Student Wellness: Mastering Work-Life Balance as a Medical Student

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 work-life balance related to student wellness at Cleveland Clinic's Lerner College of Medicine of Case Western Reserve University. I'm your host, Dr. Tony Tizzano, Director of Student and Lerner Health here at Cleveland Clinic in Cleveland, Ohio.

Today, I'm very pleased to have Dr. Stacey Jolly, Associate Professor of Medicine and Director of Career Advising at the clinic's Lerner College for Medicine here to join us. Stacey, welcome to the podcast. 

Dr. Stacey Jolly:

Thank you, Tony.

Dr. Tony Tizzano:

To get us started, could you tell us a little bit about yourself, your educational background, what brought you to Cleveland, and your role here at the clinic?

Dr. Stacey Jolly:

Yes, it's great to be here. So I am a general internal medicine physician. I did my medical school training at Stanford, and I did my residency at UCSF.

I've been here at Cleveland Clinic since 2009. My role in the medical school is Director of Career Advising, since 2019, and we moved here to Cleveland thanks to my husband's work at Case. And I will say that it is- took me probably five years, but I feel like I am getting a little bit of the work-life balance living in Cleveland, having been in California all my life, (laughs).

Dr. Tony Tizzano:

Yeah. When you said that, I thought, "Wow, you came, you came from California all that time, and then to Cleveland." I knew it wasn't exactly for the weather probably, but it's good to have you here, and we're lucky to have you here.

So in today's segment, we'll focus on the importance of work-life balance in the first of a three-part series exploring the topic of student wellness for medical students at the clinic and in the Lerner College of Medicine. So Stacey, could you help us sort of frame the topic that puts work-life balance front of mind in consideration related to student wellness? 

Dr. Stacey Jolly:

Yes. I think that this comes up a lot. Our students are so incredibly talented, so busy, yet also so much inundated with social media. And I think contrary to all that we see on social media, that a career in medicine is long and one needs to have a lot of perseverance, a lot of being okay with it's not going to fit, maybe, neatly into a six-second soundbite or a (laughs) 30-second TikTok video.

And on the flip side though, it is something that one will do for 30+ years. And so, kind of finding something that one enjoys in that work-life balance, career, family, community, and that will nurture one throughout that time.

Dr. Tony Tizzano:

Yeah, it is certainly a journey. You know, I, I think of the impact of social media on so many things, and when I think of how we look at it, and people generally tend to post great things that are going on. And not everyone has a great thing happening every single day. And I wonder, do we end up comparing ourselves to something that isn't really realistic and thinking, "Wait a minute, what about me?" 

Dr. Stacey Jolly:

Ab-

Dr. Tony Tizzano:

Does it play that way?

Dr. Stacey Jolly:

Absolutely, and I think that's where some, in the whole thought around work-life balance, there's other terms that sometimes get used, is it management of time? We're all given the same amount of time in a day; how do we manage, or integrate that time?

And also, that it's gonna ebb and flow. That transition, I remember going from undergraduate to medical school, and perhaps the material that wa- maybe came super fast in undergraduate, in medical school it is, you know, at hyper-speed, an enormous volume and maybe doesn't come as fast. And so, the effort and time and studying and how one shifts their time around definitely changes.

And then you get a pattern, and then you go to clinical rotations, and then now, your time is really tied to the clinical activity in the hospital and maybe feels a little less flexible, so how do you adjust to that? To then, for our students who do a, a whole fourth year of research, then, it's a lot of time. And now, you know, what you do in that extra time there to kind of rekindle those things that brought joy to you.

Dr. Tony Tizzano:

Yeah, there's certainly a lot of variation. I, I certainly can see that. You know, we- you mentioned work-life and management of time. I wonder if maybe that's not a, a better word, because when you think of balance, you think it's a 50/50. And I doubt that we really ever have a day that works out 50/50. We have to ebb and flow one direction or another. What would you say to that?

Dr. Stacey Jolly:

Absolutely. I also think about knowing what our skillsets are and helping utilize friends and family. I think about, who do we think of as perhaps most organized, and who do we want to try and emulate, maybe learn some skillsets from them? Also, one of the things that we've certainly done in our department, 'cause work-life balance inevitably goes into around physicians and physician burnout, and that the need to be able to detach and step away from the electronic health record. And so, being able to, you know, have truly, kind of, electronic-free time, I think, is important for our students to learn as well.

Dr. Tony Tizzano:

Wh- is that why we're supposed to have a work phone and a personal phone? Because really, it's very hard to set your work phone to site and not bring it everywhere you go. And when you feel a little buzz, uh, even at dinner, to like, slide it outta your pocket and look and see, "What was that? Is it something that I need to respond to?" How often do you really disconnect?

Dr. Stacey Jolly:

No, I think it's very true, and I will say, I feel like that is something that I very much appreciate from students. And I also work with residents, so some of our residents, I feel like they are doing a much better job than I did at their age, at really trying to have that, you know, away time and put the phone away, or not check things 'til they're back on, you know, service. Take that time away.

Dr. Tony Tizzano:

So you think it's become more of a priority, from when you and I perhaps trained, where, you know, it's okay, you don't have to be the iron horse. You can actually set it aside. And do you think that, I know we say it, do you think we believe it and we're rewarded for taking that time, or do you think there's still this underlying expectation that you're the iron horse?

Dr. Stacey Jolly:

I think that things are changing. Things are changing amongst our leadership, things are changing amongst systems. We have now, sometimes I've noticed on individuals' end of email signatures, you know, "Please do not feel obligated to answer my email after-hours," or, "on the weekends." Things like that that I, you know, definitely do not recall seeing 20+ years ago.

Dr. Tony Tizzano:

I like that. I never thought of that. That actually kinda gives permission. And so often, what we are looking for is permission.

What tools might you, as students come on board and you're trying to give them a handle on how they might do this best, what tools are there that help them to perhaps structure, manage their time, but in, in a somewhat malleable way?

Dr. Stacey Jolly:

Yeah. This is one that, you know, students will have likely had a system that they used in undergrad, even a system many of our students have been working in a research lab or other setting for a year or two before joining us. So they have a system coming in, and, and many will continue to try that system, and it'll work. And for others, they'll find that maybe it doesn't with the amount of activities that a student has, between their PBLs, their advisor meetings, their other curriculum, the sheer number of emails that, that they'll have.

They may need to find another system. And so, working with their peers, time management sessions, utilization of the phone can be quite helpful. I know for me personally, having it as my peripheral brain if I'm gonna make an appointment or set up a meeting with a student, then I like to have it put in immediately in the calendar so I don't accidentally over-book, things of that nature.

Dr. Tony Tizzano:

Yeah. Barring having a secretary, it's- it can become very... Uh, and in the short time in my career that I had one, I thought, "This is the best thing that has ever happened to me," that someone kind of kept tabs and didn't let me overlap. And I think it can be really challenging.

You know, I look at all of the electronic devices that they can have, and perhaps that's a bit of a, a game-changer, and, you know, trying to, uh, create, these are things that I have to do, these are things I want to do, these are things I hope to do. And if I have time left over, do you, do you parse it out like that? Is it, is it- that the sort of thing you're looking to do, or do you fly by the seat of your pants more?

Dr. Stacey Jolly:

Yeah. I think that, you know, every student's gonna have a sense of where that zone is that they like. For me, personally, I like to be th- as uber-organized (laughs) as possible and, and get, and get things out. I don't like being in the, "Oh, my goodness, is this urgent?" That sort of feel. But I n- students are certainly gonna know where they land.

And then, also, this is part of our process around, you know, feedback. I think about students that work with us in-clinic and they need to turn in their CAS logs at the end of the clinic day. And I'd say a vast majority of students do that. And if a student is maybe having a little trouble doing that, it could more of an organizational skill, and, and how to program that in and, you know, maybe change the work habits around that. So I think it's also an opportunity with that curriculum, if this is a skillset that they need help with, kinda besides the electronic tools, finding out how their peers are doing things.

Dr. Tony Tizzano:

Yeah, I think talking with peers is really helpful. But, you know, there's also, in, in Lerner, there's a tremendous amount of mentorship available. And, you know, being- feeling comfortable saying, you know, "Dr. Jolly, how, how do you do this?" Or, you know, "You've got such a busy clinic. How do you do it?" And I mean, I think we really like to hear from our mentors that, you know, w- they face the same sorts of things, at one time or another, and this is what they do. Th-

Dr. Stacey Jolly:

Absolutely.

Dr. Tony Tizzano:

So, there must be various services or efforts within the college to support students achieving these. Is there something formal in terms of wellness and work-life balance that we look to or strive to do?

Dr. Stacey Jolly:

Yes. I think our students are well-supported. You know, Cleveland Clinic, Lerner College of Medicine has a Director of Wellness and Wellbeing. I think it's something that is interspersed throughout our curriculum. We have a robust humanities curriculum, we have the art and practice of medicine curriculum to allow for that reflection, that way of deciding how work-life balance is going to play in their lives, and realizing that may change over time, from what career they might be thinking of in the first year, to what career that they end up selecting to apply in their fifth year.

We also have incredibly compassionate, empathetic students who really wanna give back. And so, a lot of community service opportunities that can also be, you know, one day activities, but kinda get you outta the classroom, outta the books and interacting with your peers. That can be another way to rejuvenate.

We have cooking classes and advising and coaching, as you've alluded to. And then, something that, you know, I learned recently from one of your colleagues is that, you know, we have a Cleveland Clinic social worker that's available to our college program students as well.

Dr. Tony Tizzano:

Yeah, I think that's a tremendous asset, that, you know, we have opened up what we've offered to physicians, we offer to our students as well, and I think it's so important. You mention the word reflection, and we hear a lot of that within Lerner. And it's something that w- in my training, I never even heard that. I wouldn't even know what they were talking about. I really enjoy hearing the students' reflections. Tell me what your perspective is, that, you know, they do something, they see something, and then they're asked to digest this a bit and tell us what they think.

Dr. Stacey Jolly:

Absolutely. So, I've seen it in many formats. And working with students in-clinic, as a longitudinal clinic preceptor, I really value the relationships that I get to build with the students there. They can, to your point, see how, one, busy it is in-clinic, but at the same time, how do those relationships get maintained with patients, and how to then, for me personally, balance; they know that I am, you know, a married physician with two children. And so, many will inquire as well around my trajectory and, you know, curiosity around how to kind of balance, or, or integrate it there.

And then, within the curriculum, in terms of things like the medical humanities, as well as our practice of medicine, I've seen students reflect on, you know, where might they see their career in 20, 30 years? And if they were to write an article about it now, what would that look like?

Dr. Tony Tizzano:

Yeah. That would be an interesting way to, to put it out on the table and make yourself think. As we consider all these aspects, is there a deeper purpose behind work-life balance that speaks, perhaps, to self-awareness and empathy, and other humanistic qualities that collectively make for a more confident and caring physician?

Dr. Stacey Jolly:

Yes. I think about, when we are choosing to, you know, come to medical school, that we do have this, you know, strong sense of desire of helping others, helping our fellow human beings, and that while we may not enjoy everything 100% of the time, the vast majority of the time, we do enjoy it. And that's what is bringing us meaning and joy, and, and hopefully, rather than a surviving mentality, more of a thriving mentality, more of a caring mentality, one that helps us, you know, to be the best we can for our patients and our colleagues, a- as well as our family.

Dr. Tony Tizzano:

I love that idea, rather than surviving, to thriving and caring. And, and perhaps by doing that, taking better care of our ourselves, can we take better care of our patients because of that?

Dr. Stacey Jolly:

Absolutely. I also, in this role as a Director of Career Advising, have really appreciated how there's been evolution of really trying to help students think about their values. And there is a survey in the AAMC Career in Medicine website around physician values, and thinking about, is it things like prestige and being the one that's gonna discover the next cure for this particular kind of cancer, and maybe wanting to be the leader of that professional society, to the value of those longitudinal relationships, to the value of autonomy and being a, a strong sense in the community. So that, also, to help students think about the aspects of physician life.

Dr. Tony Tizzano:

Yeah. I think that's a really interesting piece to have on one's to-do list. And you had mentioned that to me before on, on another topic that we had discussed previously, and I went and looked at that. And I was really surprised at how what they had to say there resonated with me. I thought, "Oh, what do you need that for?" But when you do it, you know, it starts to weigh in. Like, "Oh, you know, that's a good point. And I think this, and I think," and it changes.

So, you know, Lerner has this goal of nurturing physician researchers, which adds a whole 'nother level of something they have to do. And I think they're really great challenges for some of these individuals, whose demanding career involve multiple professional commitments and trying to weigh these against personal goals, and now they have research goals on top of it. How do students deal with that fourth year, stepping out, doing something very different, then finding themself thrown back into their last year and a lot of clinical work and a greater level of expectation?

Dr. Stacey Jolly:

Absolutely. I think, you know, our goal of training the physician scientist is very important. I also think that one of the things we do well, and our students see it in the fourth year, is the importance of teams and the importance of the research team. To your point, the kind of days of old where it was maybe a singular lab, running everything, getting all of the grants is highly unlikely these days. So much of research is team-based, collaborative, understanding the data, needing for so many others as part of it, from statisticians to psychologists, to our administrative professionals. So much of grants is paper burden (laughs) now.

And I think our students then get a chance to see that when they're in their fourth year of research with their mentors. These are our research advisors and our research mentors that take our students in for their fourth year of research, have incredible investment of time and energy in the students' success, as well as letting the students know kind of the pros and cons of the career that they have chosen as a physician scientist. Right? There will be continued grant-writing or other mechanism of funding from foundations, the need to publish, the need to present at national meetings.

But also, the fun part of that, discovery and asking a question, and maybe getting part of an answer that leads to another question. And the students in their fourth year still maintain some clinical activity, and that can then start to bring it back to what are they seeing in the lab, or what are they learning from their work on a certain database that now applies to the patients they're seeing?

Dr. Tony Tizzano:

So the connectivity is maintained.

Dr. Stacey Jolly:

Absolutely.

Dr. Tony Tizzano:

But it's intriguing. I think that there is so much on their plates, and I look at some of the work I see them do, and the work product. And then, the things they go on to do, when you see them graduate, and it really is impressive. And I think we're certainly on the right track.

If there's anything I feel since having joined the clinic, it's been over 20 years ago when I was in a multi-specialty group, we are certainly a team. That notion in my mind that I have other people who are gonna have greater expertise in areas. I may have this little niche here or there, but there are people that I need help from all the time. And it- I used to feel, in my training, it was a sign of weakness to have to ask those questions.

But now, I feel that sharing that with patients and recognizing, you're not just seeing me, but we have access now to a whole team. I think that the whole way that Lerner works with those four teams of eight from the very outset really helps to cement that. What do you think?

Dr. Stacey Jolly:

I agree. That ability to communicate with one another, to realize that somebody's strength may be higher in this area of the physiology than another, and then the teams. I also appreciate that they shift as well, so that students again will get a chance to work with every one of their colleagues in that. And then, they take that with them to their longitudinal clinical experiences, to their clinical rotations, to their fourth year of research.

Dr. Tony Tizzano:

Excellent. So in the time that you've watched this evolve, and I know it's not lost on me from when I began residency, or even medical school. My year in medical school was the first year at Ohio State that the class was 50/50 men and women.

And so, when I look at the physician scientist, there is definitely a feminization of that career entity and the path getting there. I think it's perhaps had some great influence, because, like it or not, there are expectations in society for women that are different for men. As much as we try to flatten that, that makes it important to have systems in place that allow for those differences without any criticism. Are we there?

Dr. Stacey Jolly:

Well, we know at least for women in science, and that we're not quite there in terms of the sheer number of things like R01s, or at the level of professor or leadership. But I think we're making progress, and we're making progress, I believe, for many junior faculty that are coming in that are maybe wanting to prioritize that work-life balance integration, and, yes, want a research career, but not to the detriment of the other aspects in their lives.

And so, that's where, definitely, a team-based comes in. That's also where many programs have, that perhaps 10-year or the next level of promotion, where, in the past, if we may have been quite rigid with it, should be X amount of time and Y amount of items, that we know in some of the promotions and tenure of committees, that changes and adjustments are being made to incorporate all of the things that a faculty member is doing, as well as that timeline as well. And then, I think the individuals realizing that, you know, there are multiple sources of funding as well, from not only federal government, but foundations as well.

Dr. Tony Tizzano:

Yeah, you make some great points. And I think back to just, as an obstetrician gynecologist and working with two college campuses on your buy-in, this whole notion of tenure and how a couple can maintain just... Both work at the university, they're both in impeccable health, they exercise, but they're delaying child-bearing, for example, until they've got tenure.

And now, they're 42 and they're ready to start a family. And you think, "Okay," (laughs), knowing that it's going to be difficult. And there is this sense that you could have done this differently, and we have it on a piece of paper, or you could have paternity leave and that's written on a piece of paper, but not used perhaps as much a- as it might otherwise be. How do you think we do at Cleveland Clinic for saying, "Yes, we- we want you to take advantage of these things. We think it's important to do."

Dr. Stacey Jolly:

Yeah. Well, we certainly have continued to improve. We've had leave policies for our professional staff that have also started to come into alignment, and including for paternity leave for our male colleagues, where we had, you know, maternity leave for a long time. That was really wonderful to see. I think it's also, again, the shift of seeing others do it, seeing leaders do it, as then really helps make that become less of a not the norm, to this is the norm, this is what we should expect, and, and what we should want too.

Dr. Tony Tizzano:

That's an excellent point, leaders setting the stage. So as, Stacey, as you look at the horizon, what do you think is next? What, what are we hoping for?

Dr. Stacey Jolly:

I think that the, the future is bright. I think there's gonna be a lot of change. I feel like technology is going to help us over time. We're already starting to see some of it slowly come in, um, particularly in my field and internal medicine, primary care, where we're incredibly busy, lots of patients a day, short amount of time, how can we make things meaningful for me and the relationships with the patients, and utilizing my expertise and less of my, perhaps, fingers and typing. So, in the area of AI and somebody else writing the notes, things of that nature, I think will help us over time. And hopefully, then, allow for then that more connectedness. That's certainly what people are craving.

Dr. Tony Tizzano:

So we need to extend the kind of assistance we get in the office. Well, I could see that would work well, if we could do it. So, I'm amazed at the extent of your knowledge in this area, and we're so lucky to have you. Are there questions that I should've asked and didn't ask that you would like to address?

Dr. Stacey Jolly:

I think this was a great overview, and certainly, I hope will stimulate questions among the audience. And I also feel like this is something that, you know, I try and, you know, grow and change and learn and adapt over time as well, from when I started in the medical journey to early on when my children were young, to now that they're, you know, older and outta the house. It's certainly that work-life balance integration changes over time.

Dr. Tony Tizzano:

So you've been practicing what you're preaching, I, I can see. That's fabulous. Well, Stacey, thank you so much.

Dr. Stacey Jolly:

Thank you, Tony.

Dr. Tony Tizzano:

This has been an enlightening and thought-provoking episode of MedEd Thread. To our listeners, thank you very much for joining, and we hope to see 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.