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Interviewer: What does it take to become an infectious disease doctor? That's next on the Med Student Mentor.

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Interviewer: Today we're going to talk about what it takes to become an infectious doctor with Dr. Andrew Pavia, Chief of the here at the University of Utah. Thank you, Dr. Pavia, for joining us today. We're very excited to have you.

Dr. Pavia: Well, thanks for having me.

Interviewer: So first of all, can you tell me a little bit more about your path to infectious disease as far as your residency and fellowship? How did you get here?

Dr. Pavia: Well, I followed a somewhat nontraditional pathway and it's nontraditional in many ways. I did my residency in internal medicine and was a chief medical resident. Then I did my fellowship at the Centers for Disease Control in something called the Epidemic Intelligence Service. But that doesn't include a clinical component. I worked on problems that affected children and adults but predominantly children. I decided at that point that I was really interested in pediatric problems as well as adult problems. So when I finished my three years at the CDC, I was in Utah at the time and I did my clinical fellowship training in both adult and pediatric infectious disease.

But as a fair warning, that is not the way most people are going to go through their training. And it's certainly not the order they're going to do their training in. What it does point out though is that there are many pathways. It also reminds people that in medicine you can keep reinventing yourself. And you can keep doing things that you're interested in and adapt as you go. Don't think that a decision you make as a second-year medical student is going to determine where you sit at 45 years old.

Interviewer: And that's good to hear especially as a second-year medical student. It's really stressful and we constantly get asked "What will you go into?" and "What will you specialize in?" So I feel like it's good to hear that there are different paths and you don't have to decide everything right away. But there are those students that are 100% sure that they want to do infectious disease. So what would you tell those students? How can they prepare in the first four years of medical school to become infectious disease doctors?

Pathways to Infectious Disease Fellowship

Dr. Pavia: Well there are two main pathways to infectious disease fellowship, really three. One is to do an internal medicine residency and then do a fellowship in adult infectious disease. The second is to do a pediatric residency and do a fellowship in pediatric infectious disease. And the third is to do med-peds and then you can either do one or both of the infectious disease sub specialties. Probably the most important thing though if you're really thinking about infectious disease is to start to get your feet wet early on. There are a lot of ways to do that.

It may be to do global health. It may be to spend time in Africa and see the clinical impact of infectious diseases and see not only how much of an enormous impact they have on people's health but what a difference it makes when you have effective treatments. It may be to get involved in the laboratory and to see some of the incredible new tools that are available. For instance, we can now sequence the entire sequence of a bacteria in under a day and learn things about it that took a lifetime, a career to determine. We can even find bacteria that you can't grow in the laboratory through sequencing.

And the third pathway—the one that most reflects what I have done—is to work on what we call clinical and translational research. That is, research that is really much closer to the patient that either looks at what treatments work best or what features help you determine what kind of disease a patient has or to compare outcomes. Where can you get the best outcome for the least resources and the least risk for a patient?

Interviewer: And those all sound like great opportunities. I also think that med school is very stressful and there's so much going on and it's hard to narrow down what extracurricular activities to do, just because our time is so limited. So if you had to pick something that you feel best represents infectious disease from the standpoint of a second year medical student, what would it be? What activity do you think would be best?

Dr. Pavia: Well I think you have an opportunity as a fourth-year student to do a clinical rotation elective to give you an idea of the day-to-day life in the hospital. But as a second-year student there are a couple things that could be much more fun.

First, would be to look for research opportunities. We've had a number of medical students work with us over the years on projects that often resulted in their publishing a paper. A number of them have ended up in infectious disease or have done something else academically that was closely related.

Another would be to take advantage of some of the great opportunities we have here at the University of Utah to do work overseas. If that's something that excites you and if you have a language skill and a passion for working with people in less fortunate circumstances, they're great opportunities to pursue.

I think there are people in adult infectious disease and pediatric infectious disease who would love to talk to you. There's a Dean for International Affairs, Ty Dickerson, who would love to talk to you about things like that. Of course, there are opportunities that you'll hear about in med school.

Personality Traits Well-Suited to Infectious Disease

Interviewer: That sounds very exciting. Just a couple more questions. Every time I ask people what should I go into, what do you see me doing, they always say "Just follow your heart and go wherever you think your personality fits." And that sounds like a simple response. But it's actually really confusing because I find myself thinking, "Well, what does that mean? Where will my personality fit in?" So what kind of personalities do you think best fit in infectious disease?

Dr. Pavia: Well, there's a joke I like to tell about infectious disease doctors which is they have to be the consummate clinician and really be good at almost every part of medicine. They have to really care about people and understand problems in society. They have to have a great interest in science because things are constantly changing and they should probably marry a wealthy partner. I say that facetiously. You will not starve as an infectious disease doctor, but if your goal is to have a 140-foot yacht and to drive a new Mercedes every year, you probably should look elsewhere.

But if you're curious and interested in your patients and like to be around a group of people who are excited about what they do, infectious disease fits well. We really have to dig into patients' lives because understanding in an individual clinical encounter, understanding what somebody has, may hinge on really understanding where they have been traveling, what their hobbies are, the interactions they have had with animals or with food. So you really have to be a good clinician and curious about people.

You may be working with a lot of people whose lives are very different than your own. Maybe they're a war refugee from the Sudan. Maybe they're an IV drug user. And so, you have to really be able to get inside their lives with them a little bit. And if these are things that match with your clinical personality, I think ID is well suited to you.

Understanding People & the Societies in Which They Live

If you want to sit on the other side of a computer screen and use technology to understand your patient, there are opportunities for that in infectious disease. But that's not what most of us are like. Now, that's not to say that many people don't work with big data or aren't experts in everything ranging from genomics to data visualization, to designing diagnostic tools that let you put in what information you have and generate new probabilities that guide your diagnostic thinking. But in the end, infectious disease is really about people and the societies they come from.

Interviewer: It sounds really exciting. I know you've gotten me excited about it and I feel like I have to find out more about it.

Dr. Pavia: Well good.

Interviewer: It definitely sounds exciting and I think that's fun just to have something that's constantly changing. You're like an investigator and that's what infectious disease sounds like, so that's very exciting. Do you have any additional advice for someone who wants to succeed as an infectious disease doctor?

Dr. Pavia: Well, I think many people go into medical school with kind of a public health bent. They want to make a bigger difference in society rather than one patient at a time. That's really my background as well. Infectious disease is one of the fields where you have the skills to do that. There are other areas -- birth defects, maternal health. But in infectious disease, if you're interested in improving the health of populations in society, then that training is really useful for it. At most health departments, at the CDC, at the WHO, infectious disease doctors are in great demand because after all, infectious diseases remain the number one killer in poor countries and in the top five even in the wealthiest places.

Interviewer: Great. Well thank you Dr. Pavia once again. It was a pleasure and it was great talking to you.

Dr. Pavia: Well thank you and I hope we've excited a few people about a field that I'm constantly excited about.

Interviewer: Definitely! You excited me, so that is one person.

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