, that'sa really good question.
Like you said, it's quite a bit different

(04:39):
and quite a bit more nebulous.
And I find that one thing that we were
gonna mention before was talking about
sort of the hiddencurriculum a little bit,
which is maybe not, like,these are the sets of entities
that you have to look at and learn.
I feel like on the clinicalside of clinical pathology,
it lends itself more to a bitof this hidden curriculum.

(05:00):
So things that aren't, youknow, gonna be in a syllabus,
but it's sort of like theteamwork sort of things.
You know, especiallyin clinical pathology,
you're interacting quite a bit more
with allied health professionals as well.
So it's really importantto find good mentors,
good role models to kind of see
how they approach challenging calls
and really to help have them guide you

(05:23):
in sort of that, like, apprentice
and learner sort of relationship,
so that they can really help highlight
what are the more important things
to kind of key you in on as well.
Because otherwise, you're quite right,
you know, it's like,this is all of academic
or clinical medicine, you know, go for it.

(05:44):
Learn what you need to know, so.
I found from my personal standpoint,
finding those mentors tokind of watch their practice,
kind of see what things they key in on,
that's really been helpful to me as well.
- Yeah, I really like that,'cause that does sound like
something I can get myhands around, right?

(06:04):
Thinking back to where Iwas as a junior resident.
And then what do you say about
kind of the frequency of, like,
is it kind of like at least once a day
when you're coming on a new service
that you're kind ofchecking in with mentors
and asking about, you know, how am I doing
and this is where mythoughts are on x, y, or z?

(06:29):
- I don't think there'sa defined frequency.
Like, based on what, say like
if I'm on call for aday, hot seat for a day,
as many times I'm getting, like, some kind
of difficult calls whichI'm not confident with,
I would approach myconsultant or my mentor
and see like, this is how Iam thinking about this topic.

(06:50):
What are you thinking about this?
- I like that, right?
So highlighting for our audience, right,
whenever the uncertainty, you're like,
oh, this is new territory for me.
Or I guess maybe to your point
is like maybe it's a new iteration,
like you've handled similar calls before
but this one's just alittle bit different,

(07:11):
that might be a nice timeto check in with faculty.
You know, you guys have both,
oh sorry, were you gonna add?
- Yeah, I was just gonna add one thing.
So checking daily is helpful
but I find that, like, having some sort
of reflective practice inresidency is important too.
Listen, journaling isn't for everybody,

(07:33):
but having some way ofkind of keeping tabs
maybe over the course of a week
to kind of figure out maybewhere you've struggled,
and then having that, youknow, like 10, 15-minute redux
that's set away from busyservice work to sit down
with the faculty mentor wouldbe really helpful as well.
And then you could try tothink about some themes
or kind of general ways to approach things

(07:54):
so it's not just onecall, one itty bitty fire
to put out kind of ata time sort of thing.
- You know, diving in that Dr. Kubik,
do you think there's, youknow, you mentioned that,
you know, journaling isn't for everybody.
Certainly that's the way thatme and my younger daughter
are connecting these daysis doing a little bit

(08:14):
of this bullet journaling type of thing.
You know, what are some ofthe diversity of practices
that you've seen maybe differenttypes of residents do that,
you know, still is thiskind of reflective practice?
- Yeah, I think, so here on abusy service that we've had,

(08:34):
I find that with a couple oftrainees that have come through
or I should say learners,I would just sort of flip
through their on-call kind ofnotebook throughout the week
when thing sort of die down andsay, "Let's go through this.
Was there any other callthat you kind of wanted
to chat about that didn't quitego as well as you wanted to,

(08:55):
or that you feel like youdidn't quite answer well?
Let's chat about that now."
So I find that's kind of oneway to do it, have a record
of something and then goback to it and revisit it.
'Cause it's really hard to pull, you know,
examples straight out of the air.
- Just to add to it.
Like, something what I try to do is like,

(09:15):
I would try to self-reflect,
I think this is something you taught me,
on what I have done in thatweek and have I achieved, like,
the things that I were trying to achieve.
So it's easy, like, if I'mpracticing transfusion right now,
transfusion is a vast word,
and it's easy to get lost inthe sea of clinical service.
And then are you learning new things?

(09:38):
Are you achieving yourtargets as well on the side?
That's important to realize that.
So reflecting back on thispast week, what you have done
and then setting up goalsfor the next week so that,
along with your busy schedule,you can fit those goals in.
That helps a lot.
- Yeah, that's really interesting.
That sparks in my mind, Ithink you're highlighting.

(10:00):
Dr. Kataria this issue of, youknow, every training program
is going to inherentlyhave maybe blind spots
or things you may notnecessarily be exposed to
or may be exposed to a lot of, right.
But by having this thoughtfulpractice that you described,
you can catch that or have that look
into what's in your blind spot.

(10:21):
And so then have a targeted approach for
how are you gonna work on that.
You know, sitting downwith a mentor, for example,
and having a conversation about, geez,
I haven't seen in cases like this,
but what are your, you know,how should I approach that?
You know, one thing, nextquestion I have for you,
and again, this is at theend of your academic year,

(10:42):
so you've seen a numberof trainees come through,
both junior residents aswell as senior residents.
I'm curious, having workedwith several of them,
are there a few commonchallenges that you've seen
that they kind of might run into
when they're on transfusion medicine
with the idea that thelisteners can kind of be

(11:03):
kind of heads up about this andanticipate these challenges?
- Definitely.
Like, I think as aresident, both as a fellow,
like, there are a lot of challenges,
especially that there are gaps
in medical school and pathology residency.
Pathology, like residency, basic skills
like histology, grossing, andthen transfusion medicine.

(11:25):
They're not taught in the medical school.
So once you actually start your residency,
it becomes challenging.
It becomes simply overwhelming.
And I remember when I started my residency
and like, as physicianswe target for excellence.
I started feeling overwhelmed.

(11:47):
I wanted to know everything on day one
or on my first month.
And it was just puttinga lot of pressure on me,
and that I had to talk to my seniors
and like, bring the self-realization
that I cannot learneverything in on day one

(12:07):
and it's gonna be a journeyand we are lifelong learners.
(Nidhi laughing)
- So I get you're sayingthat pathology trainees
may be partially selectedfor perfectionism
(Justin and Nidhi laughing)
as a character trait.
(Justin and Nidhi laughing)

(12:28):
Are there ways that you'vekind of, when you recognize,
wow, this person has got, you know,
and it's nice to followprotocols and the like,
but where maybe the perfectionism
is getting in the way ofmoving forward in practice.
How do you help that personovercome that barrier?

(12:49):
- Yep. So I think just a senseof graduated responsibility.
People that will tell youthat, but first of all,
self-realization of thatis extremely important.
Be compassionate to yourself.
(Thane humming)
Don't be too hard.

(13:10):
We as physicians wouldshow compassion to others,
but we often forget self-compassion,
and that is a skill to learn.
And then just realizingthat this is a journey
and this is not, like, one-daytask or one-month task,
and everyone is in the same boat with you
and we are here to learn.

(13:33):
Like, celebrate every day.
Like, I learned this new entity today,
I learned this new thing today.
So achieve, enjoy those victories.
- What are some of the waysthat you guys have seen,
like, you're talking about this, you know,

(13:54):
I think you said that we'recompassionate to each other
and that that was a skill to be developed.
What does that skill look like?
- That's a really good question.
I think part of that is somethingthat you can model off of
just good, like, generalprofessionalism I would say.

(14:18):
So we all kind of work.
Pathology doesn't exist on an island.
We work with a lot of alliedhealth professionals too,
whether they're pathologyassistants in the grossing room,
you know, our clinical teamsthat were phoning a lot
about, you know, additional platelet units
and transfusion medicine, et cetera.
But just always sort of being humble

(14:40):
and really that you'retrying to work the best
and do the best possible job
for the patients thatyou're looking after.
And recognizing thatyou're gonna make mistakes,
but if you approach it with humility
and an inquisitive attitudesometimes by saying,
"Hey, I don't really knowhow to approach this,

(15:00):
but can you help me out?
Can you point me in the right direction?"
I feel that outward professionalism
and compassion can thenbe sort of mirrored
and then imprinted onyourself a little bit too.
- Yeah, I like that.
I see that quite a bit and that does,
I think, come across as a skill,

(15:21):
something we all candevelop and get better at.
And I'm sure you probablyhave seen various mentors
kind of approach that in different ways.
Maybe if I flip the equationaround to the other side/
So we've been talking about maybe
where are some challengesthat you guys have seen
and talking aboutperfectionism, talking about

(15:41):
how we can realize it's ajourney, breaking apart.
You guys have been talking about
a lot of really powerful ideas.
When you think about peoplethat, maybe senior residents,
that have come through that are just
knocking it out of the park, right?
What are they doing that maybe
some of the others of us need to learn?

(16:04):
What are the reallysuccessful residents doing
as a matter of habit that'shelping them be so successful?
- [Nidhi] Okay.
- You can go first andthen I'll add. Yeah.
- Be consistent.
As we have been saying,like, it's a journey.
So like, be disciplined and be consistent.

(16:29):
There are no shortcuts to success.
If you are doing something every day,
by the end of three or fouryears, you would have acquired
that cumulative knowledgeand that would really help.
And then also know, like,what you are supposed to do.
Like, if you don't know,
you may be just lost in this vast sea.

(16:49):
So talk to your mentors,talk to your seniors.
And if you are in a certainrotation, I try to make sure,
like, I would sit withthe rotation director
and understand what the objectives are,
what would be the best resourcesto go for that rotation
so that by the end of that I should

(17:10):
at least achieve those objectives
and maybe even have, like, moreknowledge about that topic.
And then also one more thing, like,
having a proper system to do things.
We see so many residentscoming on transfusion service
and often we see that, like,

(17:31):
if you don't have a propersystem to follow up on things,
your follow-up listwill never be complete.
- And especially, like-- You're in trouble.
- Coming from the busy clinical service,
like, things will get lost to follow up
and there would be trouble.
So having a proper system in a place helps
and prioritize your tasks.

(17:53):
- If I can hop in there really quick
and say like, riffing off that,
oftentimes newly acceptedfellows will ask me about, like,
what do I need to do toprepare to start fellowship?
You know, which, transfusionbook do I need to be reading?
And I always just recommend, you know,
we'll deal with that stuff, but you know,

(18:14):
the biggest thing to workon is what is your system
for capturing the to-do listand working through that.
I think that that structure brings
what you're talking about,about consistency and this idea
that you can be reliedupon to follow through.
So strong.
Dr. Kubik, what are yourthoughts about, you know,

(18:34):
what those highly-performingresidents are doing
that rest of us can learn from?
- Yeah.
So I think, you know, there'sa big change that happens,
you know, in the early years of residency,
and then sort of as things transition
towards your senior years of residency,
at least it should, I think.

(18:55):
And I think that this ispart of the hidden curriculum
and where people who reallystart to understand this
can really start to do an amazing job.
And what that is, isreally you should kind of
look at the final years of your residency
as a transition to practice, I would say.
By that point you should be focusing
not just on the entities anymore

(19:15):
and like, learning the skills,
and how to chat with clinical teams,
but really starting to lookat how different pathologists,
transfusion docs,whoever, how they practice
and how you're gonna emulatethe way that they practice,
you know, into your own unique
kind of flavor of practice going forward.

(19:36):
So the residents that do really well,
they'll sort of kind ofbe pick and choosy about,
you know, okay, from this attending,
I'm gonna take this skill orthis presentation technique
or this way of approachingthis particular problem,
and then develop their own style.
And I feel like nobodytells you that you have
to develop your own stylekind of along the way,

(19:57):
but ultimately it's gonna be you
making the calls at the end of the day.
There'll always be backup tosome sort of extent, you know,
whether it's throughquality assurance rounds
or knocking on yourcolleague's door or whatever.
But at the end of the day,
you should be an independent practicing
pathologist, transfusion doc, whatever.
And you have to use that time kind of

(20:19):
in your senior residentyears to kind of develop
what your own style isand your level of comfort.
- I love the way you putthat 'cause I see that
as really kind of somebody developing
a sophisticated medical practice, right?
It's not just, you know,can I diagnose this?
But you're starting to recognize
the nuances and the differences

(20:39):
that is this thing we callclinical judgment, right?
And like how are we appreciatinghow different mentors
are applying this andhaving a sophisticated way
of taking from some, leaving from others,
and building who we areas individual clinicians.
I really like that. Now let's rotate back.

(21:01):
I put a pin in research because I know
that's always a challenge and you know,
for our audience that arejust starting residency,
I hope that this has been areally key thing to appreciate
and helpful as you kind of frame
how to approach the beginning phases,
or if you're a listenerthat is already in practice,

(21:24):
you know, when youmentor maybe new trainees
or if you have new faculty thatare just finishing training,
this is helpful as well.
But now let's go backto this research idea.
Dr. Kataria, you weresaying that, you know,
research was a novel wayof, a new way of thinking
that you hadn't reallybeen exposed to before.
And certainly in all of ourACGME accredited programs,

(21:48):
research is an expectation of that.
Do you have thoughts onhow students can kind of
maybe more successfully launch into that?
- Sure.
So again, like, I thinkmentorship comes a big way
in research because once you transition
from med school toresidency, you may have no

(22:09):
to limited experience of research.
So having the rightmentor who can guide you
in the right path is important.
And then seeking out, like,I think for me it was like
I figured out what I'm interested in
and then I try to focusmy research on that.

(22:30):
Having said that though, itis not like you will just,
you may get another opportunities too,
in which you may be putting less effort
but maybe getting more out of it.
And I think it is important to recognize
those opportunities and grab onto those.
And sometimes those opportunitiesjust come out of nowhere.

(22:52):
For me, like, during Covidtime we had a book club
where we were reading WHO HemePath
and then some of the seniors said,
hey, do you guys wanna come up with like,
a book for writing, like,summary of WHO kind?
And that was a small thought.
And with that small thought, like now
we first published, like, our first book,

(23:15):
which was Ace My Path,Neoplastic HemePath,
and then now there's aseries of that books.
So it can come like, youshould not miss an opportunity
where you see it, it may requireextra time and dedication
and that is something you'll have
to work out in your schedule.
- I like that.

(23:36):
You know, I think that being open,
that being curious,that kind of resonates.
It's kind of a rolling thread
that regular podcastlisteners will pick up on.
Something you mentioned there was
about the idea of the right mentor.
And I'm curious to hear from both of you
'cause you're really in the thick of it.

(23:59):
How do you identify that right mentor?
- Yeah, so kind ofspeaking from experience,
I find that, you know, ifyou're kind of new to research
or even if you've doneresearch projects in the past,
it's really hard tokind of get the sense of
who the right mentor ismaybe with one meeting.
Or even if it is the right mentor,

(24:20):
it might not be the right project, right?
So I think it's important tokind of cast a wide net first.
You know, maybe not, as hard as it is
'cause we tend to be yes people,
maybe just say, you know,I'll get back to you on that
and kind of play the fielda little bit, get a sense
because A, the right mentor is important,

(24:41):
but also the right project.
Unfortunately becauseresidency is so time bound,
you need to find projects
that are gonna achievesome sort of liftoff.
And you know, you don'thave time for a magnum opus
or a thesis kind of inyour residency position,
unless you choose to goon in their, you know,

(25:01):
clinician science training programs,
you know, you could doyour PhD, et cetera.
But the advice I wouldgive is talk broadly
and then find smallerprojects to start with
and then you can alwaystake on more later on.
But find ones that, you know,
have a good success of achieving liftoff.

(25:26):
- Dr. Kataria, do you haveadditional thoughts on that?
- Yeah, sure.
Just like, echoing onthat, like, small projects.
I think it's important to have some.
I try to have somethingon my CV every year
so that it at least keeps me, like,
saying that I'm doingsomething every year,
whether it's a poster or a case report,

(25:48):
like, you are makingsome kind of progress.
That is important.
And so going back to yourquestion of right mentor,
early on it was more like
you don't really have an idea,
and you just see whatopportunities you are coming for,
and like, as Thane said, like,you have hard time saying no.

(26:10):
But now I just try to reflect upon, like,
what are the fields I am interested in?
And then mentors, like,
I'll do maybe a small project with someone
and then see how our bonding was,
and like, did I get to learn something.
And if I get that feeling,then I'll do a big project
with that person and thenjust build on that bond.

(26:34):
- That's awesome.
We've been rounding withDoctors Kataria and Dr. Kubik
for optimizing the residencyexperience, that's optimizing
the residency experience.(Thane and Nidhi laughing)
So thanks so much for joining us today.
- Thanks for having us.- Thank you so much.
- This was fun.- It was a privilege. Yeah.
- And to all our listeners,thank you for joining us today.
We invite you to share yourthoughts and suggestions

(26:55):
by email to [e-mail].
If you've enjoyed thispodcast, please subscribe.
And until our next rounds together,
we encourage you to continueto connect lab medicine
and the clinical practice througheducational conversations.
(bright music)