You can have the best scores and grade, but personality counts TL;DR Affective presence is the lasting and stable impressions your interaction partners get from you.Your scores and grades only get you in the door.It’s your personality that makes you a medical student, and later, a doctor. So make sure you’re giving off the right vibes!Listener Kalmen reminds us of a paths for some students who don’t match. Dave continues his ruminations about why a very few people don’t match into residency. He thinks that some of those people (who weren’t the victims of luck or strategic errors) were burdened by a negative affective presence–the feelings that others have about interpersonal interactions with them. Which brings up (at least) two questions: how do you know if people have a negative impression of your affective presence? And even if you do notice, how do you fix it? M4 Holly Conger, M3 Emma Barr, and M1s Albert Pedroza and Rick Gardner help him hash it out. And reacting to Dave’s other concerns about graduating students having additional paths if they don’t match, listener Kalmen writes in to theshortcoats@gmail.com to point out that some states do have such a path. These states offer licensing for so-called associate or assistant physicians. Aside from the confusing name of this kind of practitioner, Dave is down with that because he just wants everyone to be happy. But many–including Holly–aren’t so sure. We Want to Hear From You How’d we do on this week’s show? Did we miss anything in our conversation? Did we anger you? Did we make you smile? Call us at 347-SHORTCT anytime or email theshortcoats@gmail.com. It’s always a pleasure to hear from you! And remember that we livestream every recording on our Facebook group, The Short Coat Student Lounge. Join us and help us with our discussions! What an AI thinks we said 361 Your Affective Presence Could Sink You Dave Etler: [00:00:00]Welcome back to the short coat podcast, a production of the university of Iowa Carver college of medicine . I’m Dave Etler. With me today in the studio. I have Emma Barr. Hello. Hi, Emma. And then , uh, I , uh, Oh, good Lord. I don’t know what just happened. Coming to us from the internet. We have Albert Pedroza. Hello? Yeah, it’s still an audio podcast. We have Nicole Heinz. Oh, yeah, the coal Hines. I’m I’m this is a good start. I’m kicking butt podcast and wise today. And we have Holly Conger. Hey there. Yeah. So today we’re going to talk about a touchy subject, a subject that before the show, Nicole said she was a little nervous about Leland. What little nervous. You’re Holly Conger: a little nervous. Nicole. I’m a little nervous. Nicole Hines: I’m always a little Dave Etler: nervous though. It’s fun. Fine. It’s fine. We’re going to talk about personality. We’re going to be, you know, like is being smart, technically proficient, hardworking enough when it comes to a career in medicine, or will I don’t, you know, like I don’t want to broaden it to personality. Cause I feel like that is like, okay. Or will your personality kill your chances at a career as a physician? Now the answer is no, but I want to talk about, the kinds of personalities that make your life more difficult in achieving that goal. But first I do want to say, and this is something I’ve been wanting [00:02:00] to say for a while on the show. And I haven’t really known how, but that is, there is some shit going down in America. And I wish I could help, but all I have is this podcast in my wildest dreams, you have the support, you need to lead a life of your choosing. You deserve to be happy, healthy, and successful in whatever ways you define those words. So if you need support because you experienced racism, discrimination, harassment, mental health crisis, I want you to be able to get the help you need. And so I’m going to put some links in the show notes from now onto some resources, but the bottom line is that for what it’s worth, I see you. I wish I could do more and maybe I can. In ways that I don’t understand yet or know about yet. But I see you and I’m glad you’re here. And other people are too. Thank you. Listener feedback from Coleman about assistant physicians or associate physicians. So common is working towards a nursing degree. With an eye on medical school someday, you heard us talking about students who didn’t match and know someone who wasn’t successful on her first try. Fortunately, she was successful in her second tribe. So, but our discussion resonated with common because of that. I hope I’m pronouncing your name, right? He points out that the States of Missouri, Arkansas, Utah, and Kansas have started licensing a new form of provider called an AP. Or GRP. I’m not sure what GRP stands for. But H AP I think is a assistant physician. He says these are medical school graduates who take step two and get boarded to practice in a legal framework, virtually identical to physician assistants. Hm. It’s just something we’re more familiar with. He said he contacted the state rep and she was willing to attempt to pass it where he is. And several other, other States are working on this as well. And I’ll add verbatim what he said. I’d say medical schools and medical students who you lobby for these laws, as well as raise awareness that such programs exist because they seem to be the best kept secret in medical education almost every year, at least one and four commit suicide after failing to match. If we can soften the blow just a little, we can save careers. Save mental health and perhaps [00:04:00] even save some lives. So yeah, Arkansas, Kansas, Utah. And Missouri. And so I did a little research. We’ve talked about this on the show before. I did a little research, Arkansas these folks practice under the supervision of a physician. I think there is a a naming problem here. I think associate physician or assistant physician sounds too much like physician assistant. Yeah. I would suggest associate MD. How about that? Emma Barr: Do these people like go into that job, working like with the idea of doing it for a year and applying Dave Etler: again? Well, this is what I’m thinking. I mean, maybe I think that’s possible. I think there should be a path going forward. From MD into a full fledged, independent physician you know, say after X years of call it associate MD hood or, you know, you could do your job hunt outside the match just like normal people do. When you think about that. I feel like if you Emma Barr: say you have to do X number of years before you become like a like board certified, that’s basically just yeah. Dave Etler: Essentially. Yeah. Yeah. Okay. Yeah. I’m down with that. And Emma Barr: you have to have regulations over, like, did you see this many kinds of patients and. That kind of stuff. Nicole Hines: So are you, are you recommending people apply, apply for it? Sorry. What was, what you just said where you say people apply for these while they’re also applying for the match or after they don’t match, then they look for these Dave Etler: positions. Yeah. Oh, I think probably the default should be matching. And I, and the reason I think this is because actually the match success rate is actually pretty high. Most people at least you know, like above 90% of people, I think it’s like 94% of people nationally find their match. And we do a little bit better than that. Actually, we do pretty well. So I think that’s how the default should be, but I also think I also feel that we should have a path forward. In some way, and this kind of struck me as like, well, if you provide that path, th WMC, for instance, disagrees with this whole idea they [00:06:00] cite patient safety and I know among physicians, it’s a controversial plan and maybe Holly has. Thoughts about that now that she’s almost a physician I’m willing to bet that Holly does have thoughts. I do. Yeah, go ahead. What are your thoughts? Holly Conger: I guess I’m confused as to what those purpose would be, because I know that there’s usually two groups of people who don’t match there’s those who were, you know, Great applicants going for a very competitive specialty that don’t match that can very easily soap into something else or do a prelim year and apply again or take a research year to go for that super competitive thing again. Or there’s people who weren’t going for anything competitive and for whatever reason that may be, whether they have a red flag on their effort interview terribly or whatever it is, don’t match, even in a non-competitive specialty. And I think those are the people that maybe this is aimed at. Cause I think it’s normal to try and soak. And so like they’re not match rate. I don’t know if that counts people who had the soap or not, or if it’s just straight up didn’t match ever after the soap or not. Dave Etler: Well, again I think this is an alternate path for people who, okay, so here’s the thing. If you have an MD and you can pass step exams and your only roadblock to getting hired for a residency position is well, and your only roadblock is getting hired to be a resident because the system trains several thousand people more than it can handle every year. I think that that’s what I’m aiming for. Holly Conger: Yeah, it was like, there are fewer applicants for the spot, so I don’t think Albert Pedroza: there’s a lot of spots that go and fill every single year. Dave Etler: But why is that? Is it because they do they give up? I mean, this is what I don’t understand. Like did those, those programs could fill their positions if they wanted to. Albert Pedroza: I think so, but I think the issue is with the whole matching process with the whole algorithm. And then I don’t think there’s anything set in place for the ones who don’t match besides the soap. So there’s soap and then. There’s nothing else after, so yes. And then those spots go unfilled, Dave Etler: but again, why do they go unfilled? You can match [00:08:00] outside soap after soap is complete. That is a thing that you can do, but people don’t, Nicole Hines: is it a lack of interest in that specific field? Like, even if you don’t match, but you’re given. Just the one field that you absolutely don’t want to go into. Dave Etler: Well, I mean, that’s possible. I don’t think Albert Pedroza: so because there’s a lot of specialties that go that have spots that are unfilled. It’s not just a few Holly Conger: like family medicine and internal medicine, psychiatry, I think are the ones that always have spots, but like, ER, the surgical subspecialties, like usually they have none. Dave Etler: Yeah. I mean, there are certain, there are certain that don’t have any problem filling their positions, but also there are certain, there are people who want to go into positions that just don’t have that they don’t make it in because the numbers aren’t there for them. And what I’m saying is that, perhaps. Students are making choices about their specialty that are unrealistic, maybe. I think that’s possible, but I also think that you know, the other problem with soap is that the more times you go through it, I eat more than once. The less likely you are to match them next year. Emma Barr: Do you mean like each round Dave Etler: during the soap week? No. No, no. If you go through it next year, again, your chances drop by. Tens of percent. Yeah. Cause it looks like a black Mark and I, I don’t like it. I just don’t like it. I think the whole system is weird. I mean, like we are, on a personal level and after 18 years of doing this, like sometimes match looks like I don’t know, I’m used to the concept. But everybody else who looks at this as like what in the world, Holly Conger: it’s a very weird process for sure. Very anxiety provoking, even when it goes your way, even when it turns out while it’s super stressful, Dave Etler: weird. It’s just a weird situation. I mean, on the one hand, it’s nice because. You know, 95% of people get a position, but then there are those people who it’s kind of a mystery as to why they didn’t get a position. And they’re kind of screwed a little Emma Barr: bit. So were you saying that programs can see how many times an applicant goes through the soap? Dave Etler: I believe [00:10:00] that that is Emma Barr: well, they can tell that they’re reallocate and probably Dave Etler: yes, yes. Now. Okay. So there, I know there are a lot of edge cases. I know this is a weird idea. That I’ve had. But you know, I don’t feel like it’s necessarily a safety issue as the WMC fears. Guess my question would be like, well, let me, let me finish your goal for that person. They’re going to go to residency. My, goal is either for them ultimately, as a career in the thing that they spent $300,000 doing and which they are competent to do based on the fact that they’re graduating from medical school. And they passed. The licensing exams. If that’s what the bar is for being safe enough to practice medicine, to being knowledgeable enough to practice medicine, they have achieved those things. The only thing they didn’t achieve was getting a job after med school and the stakes in that situation are so high to me that we, as a as an industry, I guess, as a system, I feel like we should be providing them with a backup plan. No, Holly sonar, Holly, Holly. Has never bought anything less than what I am saying, right. Holly Conger: To play devil’s advocate on the flip side, you know, if someone is not matching multiple times, you know, I would question why, you know, and I would question like, is that someone that I would want. To take care of my family. Like, is there something coming out and this whole process, that’s like a big red flag possibly, Dave Etler: but it’s also possible that it’s just bad luck. I mean, once you don’t match once that is enough to plummet your chances by a certain number of points. Right? Well, Holly Conger: I think it will, every time you have Albert Pedroza: to apply, but it also has to do with, for example, let’s say you have somebody who applies to 10 different places and they only ranked 10 places I mean, the chances of them not matching is higher than somebody who let’s say applies to 40 places. Dave Etler: Yes you can make it, you know, you can make mistakes. Yeah. In how you rank people, et cetera. And the mistake that you could make is, I mean, basically we tell people during the match, like you have to [00:12:00] rank enough spaces, enough programs to make sure that you match that is your goal. Soap is not a backup plan. And so we tell people that, and invariably some people are specific enough in their wants and needs to have that be a problem for them. And so, yeah. I understand that. I know that there are a lot of reasons why somebody might not match, but the reason I don’t like is the chance part of it. I just want people to be happy. I want people to be happy. Yeah. I know I want people to be, I want people after they’ve spent $300,000 and invested so much money and so much time and so much energy. I want people to have something. I have two Emma Barr: thoughts. So one of them you’re saying that like, once you take your step exams and you graduate from medical school, you’re like quality qualified doctor, but that’s not really true. Dave Etler: What I’m saying is that you’re qualified to be a resident. So you’re qualified. I mean, assuming that this idea gets enacted, you are qualified to be an associate MD. Right. Whatever you want to call it. And you are qualified to practice under the supervision of a resident, right. Of a physician who may not be part of a residency program, but who is nevertheless a physician. Emma Barr: Right. But then if you take that to employers, like that’s not associated with the residency program, they’re not used to, like, they may not be used to having that. So that would be a barrier too. Dave Etler: I mean, I’m not saying that. You know, you propose this, you make it and it fit in and happens overnight. . Holly Conger: I guess I would wonder, like, how do you get them licensed and how do you get them insured? Because you graduated from med school, but you didn’t go to residency and it creates this weird, you’re not board certified. You never trained, like, what are you, what can you Dave Etler: do? Yeah. Well, I think that’s the intent of these laws in these, you know, Four and perhaps growing number of States that, are looking into this, that Holly Conger: comes with it, or just if you dropped a fourth year med student, which is basically what somebody who didn’t match is into a hospital and said, go. You know, they need residency to teach you how to do whatever it is. And so like, I definitely wouldn’t Dave Etler: work that Holly Conger: way, struggling to imagine a path where they can just like, be a pseudo position, [00:14:00] I guess. I just like don’t know what their role would be. Yeah. Well, Albert Pedroza: I think what Dave is saying is that you’d have sort of like an apprenticeship. Dave Etler: Yes, actually, that’s a better way of putting what I’ve said, Albert Pedroza: for example, like somebody who you don’t necessarily have to go to college to become an electrician, they have a program where you work under an electrician for two, four years. And then after that certain amount of time they basically say, okay, you were supposed to learn everything you needed to become an electrician. And I think that’s what Dave is saying, right? Dave, like under a physician. And then after a certain amount of years, you would be. Said too. It would be said that you’re competent to be a physician. Dave Etler: I think that’s it exactly what I’m saying and, and said ever so much better than what I said I know that people would have difficulties with the comparison between, you know, an electrician and a. And a doctor or something like that. I understand that. But conceptually that’s what residency is. Anyway, a residency is an apprenticeship model. It’s just not called that. And the other problem with my idea is that residency is also very structured. You know, in a lot of ways, you know, there are things that you can do as a, as a second year that you’re not doing as an intern. And then there are the classes and things like that. So I know there’s a lot of details to work out. I just want people to be happy. I want people to leave here. I want everybody to leave here with prospects and not have to wait an entire year or more before achieving their life’s ambition. I think I just, I like it. Holly Conger: I agree. And I think that I mean there’s like weird consulting jobs and other things that you could do, but usually the best path is to go to residency. I guess I would just be concerned if you just like eat. All of the regulation of residency and all of the training requirements and careful planning to make sure you’re competent, you know, like that would be very scary to me. So like letting someone just like avoid that whole path and still hold the same title and responsibilities would frighten me. Dave Etler: Yeah. Again, I’m not arguing that there isn’t structure. I’m just arguing for. An additional path [00:16:00] that puts them on the road too. And maybe when I say achieving their dream, I’m, arguing to put them on a path that will allow them to approximate something of what they imagine their life would be like. Let’s, let’s be honest, nobody, In this world, most people don’t achieve their life dreams, you know, like it’s just not a thing. You know, so I guess nobody has the right to achieve their dream, but if you work really hard and you’re a good person and you, and you, embody the ideas and it just doesn’t work out for you. Especially after you’ve paid so much money and so much time and so much effort, it doesn’t seem right. Yeah. Okay. Enough. I have an, I have a whole nother, I’m going to give myself the last word because you all had come up with with very reasonable objections to my plan, but I still like my plan. You’re making Holly Conger: me feel like a butt humbug over here, but like, I don’t Dave Etler: I love you, Holly. Let’s Emma Barr: see, actually listening. I have one more word. That’s what I have to do with that specific idea. I was listening to a podcast on how to give your elevator speech on like a project proposal or whatever. Yeah. So I feel like you just gave us your elevator speech and we’re giving you feedback and you’re not supposed to wait too long into your like planning period. Introducing the idea to other people. Cause then you get too attached to the idea, but you also don’t want to introduce it too early because then you might not have some thoughts I Dave Etler: have. And so what you’re saying is that perhaps have introduced this idea to appreciate that. That is excellent. It’s all been great feedback, like, okay. Like as I said, you all have said reasonable things to me about why this is. If not impossible, at least there are problems that need to be worked out right Holly Conger: now. Emma Barr: You can go work on it and then come back to us. Dave Etler: All right. All right. I will add this to what was I supposed to do last week? There was something I was supposed to fix last week. I can’t remember what it was. This Holly Conger: headphones. [00:18:00] Dave Etler: This is not good. Holly Conger: I know. It’s like licensing. Each state fester rules for how many times you can fail a board exam and still be licensed. And so sometimes I think that is what gets in the way of certain people. Because if you fail step one more than Y you lose a lot of States that you can even be a doctor in. If you fail it three times, it’s even more, you know, like there’s a lot of nuance in there, I think. Yeah. Dave Etler: Yes. Affective Presence All right. Let’s shift gears for a minute, cause I want to talk about something else. That affects your career. I want to talk about effective presence. Do you know what effective presence is? I did not know what effective presences until this week. Anybody, any, any ideas did you read? Nicole Hines: I read the article. Yeah, Holly Conger: I think you could explain it better. Dave Etler: All right. Effective presence is the consistent and stable feelings that an individual tends to leave in their interaction partners. This is an interpersonal trait because it is defined by the experiences of the interaction partners rather than by those of the focal person, which means that you can’t judge this on your own, or you might not be able to judge this on your own. I worry that some people enter medical school with personalities that will make it tough for them to get a residency position or to achieve everything they want to in their careers. And you know, so, one of my questions, you know, was effective presence of factor in the 2021 match. And you know, who knows? There’s no way for me to know whether that’s true or not, but I do know that, there was some decrease in certain categories of people applying to the match in, in their success. And maybe one of the problems that people are talking about is Students spent more time doing clerkships in their own institutions while institutions [00:20:00] were trying to protect their own because they couldn’t go away for match for a residency. They couldn’t go away for a way rotation. Good luck. All residency interviews, you couldn’t go away for a away rotations. And so they had to spend all their time in their home institutions and for some people. And, and so that meant that students had more opportunities to impress their home in institutions specialty decision-makers or the opposite or not. So even though some think that home institutions protected their own by ranking people, they knew more highly it’s possible that overexposure hurt some people who didn’t deserve that outcome. So that’s my thesis thoughts so far. So I’m looking at, you know, like Holly for some reason is, is I’m gonna, I’m going to on the live stream, I’m going to turn a Holly, I turn on grid grid view again, because Holly is the only one looking at me. And I feel like after the first topic today, Holly’s face basically is saying, Dave, Got Holly Conger: trying to say that with Dave Etler: my face. Well, now, now I’m reading into everything hot into every, into Holly’s every expression change. Nicole Hines: She using her eyebrows today. She’s Dave Etler: using her eyebrows very expressively. Emma Barr: Oh, I don’t want to receive that comment again. Holly Conger: Sorry, Emma. Emma Barr: I had so. When I was reading the, the popular ardor article, not the actual manuscript, it seemed like they focused on the negative aspect of effective. What is it called? Effective, effective, present, present. And there were saying like, you know, you can annoy people and things like that. But then when I looked at the manuscript or the study that you sent us, I didn’t read all of it. It was like 54 pages. But they, it seemed like they were talking more about, can be a positive thing or a negative Dave Etler: thing. And it absolutely can be, of course. You know, if you. And, and that’s the point, right? If you, if you walk into a room and people want to interact with you, you probably have, and they know you, you probably know I already have a [00:22:00] positive affective presence. But there are people, and I think we know people, we can probably each, you know, sort of think of people that we know in our lives, who on occasion you’re like, or maybe the instant, they walk into a room you’re like, Hmm. You know, like, I like you. I like you in all. Emma Barr: But I wish you weren’t here right now. Dave Etler: Where’s there other people in your life. You walk into a room and homeowner, no matter what you’re doing, you’re happy to see them. You’re happy for the interruption or whatever. Circumstance there was, Emma Barr: but I’m also wondering, are they also talking about, you know, those kinds of people that can walk into a room and like whatever their emotion is, like, it kind of spreads throughout the room. Like if they’re happy, everyone else can be happy. But if they’re like having a bad day and grumpy, then everybody else is kind of, I don’t know. I Nicole Hines: don’t think that’s what it really is because there was a line in there that said like, Some people could be like super depressed, but they’ll be the positive kind of effective presence. Okay. So Emma Barr: yeah, it’s more constant, like a constant negative or Dave Etler: stable feelings. Yeah. According to the definition they read consistent and stable feelings. Holly Conger: I’ve met people before that just like, I don’t know what it is, but they irritate me and I’ve also met people that I just like really enjoy being around. But those people, I don’t think are always the same for everyone, you know? So I might find somebody annoying, but you might think they’re great. You know? And so I was, was wondering like, how consistent is this across. Dave Etler: I did read something that said that maybe it was what maybe it was the popular article that I posted that, that said that research seems to say that those are, that those feelings are, are more or less stable across people too. So it’s so that the same person that you might feel positive about other people also feel positive about it, but of course that’s not a hundred percent true. I mean, I Holly Conger: think. Nicole Hines: With the people that come to mind for me, it, it definitely seems to be more of that stable feeling that just everybody around kind of gets that energy from them. Albert Pedroza: is effective presence, [00:24:00] essentially? Charisma is what, right? Holly Conger: Hmm. That’s what I was going to say. I was like, I think if you’re like a compelling person or like a good leader, like you’re, you know, you can woo people, but there were Dave Etler: people who. I guess. So, I mean, charisma, I feel like charisma has a, has a connotation for me that is more about public versus private, but maybe that’s, maybe that’s a false, like if you have charisma, you know, you’re, if you say somebody has charisma often you’re referring to there. Sort of like onstage personality kind of thing, but maybe that’s bullshit. I don’t know. I’m not going to say you’re, I’m not going to say you’re wrong. I don’t know. I think it might Nicole Hines: kind of be like social intelligence or like self-awareness type thing. Yeah, because the memories I have interacting with the people who come to mind, it’s like I would be talking with somebody and they would just. Out of nowhere up here and decide that they were hanging out with us and they wouldn’t get the signals that they weren’t really welcome. Holly Conger: They were so emotional, super relevant. Dave Etler: Yeah, exactly. That’s so I was thinking about like, Oh, say, so the problem, as I tried to point out before, the problem is you can’t tell or if you’re let me put it this way, unless you really think about it, it’s hard to tell. What your effect is on other people in this way. So you really have to pay attention, you know, you have to, you know, how do you know how you affect other people? I mean, you have to watch what people do when you talk to them for more than a couple of minutes. If they start doing other things, they start looking at their phone. If they start, you know, clicking their computer mouse or whatever, there’s one of two things that is going on. Either you interrupted them. And they have something that they really need to get done. Or they may be wishing that the conversation is over. The effect is the same, you know, either way. That’s a strong hint to go, Hey look, great talking to you. I gotta go. Nicole Hines: when I said I was, I was nervous at the beginning and something instantly came to mind. This is kind of where it lies. [00:26:00] And it’s that like, you can’t tell whether you have that positive or negative, but if you have like really bad anxiety or insecurity and you already constantly think, or self-critical in any situation that you’re in and you think, Oh, all these people hate me. They’re judging everything. I said, when in reality, They like you have such a good point. Dave Etler: What impact does that have? Yeah, Albert Pedroza: well, I would, I would actually disagree that you don’t, that you wouldn’t be able to know. What sort of presence you have, because let’s say you have people constantly telling you, Oh, you know, good job. Like these people like you, or like, we like you, we want you to come back around. Like, that’s essentially, you’re getting feedback from somebody they’re telling you, like, Hey, I enjoyed our, either our conversation, our whatever. And so I think people give feedback Dave Etler: don’t they. Yeah, we’re not talking about your mom, Nicole Hines: that validation doesn’t always come and it doesn’t always come at the right times. Emma Barr: Exactly. Like I’ve had two clinical experiences where I’m working with a team and I interpret silence or like no feedback as like I’m doing a bad job. Like I I’m automatically self critical. And then I find out, you know, A day, a few days later when I asked her feedback, they’re like, no, you’re doing great. Like, you know, this is awesome. All this like positive stuff. I’m like, why didn’t you tell me, like, I’ve been thinking I’m doing wrong the Dave Etler: whole time is why it’s really hard to know. Isn’t it. It’s, it’s hard to tell. I mean, you almost, you have to ask, which is why you ask, you know, this is why you ask Albert Pedroza: it’s a little bit weird, like, yeah. Cause Emma Barr: it’s like your personality, like Holly Conger: there’s only so much you can change. Dave Etler: Well, look, I mean, there are ways, there are people that you could ask, right? You could, you could pay for a coach if you want it to do. I mean, that’s an extreme, that’s extreme. Possibility. Right. What Emma Barr: do they like follow you around and ask the people Dave Etler: for you? No, but I mean, they could help [00:28:00] you figure it out. They could help you, like for instance, say, you know, well, what do people do when you talk to them for more than minutes? Do they start clicking their computer mouse? I mean, you could ask your mentors, but again, you know, I know what you’re going to say, which is that you know, they’re not always, probably willing to say, well, you know, you’re kind of annoying. Holly Conger: I kind of don’t like you, but I also can’t tell you how to fix it. I think that like emails or whether this is relevant for medical school, but I think this applies to every field, you know, like every field you get ahead of people like you, every field, it’s important to be able to, you know, work with people and get them to want to do what you say and all of that. But I wonder how it’s separate from just like those like social skills and emotional intelligence, you know, like, because. Part of like the biggest feedback people have given medicine is like read the route, you know, pay attention and know when to shut up. And when it’s okay to ask a question when you’re being annoying and then, you know, when the resident can teach you, you know, like just Dave Etler: pay attention. This reminds me of helping my father fix things when I was a child. My father is a lovely man, but he would get very impatient when trying to fix things. And I can understand this because sometimes it doesn’t go well. And then you have a, like a ten-year-old. Like hanging around going what’s that? What’s this? Oh, can I help? Can I help? Can I help daddy? What are you doing? Daddy? And finally, my father is like, I’m like, okay, so this is part of the learning Holly Conger: for me. Emma Barr: So you’re saying that annoying people didn’t get yelled at us kids Albert Pedroza: basically. Holly Conger: Or I wonder if it’s bad, what is it? Bad essence. Bad. that effect, if that correlates to people with like low emotional intelligence or lower social skills. I wonder if it correlates, if it’s secretly kind of the same thing. Dave Etler: I suspect that that is true. Yeah. Albert Pedroza: Dave, did you ever get yelled at for not holding the light in the correct? Oh yeah, Dave Etler: yeah, yeah, absolutely. Holly Conger: Your [00:30:00] analogy is reminding me of like the classic med student in surgery over the med students. Like, what’s this, what are you doing? Why’d you do that? What do you do next? Can I hold this? Can I like get in here? You know, I can, they’re just like back. Emma Barr: And then they’re like, your one job is to suction. Why aren’t you sectioning production? Holly Conger: And you’re like, I don’t know. You yelled at me to get Nicole Hines: One of my interactions with a person that comes to mind and like the social awareness is this memory of being in a class, in a computer lab. And they chose to sit right next to me. And at one point they turn to their left, which is a sign them on and they sneeze. On my hand and they Holly Conger: don’t acknowledge it, Nicole Hines: sorry. Like they just sneezed on my hand and go back to their statistics. And I made sure by them again, I, I wasn’t. Confident enough to address it. I just went and washed my hands and came back and got my work done. I didn’t want to deal with that. I’d already had enough run this person. It was only spring semester of freshman year. Dave Etler: That’s the kind of thing though. I mean, recognize when you’ve made a mistake, right? Because we all make mistakes. I mean, I know like what was it just the other day? You know, I had yet another brilliant idea. I always joke that I’m so full of good ideas about how to improve medical education, but nobody ever thinks they’re good ideas, you know? So I was walked into somebody’s office. I think it was Matt Edwards. And I was like, Matt. Got a great idea. Let me tell you all about it. And. At some point, I can’t remember what he said, but he said something that to me was like I have things to do. And so at that moment I was like, Oh, I wonder how, how long I’ve been unwanted. So as I left, I cracked a joke about, I basically said, you know, I’m sorry I took up your time. Kind of thing and cracked a joke cause I left and he laughed and hopefully that diffuse [00:32:00] the situation. But the point is that, you know, it’s possible to make mistakes. That’s fine. Hopefully if you have the humility to admit that you screwed up, that you sneezed on the hand of the person next to you. Emma Barr: Like if you, if you recognize how socially inappropriate you were, it’s not as bad. Dave Etler: Cause you’re gonna make them, you’re gonna make mistakes. I bet Albert Pedroza: to say that that person did that sneezed on your hand, didn’t even know what was like socially acceptable or not. If they’re just Emma Barr: were, they were trying to get back at you Nicole Hines: interaction with them. so right when I got to college, I went for band camp. And we hadn’t even activity. So I went on a walk with my, who is my best friend now, and this person decides that they’re coming on the walk with us too, except they’re on the phone talking to somebody. So they’re trailing like 10 feet behind us talking on the phone, telling them that they’re going on a walk with some people from the Dave Etler: wow. Nicole Hines: Oh, what’s going on. Like, we didn’t ask them to come. They’re saying they’re with us. And then once their call ends, our conversation just kind of dies and they try to join in and we’re just like, Dave Etler: we’re done walking. I feel Holly Conger: like I’m just like an anxious person. So I like kind of always watch how like people respond to me. And therefore if I pick up on signals that I’m annoying them, or this is not a good time. I quiet down very quickly. And some people, I guess, just like don’t. Yeah, but I think maybe that’s part of being like the teachable and like noticing thing, which being teachable is a big skill, but I didn’t realize it till I came to med school. You know, like being able to learn and Institute feedback is something that a lot of people can’t do which is probably part of this, because I’ve asked a question at the wrong time. I’ve been told that now is not the time by a resident, but then you just like learn the pattern [00:34:00] of Oh, Don’t do that again. Dave Etler: Yeah, I, yeah. I mean, absolutely. Again, you know, this, the cues sometimes are hard to read depending on the situation. And, and so, you know, I learned that dad under the sink means shut up. Yeah. You learned that whatever situation you’re in with that resident or in that situation, you know, Probably there are better times to, to ask questions or contribute your observations or whatever. But I, you know, like I want this to not be important, you know, like I want this to not be important, but my gut says that it’s important. You know, and I think probably 99% of people who get into medical school, you know, have already have some, some facility at this. But I think it’s possible that man, I don’t even like, I don’t know if 99% is the right I get. Yeah. Okay. What the hell? Let’s just a number of people who get into medical high number of people get into medical school already have this unlock. But that can’t be true for everybody. And so I just thought it would be. You know, good to talk about, you know, because the, the stakes are kind of high, right? I mean, I, I don’t know what the actual number is, but I suspect. That, you know, let’s say 99% of medical students eventually match. Okay. And it will, but it will cost you hundreds of thousands of dollars in education to achieve that. And there are no guarantees that, that even if you get to the point where you’re ready to match that you will match. And in fact, if you aren’t successful in the first trial, you have to wait. And you know, all the things that we talked about earlier in the show will happen. Would you even want to take the chance. I think if Albert Pedroza: you go a little bit further, you can think about the responsibility that a physician will have in the future. And I know that sometimes it’s a little bit. Easy to not think about it, but really essentially what you’re going to be doing later on is you’re going to have to take care of another human being and you have to be willing to work under a high pressure, high pressure situation. And you have to be okay [00:36:00] with, for example, if you do something wrong, getting corrected, if you do something that you weren’t supposed to do, getting corrected, receiving feedback, because it’s such a high stakes profession. Dave Etler: Yeah. And, and of course also that, you know, if you, even, if it matched, even if matching isn’t, you know, a problem for you, you’re still going to have to interact with people and be a part of their lives. And, and would you rather, you know, for instance, patients. Seek you out if they need your help or would you rather than be like, Oh, that sucked, I’m going to go. Or, you know, would your, would you like knowing that your professional colleagues at least tolerate working with you, you know, like, or are they, or instead of avoiding you, like, anyway, Emma Barr: another question I just thought of like, is how quickly does that affective presence come out? Like if you have like a, okay, so if you have a 15 minute appointment with a patient. Are they going to not like you instantly Holly Conger: see what I was thinking about is what, if you ever, 15 minutes residency interview. Yeah. That Emma Barr: too, or like over zoom too. Dave Etler: Yeah. Yeah. I think it, I think it comes fairly quickly, but you know, there is a, there, my guess is from my own sort of feeling about this, my guess is that there is a. Sort of a process of confirming, confirming that idea, like Emma Barr: the person interviewing you or the patient, shouldn’t be so quick to judge you. Right. I Dave Etler: don’t think anybody’s going to immediately shut down, but people form their ideas pretty quickly. Right. Actually Holly Conger: I think in residency interviews, that’s exactly what they’re trying to do. I think the main, their main purpose. Do I like this person, you know, like they don’t care anymore about scores or all the activities on your app or your personal statement, because they’ve all reviewed all that and decided they liked it enough to offer you an interview. So the interview is pretty much exclusively about, do I want to work with you? If I am on a night shift with you at 2:00 AM, are you the type of person I want to get to talk with? Or am I going to want to just like bang my head against the wall? Because you won’t shut up for like, I don’t like you and blah, blah, blah. And so, like, I think that’s [00:38:00] exactly the purpose of residency interviews. It’s just a little scary. Albert Pedroza: So let’s say, we’re saying that 15 minutes is not enough. I mean, what timeframe would be enough, you know, so, I mean, if somebody doesn’t get a good feeling about you within 20, 30 minutes, do you want them to spend a couple of days with you a couple of weeks? Dave Etler: No. Holly Conger: I mean, I think that’s kind of like the away rotation argument that gives you more chance. To meet more people for a longer period of time, for better or for worse, you know, like it could work Dave Etler: either way for you. Less is more if, if you have this problem Holly Conger: but like for instance, the interviews, I think whether they’re zoom or in person, they’re usually about 15 minutes. Some of the longer ones are like 30, but like, so they’ve clearly decided that that’s enough for them to decide if the interview changes, how they view you. Like, I think for some people it’s like, wow, I really like this person. I’m going to move them even higher up. Or sometimes it’s like, wow, I really did move down. Or sometimes you stay the Dave Etler: same, but w w you know, I guess the question is, what can you even do about this? I mentioned like, you know, coaching, ask a mentor, all this kind of stuff. you know, I think You’ve got to figure out what it is that you’re good at and what it is that you need. Help with, I mean, one of the things that I know that I need help with is that I, I would imagine that sometimes my jokey, you know, personality is like, you know, shut up, Dave. Holly Conger: I’ve never really thought that Dave Etler: to be context here is important. Holly Conger: In other situations that’s Dave Etler: podcast, you’re trying to get I’m serious done. And there’s Dave Etler in the corner crack in his little jokes, you know, I can imagine. And the other thing that I do that I’m pretty sure is detrimental, but I don’t, I’m not sure that I can. Care is I’m a bit self-effacing and this can be a turnoff. I know. I’ve heard people on the show say, you know, that they were told that they were too self-effacing and that it was kind of a problem because, you know, it gives people the idea that you are in fact. And ineffectual bumbling [00:40:00] don’t know, puts that in their head for you. And the truth is that that a self-defensive, that is a self-defense mechanism. Hello. That’s a self-defense mechanism for, you know, like heading people off. So it’s best not to do too much of that. In my opinion, one author says one author and the proprietor of smalltalk science.com says that the best personalities are humble, caring and unselfish, positive enthusiastic goal-oriented and compassionate, playful, and flexible. I can buy Holly Conger: that’s a lot to live up to all just like likable characters. Dave Etler: Yeah. And I would add. And I think we’ve, I think Holly said this before in the show, I would add that some of those encompass the important skill of learning when to leave the room to stop talking, to receive in the background, you know, flexibility, for instance unselfish caring. Those are two things that I think link up with this skill of being like, you know what I’m going to shut up now. I think, Holly Conger: you know, being able to recognize you’re not the center of the universe is always important, you know, but like sometimes other things take priority over you and. I think one thing that Nicole pointed out that I’ve, or maybe it was Emma, I don’t remember. Like when you interpret silences that hate you is I really did that a lot as a med student too. And it wasn’t until I started being like the more advanced student on rotation, where I started to realize, like, you’ve just got a lot going on, like the closer you get to a resident and it’s not that you dislike the student or they’re doing bad, or you hate them. Sometimes you just like. Forget, you get distracted doing all your other stuff and the anxious student that projects like this be to add onto them, which happens a lot. But yeah. Yeah. Which I guess I say to try and save students from doing exactly what it sounds like we all do Dave Etler: part of the problem in that situation is that you’re expected to put yourself out there. Right. You’re told I’ve. And in fact, I’ve said on the show, you know, if you don’t talk, nobody’s going to know what you know. And so there’s a bit of a conflict there. I, I understand that. But again, read the room. Hmm. Nicole Hines: I’m still curious whether This affective presence is the same in person or virtually because with people with negative presence, I’ve always [00:42:00] felt just like zapped and drained. The moment they come around and it’s almost like an energy they bring to the room, but. Does that same energy come when they’re across the screen, because like we’ve used the term when they walk into the room, like when I sign into the room, do I bring that same feeling to people don’t know. Dave Etler: Yeah. That’s a good question. Emma Barr: I feel like it would be, have to be super strong if you’re just sitting. If they’re sitting there, like, I don’t know. I guess their Mike might not be off. Maybe they’re un-muted Holly Conger: why I wonder Nicole Hines: if at that point. If you already see this person in that way, then every little thing they do is annoying to you. So if you already see somebody from personal interactions like one-on-one or in public, then you see them virtually you’re going to overanalyze every little thing they do. And it’ll just be more, Dave Etler: yeah. It Holly Conger: feeds on. I think the only experience I have to try, and I guess it’s like the zoom interviews because I had to do a bunch of them with people I’ve never met before. And there was definitely ones where I connected really well with the interviewer and I felt like they were going super great. And I really liked the person, but know I definitely had some really awkward. Awful ones that I was like, looking at the clock, like how many minutes do I have, like, try and keep going with it. Nicole Hines: What if your interviewer has a negative effective presence? Well, how did they get to that Holly Conger: position? Dave Etler: Well, that’s a problem because you’re also trying to judge, I mean, the other part of residency interviews is you’re trying to judge them. Holly Conger: Like, it’s all about fit, which I’m hoping, like, no matter what your presence is, you’re supposed to find that people who like you and want you, like, that’s the whole point. So hopefully. You just find that, I don’t know Albert Pedroza: if this was true or not, but didn’t they say that. During some med school interviews, they would purposely try to have like a negative presence to see how you could alter that presence. I don’t know if that Holly Conger: was, so now we’re getting that at one school. Now we’re getting Dave Etler: into some science [00:44:00] bullshit right here. Holly Conger: When I interviewed at one med school, you know, four years ago or whatever it was now I was in the interview room and all of the lights shut off halfway through my interview and like, wouldn’t come back on. And I remember being like, is this attached to adversity? If that counts like unexpected stuff. Dave Etler: You know, one thing that I appreciate with awkward people is that, you know, I’ve, I’ve known some weird people in my time here and in my life. And I think the ones that I love the most are the ones who knew that they were weird. I remember one person even thanked me once for sincerely, for pointing out a full paw and seemed genuinely grateful for the feedback, which I found super endearing and made me love that person even more. So I think it’s possible to be awkward and. Have trouble reading the room, but also be somebody people want to be around. I genuinely liked being around this person, even though. I worried about them. Holly Conger: Maybe those are the people that I would worry about on like a quick interview, like them getting to know them to find them endearing. Yeah. Dave Etler: I think this is the key, like display sincerity, self-awareness humility. Those are the three things that I think could take the curse off. An otherwise problematic, effective. Presence. Holly Conger: Some of my favorite friends have what I call like a really strong sense of self, which I think is what you’re getting at, where they, they know that they’re a weirdo, but they’re, that’s who they are and they don’t make any apologies for it. And that’s who they are. And they still don’t want to irritate people, but this is just who they are. And so sometimes I really liked those Dave Etler: people too. Yeah, making the effort, I think is important too. You know, like, you know, it, it, to the extent that you are aware of a problem, if you do nothing to ameliorate that problem, and that’s obvious to the people who know you, maybe that’s kind of, that’s kind of an issue. I think one problem I have with this thought and that you’ve sort of touched on Holly, is that if I argue that you should focus on [00:46:00] the ideas and am I saying you aren’t great. Just the way you are. Is that a valid thing for me to say? I mean, I’m not saying that you suck, I’m saying that you have a choice that you can be unapologetically. Awesome. Just the way you are and understand the consequences of that choice or that there might be consequences for that choice. Or you can try to make changes that enable you to achieve something that you want to achieve. Both ideas are valid. Holly Conger: I feel like you can be unapologetically yourself and know that and know that that makes you really great in a lot of situations. But I think that also takes awareness in which situation maybe some of your personality traits are not great. Just like take some awareness, cause nobody’s going to be. Perfectly suited for every situation. Yeah. Dave Etler: I’m pretty sure that the reasons that I’ve stated about myself as being a problem or the reasons that I have never once been asked to help with resonant with a med school interviews, even though I have offered, because I think that they think I am going to sit there and crack jokes the whole time. And, and just be, not serious about it when, in fact, like I believe that I can go in there completely serious and then completely professional about it. I just don’t show them that side of me too often. I’m the, like the least professional Emma Barr: you should offer to do a mock interview. Dave Etler: That’s a good, that’s a good point. Holly Conger: Maybe it’s, they’re worried. You’re just too nice of a guy that a really horrible student can interview with you and you just like won’t write anything bad. That’s true. Dave Etler: I’ve kind of made it. No, I’ve kind of made a note that I love everybody. Emma Barr: You just said you wanted everybody to be happy. So Holly Conger: apparently David said dove, and maybe I’m the hock. Dave Etler: You and I should interview people together. Etler team. Yeah. For Emma Barr: anyone who’s listening. If the lights go out, it is a test Holly Conger: to make sure, to just pretend it’s not a big deal. Be nonchalant, adaptable. [00:48:00] How would it Nicole Hines: go over if you’re in one of those rooms with like the motion sensors and your lights go off and you just flood your heart a little bit and then pick up right where you are, what just happened, Holly Conger: whatever you gotta do. I don’t know. Dave Etler: There is a special subgroup of personalities that I wanted to also address which is people who don’t suffer fools gladly students who don’t suffer fools gladly. This is a problem because fools are everywhere. They are. You know, among the residents there among the attendings there among, you know, every, every, you know, like those people are out there. And so I have some advice for those people who I have also loved. Never let them see you. Roll your eyes. Wait, can you Emma Barr: explain, go back a little bit. What do you mean by fools? Dave Etler: I E you don’t like what somebody is doing or. How they approach the world or how they think about the world. And so you’re a fool. And so basically if I thought that Emma bar, we have to clarify camera here, if I thought the Emma bar, if I thought that you am a bar where a dumb ass, but you were like my resident or my attending or whatever, there are some people out there I have known who. Find it difficult to conceal, that sort of emotion, that sort of frustration or annoyance. So that’s what I, that’s what I say. Like you don’t suffer fools gladly. And if you can, if you let them see you roll your eyes, I said, all right, if you let them see you roll your eyes, then they’re going to know that you think that they’re foolish and that’s not good. Decide if you have to speak up. There are dangerous situations and ethical issues and things like that, HR problems, you know, things like that, that you, you know, might reasonably think that you [00:50:00] should speak up about. And again, you should know the consequences. If you do that, especially if the person is of a higher status. So if that’s what you’re going to do, whoever you talk to about this, whether it’s that person or somebody that has control over that person or something, give your feedback with sensitivity and love or don’t give it at all. That’s my advice. Figure out how to say it so that people will deal with the situation in a constructive manner. Offer a solution with feedback, with offer a solution with the feedback. Or if you don’t know what that solution is, at least say that, like, I don’t know what to do about this. Maybe you have ideas. Hmm. So is the Albert Pedroza: person who rolled their eyes? The one that’s Dave Etler: clearly I’ve clearly confused, used a confusing term Holly Conger: for which I Albert Pedroza: it’s the one who’s rolling their eyes. The one who’s also giving the feedback. Yes. Okay, Dave Etler: I follow you. So I guess the point is like, if you see something that is truly a problem, dangerous situations, ethical issues, HR problems, things that are like serious situations that should be addressed, offer your feedback with love and sensitivity. While knowing that there could be consequences. And if you can’t live with those consequences, then you have to make a decision on whether to speak up or not. But the point is give your feedback. Sensitivity love step back, consider your job done, you know, and then wipe that wipe that look of contempt off your face because that’s, yeah, Emma Barr: sometimes I feel like it’s hard to tell whether it’s like just a personality thing or like what they said or did was actually like something concerning. So like when I’ve been in that situation, go to like a third party and be like, does this sound, you know, Yeah. Concerning to you. Dave Etler: I don’t know. I just wipe my nose on camera. Anyway. Those are my thoughts. Emma Barr: I’m trying to remember when you said the rolling. I think rolling ice thing. I think I’ve gotten in trouble for rolling my eyes at somebody you in your eyes. I know I did my eyebrows. Holly Conger: I know can’t [00:52:00] remember the example. I think being able to give them like, Quote, unquote negative feedback is also a tremendously undervalued skill. Cause I think a lot of people just like won’t ever do it, which is a problem. You know, cause if no one ever tells you anything you’re not doing well or could do better than you never know what to work on. Hopefully they deliver it in a constructive way, Emma Barr: to do the positive sandwich thing, Like part something positive, then the constructive and then more positive. So hopefully you leave them with a good, yeah. Dave Etler: Like I really liked the way you do X, but you killed that patient. But good job on that form. Holly Conger: Good job on the death certificate. Dave Etler: All right. That’s our show. Albert Emma, Holly, Nicole. Thanks for being on the show today with me. Thanks for putting up with my harebrained ideas, Holly, especially, Holly Conger: I, I want people to be happy too. I just thought I want patients to be safe. So I was pointing out this, the concern. Dave Etler: Whatever. And what kind of, and what kind of games gallbladder would I be if I didn’t. Thank you. Shortcodes for making us part of your week. If you’re new here and you like what you heard today, subscribe to our show. Wherever fine podcasts are available. Our editors. They’re AJ Choudhry and Erik Bozart Alex Belzer, Al Alex Belzer is our marketing coordinator show is made possible by a generous donation by Carver college of medicine, student government, and ongoing support and the writing and humanities program. Thank you. Writing in humanities program. Loved those guys. Our music is by Dr. . Don’t let the bastards get you down. Talk to you in one week.

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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