Navigating Future Physician Career Paths

Podcast Transcript

Dr. James K. Stoller:

Hello and welcome to MedEd Thread, a Cleveland Clinic Education Institute podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise.

Dr. Tony Tizzano:

Hello, welcome to today's episode of MedEd Thread, an Education Institute podcast, exploring career advising at Cleveland Clinic's Lerner College of Medicine of Case Western Reserve University. I'm your host, Dr. Tony Tizzano, Director of Student at Lerner Health here at Cleveland Clinic in Cleveland, Ohio. Today I am very pleased to have Dr. Stacey Jolly, associate Professor of Medicine and director of career advising at the Clinic's Lerner College of Medicine here to join me. Stacey, welcome to the podcast.

Dr. Stacey Jolly:

Thank you, Tony.

Dr. Tony Tizzano:

Stacey, if we can get started, just tell us a little bit about yourself, your educational background, what brought you to Cleveland and your role here at Cleveland Clinic.

Dr. Stacey Jolly:

Thank you again, Tony, for having me here. So, I grew up in California. I am the first in my family to go to medical school. I attended a school on the West coast at Stanford. It had actually a program somewhat similar to Lerner at the time. Lerner wasn't around, I probably would've been interested in it. It allowed for five years, which allowed me time to kind of explore, again, not really knowing what all the medical field had to offer. And at the time I thought I was gonna do pediatrics. That was kind of all I knew, again, being the first in my family to go to medical school. And then as luck would have it, the way rotations went out, my first rotation was an ambulatory outpatient internal medicine rotation. And that's when I saw one for the first time, physicians that were of minority background caring for patients and caring for them over a long period of time in a clearly nice, compassionate manner.

And I then started to explore and think about internal medicine and from there went on to do residency at UCSF in primary care at our San Francisco General Hospital, the county hospital there. And after that, during the time I really couldn't think of anything else but doing clinical work. And it wasn't until after finishing I had had a daughter during residency, I was pregnant with my son after I knew I wanted to get back into academics. I had been influenced so much by people in my career that I wanted the opportunity to know what that was like and influence others. So, I went back and did a master's in clinical research. At that time my husband was finishing his career as a PhD and a postdoc. He was searching for a tenure track science position, and we found Case Western, and things have been, you know, wonderful since. So, I was able to secure employment at Cleveland Clinic and been here for almost 15 years.

Dr. Tony Tizzano:

So That's great. So, you know, you had an opportunity to explore a different area, which is always good to bring to your current position, experience from other places. And the rest of your journey was one of love and money.

Dr. Stacey Jolly:

Yes.

Dr. Tony Tizzano:

And so that's fabulous. So, in today's segment we'll explore the important role and the really art and science of career advising for medical students at the Cleveland Clinic Lerner College of Medicine. If you could help us frame the topic and the importance of career advising for these students.

Dr. Stacey Jolly:

So, I think this has been really a wonderful thing that the AAMC has brought to students can reflect back. And I had no idea what a career advisor was. There wasn't really career advising. Again, it's probably by happenstance of how I ended where I am and thankfully love it. But I think that there's now more intentionality on trying to help students really align with their goals and values and what sort of a career they're gonna enjoy for 30 plus years. And so, the AAMC has a series of information, surveys, website available to all medical students. And then I have the opportunity to really help students work through all of that information as well as their experiences as a student here at our college program to ideally have them align with their specialty of choice and match successfully in their specialty of choice.

Dr. Tony Tizzano:

Well, you said it, work through all this information, and I think that's the key. Historically, when you and I were looking, I don't think there was really anything like this and now it's become part and parcel. So, is it safe to say in the past this might have been a bit hit-and-miss and as you pointed out now much more intentional? What are some of these programs that are available for students to look at?

Dr. Stacey Jolly:

Absolutely. So, they have a medical specialty preference inventory and that has been around for a long time to allow students to answer questions. And the survey will spew out a list of top 25. Some of the specialties may get zero from a student and some may get a three or four per each depending on the student's interest and experience. And that can be taken over time. And that was certainly something available for a while. But now they've added on additional surveys knowing that so much of medicine is more than just the knowledge, but what do you value in terms of caring for patients over time, being the best in your field, having a work life integration or balance? Do you thrive in academics or more in the community? So, kind of trying to align those values as well. As we know there is many choices that some of the surveys kind of help students work through that indecision. There are many things in our lives that we may have indecision about. And so, it's just another tool to help them try and tease out if they are perhaps say conflicted on do they do neurology or neurological surgery? Right. Somewhat similar alignment of system, but you know, different work and venues and residencies yet overlap. So yeah.

Dr. Tony Tizzano:

So, there's a lot of explore yourself in this and try to help you understand yourself when sometimes we just don't take time to reflect. Although at Lerner, I think reflection is part of the DNA of the program. Is this advising that you pursue and others with you a kind of one and done? Or is this a more protracted and graduated process?

Dr. Stacey Jolly:

Yeah, so I have the pleasure of working with the students starting with their first year and I get to work with them over their five year. Were again, starting in the beginning as you alluded to a lot of exploration, a lot of having them get to know themselves. The first two years they have varying experiences in the PBL setting with our art and practice of medicine, with our research seminars, shadowing their clinical and basic science. And then I get to work with them in clinical rotations as well. That might be a time where it may affirm or change, and a student may pivot to a new career.

And then in our fourth year I really help them focus on how will their fourth year of thesis research, you know, set them up for their specialty of choice as they start to prepare in their fourth year. So many things in medicine now have been shifted early, so it's really at that second half of their fourth year we start to work with them on preparing to apply to residency. And then our fifth years, we help them all along the way in applying from understanding the application, the parts mock interviews and match day.

Dr. Tony Tizzano:

So many, many parts and pieces I can see to what might be available. So, when you look at these various student interest groups and what have you and you're trying to help match mentors or advisors with these students, what does that process look like? Where do you go for resources here?

Dr. Stacey Jolly:

So, we have a wealth of resources. We have so many faculty that want to work with our students. And so, some of it is through those interest groups when they have faculty speakers. Some of it is through the larger Case Western University program, mini mentoring sessions and specialty panels of which physicians and surgeons from all four of our kind of academic health centers are invited to come and share their experiences with our students. And then it's in those one-on-one meetings as I get to know the student and if they have say an interest in perhaps pediatric orthopedic surgery, then I might suggest some colleagues that I know to reach out to for potential shadowing or talking about what is a day in their life like.

Dr. Tony Tizzano:

So, there's all kinds of alternatives. In terms of special interest groups, for example, women in medicine or LGBTQ plus physicians, are there venues for that sort of input as well?

Dr. Stacey Jolly:

Absolutely. In the sense of making sure that students are involved in organizations and activities that they find meaning and purpose in. And then from there that may be an avenue for them to meet with a mentor or mentor in a specialty that either they're exploring and or have a very strong interest in and they can continue to build that mentor mentee relationship.

Dr. Tony Tizzano:

That's excellent. And I know when we were first chatting and you were educating me about the process, you mentioned it's not only exploring what's familiar but also perhaps what's unfamiliar that they may not have thought about. Because even though we spend four and five years in medical school, we don't always get exposed to everything, but you have a much broader perspective that you can bring to the table with the help of others. You know, do you see that as an important or key point?

Dr. Stacey Jolly:

Absolutely. I think that's probably one of the parts I enjoy the most, particularly in the first year as students complete their medical specialty preference inventory. I like to go through at least their top five and hear from them did the results come out as they expected or as not. And if there are specialties on either the top five or the full 25 that they aren't familiar with, and we talk through and certainly encourage if they may align with their interest that you know, ways to explore that further.

Dr. Tony Tizzano:

Have you had cases, and I, I'm still amazed that they go over 25 specialties in this inventory will be ranked, so to speak. And is there ever a time when a student, you look in at the top of their list, here's this specialty that they're like, wow, and they have a eureka moment, has that ever happened?

Dr. Stacey Jolly:

It has in the sense of it seems to align with their current experiences to date. So, for instance, perhaps if a student has done a lot of bone related research or worked in, you know, surgical outcomes research prior to coming into perhaps the orthopedic surgery is number one on their list and matches it almost 80 percent, then it certainly affirms what they're interested in and trying to help them along that path. And then it's exploring the other four under and how do they perhaps fit or not fit in with what they're currently thinking about and wanting in a career.

And the other part that I also like starting that first and second year is the way our curriculum is set out in the systems-based approach and the first year a lot on the kind of normal physiology interplay and then the second year on the more pathology and pharmacology. And so also having students pay attention to in a systems area, are they more excited with the cardiovascular system or more excited over the immunology system? And then within those systems there are many fields that one can impact on the health.

Dr. Tony Tizzano:

So, along the way, you also had mentioned something that sparked my interest and that was the speed mentoring.

Dr. Stacey Jolly:

Yes.

Dr. Tony Tizzano:

Tell us about that. I think of speed dating when you say that.

Dr. Stacey Jolly:

Yeah, so we are career advising and office of student Affairs partners with our university program colleagues and all the other academic health centers that are affiliated with Case. And so this is a two day recently happened on a Thursday evening and a Saturday morning where this is open for residents, fellows, and faculty of many specialties to come to the health education campus and students can then go from table to table in a quick fast speed approach, but have the opportunity to, you know, ask directed questions to the residents, fellows and faculty there. And it's a really nice thing. In fact, you know, anecdotally as I was walking over here, I ran into one of my residents who was sharing that he went to the speed mentoring and how much he enjoyed being able to talk with students about internal medicine.

Dr. Tony Tizzano:

Might they actually connect with a mentor during these?

Dr. Stacey Jolly:

They certainly have the opportunity they could exchange you know, emails or.

Dr. Tony Tizzano:

Well, you know, there are all these pieces, but one of the things that is unique to Cleveland Clinic's Lerner College is this research year.

Dr. Stacey Jolly:

Yes.

Dr. Tony Tizzano:

And you know, how do you help them perhaps maybe hone in on an area for research and then identify a mentor in that area to help explore what they might be doing?

Dr. Stacey Jolly:

So, the wonderful part about our college is that students have many advisors, physician advisor, research advisor, career advisor. So, I will often talk with students about their relationships with the research advisor in the terms of have they found a mentor in their research area and if not brainstorming on ways and how to do that. And then I like to take an approach around part of their exploration for career wise is are they finding that, are they enjoying basic science or translational research? And perhaps are they seeing mentors that are practicing in say, an 80 20 approach or a 50 50 approach, or are they more interested in clinical research and enjoying the outcomes based or epidemiologic type research?

And then with that, depending on their area of interest, making sure that they are connected with research mentors. And as their career changes, which it can often do between the first and third year is trying our best because of, as you alluded to, our focus on training physician scientists or clinician investigators, our students have that fourth year of thesis level research. And ideally in the first half of third year, so kind of winter of third year, they have a pretty good idea of what they would like to go into as a specialty. So that way they can set up that fourth year of research in an area where they will get phenomenal research mentorship.

Dr. Tony Tizzano:

Yeah, I just, I just love the detail of this program. So outside of all the science, the nuts and bolts of medicine, one of the other inventories or scales that we talked about, uh, earlier were the physician's values and practice scale and, you know, asking these meaningful questions about what satisfies oneself. Tell us more about that. Because that to me is nothing, I, I never considered anything like that in selecting a specialty, but I can look back and think of how important it was that I landed where I did.

Dr. Stacey Jolly:

Absolutely. So, it is a survey that was developed by the AAMC careers in medicine. It takes about 15 minutes to complete, and it does allude to thinking about are you motivated by longitudinal relationships or perhaps quick fast solving of things? Are you motivated by being in a community or an academic setting? Are you motivated by having the ability for maybe a control of hours versus not? So, in that regard. And then the nice part is, is unlike the medical specialty preference, which kind of lists out the laundry list in somewhat of a rank order, this is more of a gestalt of, based on these values here in parentheses are say five to seven specialties that may align with it.

Dr. Tony Tizzano:

Yeah, I think that is so key. I think of obstetrics in general and are, are you willing to live with baby time versus your time?

Dr. Stacey Jolly:

Yes.

Dr. Tony Tizzano:

Because you know what takes precedence there. So, in addition, we also talked about physician skills inventory, which again, you know, what is your hand ability, you know, do you have a surgical touch? How, how do they measure that?

Dr. Stacey Jolly:

Yeah. So again, this is another survey that is used that asks about, you know, enjoyment of say motor skills or fine motor skills, comfort level with perhaps wanting to know an answer right away. Thinking of say perhaps in emergency medicine stat labs versus perhaps say in my world of outpatient internal medicine, some ambiguity, right? A person may come and see me, I may not order labs, they may not get them for another week or two. Then is it about, are you perhaps more wanting the longitudinal relationship and to make meaningful changes over time or like the quick anything could come, you know, through the doors or anything could come into the operating room and wanting to make a difference in that regard?

Dr. Tony Tizzano:

Yeah, boy, again, uh, it's just fabulous to see all of this coming into play. So now finally we have all these pieces. I think I'm good with my hands, I've got these few specialties, I've got this lifestyle thing pinned down, but I'm still scratching my head. They have a specialty in decision scale.

Dr. Stacey Jolly:

Yes.

Dr. Tony Tizzano:

Tell, tell us about that.

Dr. Stacey Jolly:

Yeah, so again, that gets to as we talked about perhaps like say neurology versus neurological surgery in that similar system perhaps could still work with a breadth of age ranges. And so, here's a scale that kind of gets to at where are you in terms of readiness for making decision where some of the hangup over the decision and helping with thought process or next steps on how to help with that indecision.

Dr. Tony Tizzano:

Okay. So, we honed it down and we're kind of looking at which school and what residency and so on and so forth. When you consider the various professional organizations and societies, what kind of opportunities might exist there to help students?

Dr. Stacey Jolly:

Absolutely. So this is a wonderful part for our students, particularly because our students are such research focused, do amazing scholarly work that I do encourage them if they have the chance to submit abstracts to regional or national meetings, this is a wonderful way for them not only to get feedback on their research, but also to see what is the specialty like outside of our Lerner college walls, outside of the Cleveland Clinic and you know, and see how is the specialty, where do they see the specialty going? Are they excited by the other posters they're seeing there, the other talks there? And also, an opportunity to meet other like-minded students, resident's residency programs. It's just a really wonderful opportunity and many of our students have the chance to do this through their research or, uh, we have also had students apply. There are some societies that really want to encourage students into their fields. And so, our students apply for say, travel-based scholarships to be able to attend a national meeting and get, you know, connected with mentors that way.

Dr. Tony Tizzano:

Boy, that's incredible. You know, one of the things I was very fortunate about is being able to do a poster presentation. And you mentioned this kind of speed mentoring. Well, it was nice because in posters of course it takes very little time to get a sense of what something's about. But moreover, when you're standing by your poster, you have professionals, maybe other students coming by, people already in the field asking you questions and you're face-to-face and that you're not just answering something online or being quizzed on a piece of paper. But I think that's, I think you hit the nail on the head. That is an outstanding opportunity if students can have that. So now you get all the way through year four and it's time to apply for residency. What does the assistance at that level look like, the advising?

Dr. Stacey Jolly:

Yeah, this is the time where we really do a lot of class meetings. Myself and my colleagues, Dr. Bryson and Dr. Warren, a lot of working through the parts of the application in particular this year. And ERAS for the first time made major changes in terms of limiting the number of experiences, the ability to select up to three meaningful experiences and other changes that we then in class meeting format allow students to learn and ask questions. We have individual meetings, the students are meeting with the dean, so Dr. Warren and Dr. Isaacson for their dean's letters as well as then there are meeting with their faculty mentors and research mentors around their general letters of recommendation.

So, we also provide guidance and insight about letters of recommendation, asking for letters of recommendation and follow through on the letters of recommendation. We do a workshop on personal statement and really helping the students realize that it is part of an application, in particular with many programs doing holistic review, how can they really tell their story of why that specialty is the one for them? And so, we also do reviews of their personal statements. Then we move towards the interview stage where right now the vast majority do virtual interviews, so we help with mock interviews. This is another thing that we partner with our colleagues at the university program.

There's currently one specialty orthopedic surgery that does in-person interviews. So also guiding our students that may be applying in a specialty that is doing in-person. And then as they get through the interviews, they have to decide based on those interviews, which places seem like a great fit for them, and they have to make that rank order list or rank list. And we have meetings about that and how to put that in and send it away and wait for that inevitable beautiful match day.

Dr. Tony Tizzano:

Yeah. Boy, and that what a day that is. We all can remember that. So, you mentioned they can only submit three, for example, pieces to the personal statement or something. Is that too kind of try to level the playing field for those individuals who just have an overwhelming amount of opportunity because they've been in a privileged situation and gotten all these connections along the way? Is that the idea behind that or?

Dr. Stacey Jolly:

So, the idea with ERAS is they have somewhat aligned similar to AMCAS. So, the application where students, undergraduate students are graduated, undergraduate students are applying to medical school. So, ERAS allows now for our students when they're applying to residency to select up to three meaningful experiences and then they get a chance to write a little bit extra. It's about 300 characters or less. So given thankfully that many are quite familiar with say Twitter and the character count restriction can do that pretty well in one or two sentences. So yeah, that's where it's uh, different now and then it, there is a limit. So, to your point of perhaps in years past when somebody maybe could list 20 experiences in ERAS and somebody else might only be able to list three perhaps based on availability of experiences or other circumstances, everyone now is limited to 10.

Dr. Tony Tizzano:

That's great. You know, I think one of the things that the Education Institute and the Center for Youth Education, they've said, we are gonna have a way that anybody can get into the Cleveland Clinic, have a look and get some mentoring as opposed to having to know somebody. And I think that kind of speaks to the same thing. You know, knowing what I do about Lerner, it's not lost on me that it seems that you can leverage a lot of what Lerner does when it comes to residency because of the way of assessment and residency perhaps is mirrored in our portfolio-based assessment. Is that a thing?

Dr. Stacey Jolly:

Absolutely. Our students have the opportunity when they are on the interview trail to really speak to the uniqueness of our program and how they are well set up for residency, well set up for research in their career. And you know, on the interview trail, there are still institutions and people in those institutions that may not be familiar with our college program.

Dr. Tony Tizzano:

Yeah. So, a chance for them to perhaps even educate the people who are interviewing them. And that does happen. So, you know, Stacey, the tools and opportunities seem endless. What innovations do you see on the horizon? What's next?

Dr. Stacey Jolly:

I think that we will see continued growth in making sure that students feel that they're selecting a specialty that they can see themselves thriving in for years to come, as well as allowing a specialty that will have them continue to do the things that they enjoy. And the purpose, back to your point of our Lerner students, they are amazing in their openness to feedback, amazing in their research and also in the activities that they do. So many are involved in direct community service activities, giving back to the school and education committees, all of these things that they find incredible purpose and meaning in. And so being able to find a specialty that will allow those. And then I must admit, I am not necessarily the most tech-savvy or tech early adopter, but I think there's gonna be somehow some way AI involved in this. And I look forward to learning from leaders like Dr. Matta.

Dr. Tony Tizzano:

Boy, you're not kidding. And we've, we've done a podcast on that in the past and if there was something I had to do homework on, that was one of them.

And he is such a whizz kid with that sort of thing. So, I really like the direction it all takes because it seems like maybe better choices for career choices will be made and that ultimately will translate into better care of our patients because you enjoy what you're doing. Well, we've discussed a lot of things. Are there any comments or questions that I didn't pursue that you feel are important for our listeners to know?

Dr. Stacey Jolly:

I think we covered a lot and just the sheer breadth of what is available for our students and also that knowing that so many people want to help our students and I truly am appreciative for all of our faculty and all of our Cleveland Clinic physicians that readily give back to our students.

Dr. Tony Tizzano:

Yeah, as am. I feel like I'm sitting under the wisdom tree at times. Well, thank you so much, Stacey. This has been an enlightening episode of MedEd Thread. To our listeners, thank you very much for joining and we look forward to seeing you on our next podcast. Have a wonderful day.

Dr. James K. Stoller:

This concludes this episode of MedEd Thread, a Cleveland Clinic Education Institute podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, SoundCloud, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread and please join us again soon.