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Dr. Chan: What type of influence does a physician-scientist have on her young daughter? Why is it important to have a broad perspective as an M.D.-Ph.D.? How does one find time to relax and maintain balance during nine years of medical school? And what is the physician-scientist training program?

Today, on "Talking Admissions and Med Student Life," I interview Alex, an M.D.-Ph.D. medical student here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world, this is "Talking Admissions and Med Student Life" with your host, the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Okay, I got another great guest today on "Talking Admissions and Med Student Life." Alex, how are you doing?

Alex: I'm doing great, Dr. Chan. How are you?

Dr. Chan: I'm doing fantastic. Alex, you're at the end of a long journey that we were talking about before I turned on the pod, and we're going to talk about your journey. So let's go back to the beginning.

So you're a current fourth-year med student, but you also earned your Ph.D.?

Alex: Yes.

Dr. Chan: So many, many years ago, why did you apply to med school? What was the genesis of it?

Alex: Great question. So I kind of have a unique story, I guess, in the sense that I grew up with a mother who was a physician-scientist. So this was something that I had noticed that . . . or I aspired to be ever since I was young. I saw that kind of a woman physician could both be a great physician and be a great scientist. So, for me, when I was in college, I wanted to make sure that medicine was what I wanted to do. So I actually went to a liberal arts college and tried really hard to find other things that were exciting to me.

Dr. Chan: Which one was this?

Alex: Bowdoin College.

Dr. Chan: Bowdoin? Okay.

Alex: Yeah, in Maine. And so I explored other options too like economics and other fun things, but ultimately, it was medicine that I thought, you know, I have a passion for this. So, after college, I spent a couple of years doing research, and that was really what solidified for me doing the M.D.-Ph.D. track.

So it was kind of the combination of all of those things, is really having an aspirational figure that I could kind of see that this is a career that I wanted, and then exploring other options, and then ultimately, deciding that both research and the physician track were what I wanted to do.

Dr. Chan: Where did you grow up?

Alex: I grew up in Boston, Massachusetts.

Dr. Chan: Okay, so, the New England winters, you know them well.

Alex: Yes, I know them well, and I don't know that I would move back there for them.

Dr. Chan: All right. And so where did you do research after graduating from Bowdoin?

Alex: So I went to Children's Hospital of Boston where I worked in a lab. I worked in a lab at Children's Hospital of Boston with Dr. Len Zon. He's a fantastic mentor. He had a really big lab that had about 50 people, so it was a really fun experience where, you know, I was right out of college and there were a lot of graduate students, postdocs, other technicians who were all working together and they really showed me that research could be fun, that we could get really amazing things accomplished, and so that's where I fell in love with research.

Dr. Chan: Awesome. And so then you started thinking about M.D.-Ph.D.?

Alex: Yeah.

Dr. Chan: And it sounds like you had a great influence from your mother. Walk people through that process, I mean, what's it like? How is it different than M.D., I guess?

Alex: Yes, so I think that when I talk to people about this, there's a few themes that often come up. Some people are really worried about the amount of time that it takes. So that was certainly something that came up to me too. You know, most programs can be anywhere from seven to nine years total. I ended up taking nine.

And it is a long time, but the way that I eventually saw it is you're committing to a life of lifelong learning anyway, and so the things that you learn in the Ph.D. are only going to help with that process. You can do research with just an M.D. too. And I know a lot of people that have pursued that path.

For me, the additional training that I could get as a Ph.D. in terms of grant writing and writing of publications of basic research, which is what I wanted to do, was something that I thought the Ph.D. was a worthwhile track to do even though it took a little bit longer.

Dr. Chan: So you start applying broadly? How did you end up in Utah? Walk me through that process.

Alex: Yeah, great question. So something that, kind of, came up when I was talking to people is, "When are you ready to apply?" So, actually, I had originally planned to do one year of research and then apply, so that two years after college, I would go. And ultimately, in talking to people, I realized that I needed an additional year. There were a lot of benefits that I was going to get out of that third year of research. And I actually moved here to Utah while I was working for a postdoc who had previously been in my lab.

So the benefits that I gained from that extra year was that I had additional publications that were already out and published, and I think that that was really helpful when I applied. I also was able to kind of finish up a lot of premed requirements and other things, taking the MCAT which allowed me to apply early and be really prepared when I did apply.

So it ended up being a total of three years in between college and going to medical school. And my journey to Utah partly was, I moved out here but I had my significant other was in graduate school at the time here. And so even though I applied broadly, I got to experience all the wonderful things about Utah and totally fell in love with this place.

Dr. Chan: So it sounds like you're very focused on Utah from the get-go?

Alex: Yeah. But I did apply elsewhere too. And those experiences were helpful in seeing what it was exactly about Utah that I really wanted to pursue. My Ph.D. was in genetics. There is a fabulous genetics program here, as well as I'm going into pediatrics and there's a fabulous pediatric hospital here, so all of those things were draws.

Dr. Chan: Okay, great. So you start medical school nine years ago?

Alex: Yeah.

Dr. Chan: Was it hard to kind of start with a group of people that you become friends with, you get to know, your classmates, and then after two years, you kind of step off and say goodbye? I mean, has that been hard at all or . . .

Alex: I think it has been. I mean, with anything, there's pros and cons. I mean, the benefit of that is that my friend group is just twice as big. So I had a lot of classmates who went on who now can kind of not only provide me peer-to-peer mentorship, but also they are now attendings and fellows at other programs, and so they've been able to provide me feedback, kind of going into the next step of my career about things to do and stuff like that. So I still maintain that group of friends, and then in graduate school, I had a whole group of friends, and now coming back to medical school, I've entered a wonderful class.

So, to me, I don't see it as a negative. It's certainly hard to have your friends move on . . .

Dr. Chan: Be attendings.

Alex: Yeah, be attendings, but it's also a really fun relationship that you get to have with them.

Dr. Chan: Yeah, they're at different stages, different levels, and you kind of . . . Yeah, I like how you said that. I mean, you get to kind of consult them and see them around, and they can provide mentorship. That's great.

Alex: Yeah, and similarly, you know, I have a lot of friends who are doing research, and I can provide feedback on that front too, reading grants or proposals and that sort of thing. So I love the kind of hierarchy of mentorship that you can get from kind of going through this journey. Even the young M.D.-Ph.D.s who are just starting medical school, I still remember that experience, and so I love to be a mentor to people at all stages.

Dr. Chan: That's fantastic. So let's talk about your research. So you said genetics?

Alex: Yeah.

Dr. Chan: How did you end up in that lab? What drew you to it?

Alex: Yeah, so for me, I always found genetics really interesting, and it was something that I felt no matter what career as a clinician I wanted to take, I could make genetics apply. So while I had always thought pediatrics was going to be something that I was going to do, if I wanted to do oncology, genetics would be useful. If I wanted to do internal medicine, genetics would be useful.

So, really, for me, it was about learning how to build tools in my toolbox that I can then apply to clinical questions and answer questions, creating animal models of disease.

So I ended up picking a lab kind of based on where I was going to get good mentorship and support because I think that ultimately is the most important thing, not necessarily what you research.

So I worked with Gab Cardin, who's the Director of the M.D.-Ph.D. program, but initially she actually wasn't the director, so that's a role that she acquired during my nine years here.

Dr. Chan: So what can you talk about . . . because like I struggled with the difference between meiosis and mitosis. So please explain to me what your project or dissertation was in a way that even I can understand.

Alex: Sure, yes. So I was studying muscle stem cells, which are known as satellite cells. And I was studying kind of their role during regeneration as well as aging. So one of the questions that we asked is, "Are satellite cells important during homeostasis?"

So basically, during all of adulthood, our stem cells helping to contribute to muscle in a way that help prevent us from losing our muscle mass. And, as you know, as you get older you do lose muscle mass in a process known as sarcopenia.

So we hypothesized that perhaps sarcopenia was when the stem cells were no longer contributing or had kind of exhausted their potential, and that's why you lose your muscle mass. So the way that we looked at this question was, first, "Do satellite cells contribute?" So we labeled them with a fluorescent reporter and then aged these mice for a really long time.

Dr. Chan: Oh, the poor mice.

Alex: Yeah. Oh, they were hanging on . . .

Dr. Chan: How do you age mice?

Alex: They just hang out in a cage with their buddies.

Dr. Chan: Okay, just so you just try to keep them alive?

Alex: You try and keep them alive for two years. That's why it took me five years.

Dr. Chan: Is that the lifespan of a mouse?

Alex: Lifespan of a mouse can be anywhere between two to three years. I'm pushing it.

Dr. Chan: Okay. What are some of your tricks to keep mice alive?

Alex: You like hold them very gently and talk to them. They actually can . . . they respond to human interaction. So, yeah, you just have to . . .

Dr. Chan: How many mice are we talking about?

Alex: Because some of them would kind of naturally pass, but we had to have large cohorts. So we had, I don't know 50 to 100 mice in this cohort?

Dr. Chan: Okay. Did you give them names or they use numbers?

Alex: No, they just had numbers.

Dr. Chan: Okay, sorry. I'm just asking by the nitty-gritty.

Alex: Yeah, so we aged them out and then looked kind of towards the end of their life, they lived a wonderful life, at whether their muscle had green, fluorescent protein in the muscle fibers no longer in the stem cells. So our hypothesis was, "Okay, do satellite cells contribute?" We hypothesized yes. And so, in fact, we did see that these muscle fibers were now green, suggesting a green satellite cell, stem cell had entered into the muscle fiber itself and turned it green.

We then asked the parallel question, "Okay, if they contribute, is it required?" And then we actually got rid of satellite cells earlier on in the mouse's life and then aged them out in the same way. And actually, even though we saw that they contributed, the effect, once we got rid of satellite cells, was less strong than we were expecting. So it was an interesting result.

Dr. Chan: Well, it sounds like this is leading towards a potential practical application. Is it like the fountain of youth? Is this kind of trying to turn back to clock a bit?

Alex: I mean, everyone is looking for the fountain of youth, yeah.

Dr. Chan: Yeah, an anti-aging agent one day. So is it my mind making a jump too far?

Alex: Well, I think that would be the next step for people to look at.

Another step that we were thinking of is whether how exercise contributes to that. So if you exercise more, you're getting more of your stem cells contributing to your muscle, and is that helping to prevent aging-related loss of muscle mass?

So it's hard to get a lot of mouse treadmills, we looked into it, but they're expensive.

Dr. Chan: They are? Wow?

Alex: Yeah.

Dr. Chan: Okay, how much are we talking about?

Alex: Like lots of money, like on the order of, you know, human-sized . . .

Dr. Chan: Like $1,000?

Alex: Probably.

Dr. Chan: Okay. Wow. I just have an image of a hamster wheel, I guess that won't do.

Alex: Well, you can have a hamster wheel-type of thing, but then you have to measure how many revolutions each one goes through, and each mouse has to be housed individually because you have to make sure that . . . So it ends up getting expensive, which is the only reason we could address that next question.

Dr. Chan: All right. So you're doing your research, you complete this amazing project, and you're were thinking about pediatrics the entire time?

Alex: Yeah. So, even though I was doing this mouse-aging project, which was not pediatrics-related, again, I said you should go for the mentor who is with it, not necessarily the project. So yeah, I had always thought pediatrics.

For me, kids are just so much fun to be around. It makes going to work, like, such a pleasure. They say the cutest things, and they're just so resilient. So, for me, that's where I was drawn to pediatrics.

I don't know that I'll necessarily stay in muscle, but each of the projects that I worked on, whether it was in high school, or college, or after college, I feel like I built a whole bunch of toolboxes or tools in my toolbox to now address different questions. So I find myself going to different lectures in, for instance, like cardiology. And even though I studied skeletal muscle, there's parallels between skeletal muscle and cardiac cardiomyocytes.

And so I think having that broad perspective allows me to address different questions in different ways.

Dr. Chan: So during third year, when did you schedule pediatrics?

Alex: I scheduled it for the winter time, so it was right over . . .

Dr. Chan: So kind of the middle?

Alex: Somewhere in the middle. Yeah, and that was good advice.

Dr. Chan: And then when you had it, so like you just knew once you did your take, like, this is for me?

Alex: I think so.

Dr. Chan: Found your people, found your home.

Alex: I think so. Yeah, it was partly about the people. I just . . . You kind of have to be bubbly and fun and happy to be in pediatrics. So I loved to be around those people.

Dr. Chan: You never wavered. No other field kind of enticed you? It's okay if it didn't.

Alex: I don't think so. I mean, I really enjoyed a lot of different things, but peds was just where I really fell in love.

Dr. Chan: Okay, and so you decided to apply the pediatrics, fourth year starts. What kind of electives were you doing during fourth year? Preparing for pediatrics?

Alex: I'm applying for the physician-scientist track actually within pediatrics. So most . . .

Dr. Chan: Oh, what is that?

Alex: So it's a newer track, kind of like, M.D.-Ph.D. plus. So they're calling it PSTP or Physician-Scientist Training Program. There are several of them around the country. I would say 8 out of the 10 programs I applied to had them. And the ones that don't yet have them are looking to acquire them.

So even though they're about five to six years old, and they're including fellowship is kind of added onto your residency training. So when I was applying to residency, I was also looking into fellowship fields that I would be interested in, because when I was interviewing, they were asking me, "What fellowship do you want to do?"

So getting back to your original question about electives, I was doing electives in things that I thought would be interesting fellowships to pursue, so peds endocrinology, peds cardiology. I did a peds genetics two-week rotation, and I had done an infectious disease rotation earlier in third year. So all of those were great experiences, and all of them are potential fellowships that I'm interested in.

Dr. Chan: So with this specialized track, do they ask you . . . it sounds like you pick a subdiscipline or like a fellowship at the beginning?

Alex: So you can. There's two pathways that are currently like sanctioned track pathways. They are a little bit accelerated. One is called the accelerated research pathway or ARP, and so you can do residency training in two years and then you'll do fellowship in four, and basically add on a year of research into your fellowship.

Another way is to do the Integrated Research Pathway or IRP, and that can guarantee up to 11 months of research within your 3 years.

So it's not necessarily shortening your time, but they're recognizing that for physician-scientists, having that research kind of integrated throughout residency is going to be really helpful. So both of them are pathways that I'm interested in pursuing, and depending on what fellowship I want to go into, each one may be better suited for that.

I also talked to a lot of physician-scientists along the trail who said, "You know, I really wanted to use my three years of residency to really just gain all that knowledge." And so they didn't do either of the tracks, but they're still pursuing research, have ones doing physician-scientists. So it's just another option for physician-scientists if they're interested in that path.

Dr. Chan: And can only M.D.-Ph.D.s apply to these programs?

Alex: No, but I would say that the majority of people who are doing it are M.D.-Ph.D.s. So I didn't see any who were straight M.D.s who were doing it. They were all M.D.-Ph.D.s, but in theory, I think it is open to people with a strong research background, say if you've taken couple of years off in between years of medical school or something like that, you could also pursue that.

Dr. Chan: I might be wrong, but it doesn't strike me as a . . . I mean, there's no . . . I don't think . . . first of all, there's not a lot of M.D.-Ph.D.s running around.

Alex: No. There's not.

Dr. Chan: And there's even fewer who are going into pediatrics.

Alex: Yes.

Dr. Chan: So do you kind of know all these people when you go out and see them on them on interviews and stuff?

Alex: Yeah, so that was really fun. I think we figured out that there was probably about 50 to 60 in all of pediatrics that were applying, and so then I was seeing the same subset of those people along the trail. So that was really fun. And I bet we'll end up at similar programs together.

There are certain programs that tend to want the strong research background, so, you know, they were at least saying that they aim to have up to one-third of their class in pediatrics to be M.D.-Ph.D. So that's a big cohort considering that here, you know, we're 4 to 6 out of a class of 100. So it would be kind of different for me to be in a class where a third were also M.D.-Ph.D.s.

Dr. Chan: And then when you go on interviewing, I assume, are you talking about your research a lot, or is that just kind of you know, are they more focusing on like, you know, the residency part? I mean, I'm just kind of curious how would they be different.

Alex: Yeah, so they do a two-day interview, because similar to when you apply to M.D.-Ph.D. programs, usually they have a research focus day and then they have a clinical focus day.

So, on the research focus day, it's usually only the other M.D.-Ph.D. cohorts that you're meeting with. And then it can vary from having lots of speakers to having lots of interviews. And then the interviews can range from them asking you about your research to very structured interviews where they have specific questions that they've been told ask everyone in the exact same way. So that it can vary.

For the clinical side, that's a lot more like what people going straight into pediatrics residency would get. It's not very different for M.D.-Ph.D.s. You're meeting with people just interviewing you for the, you know, "Are you going to be a good fit in our program?"

Dr. Chan: Yeah, are you a good team player, you have good interpersonal skills like that stuff.

Alex: Yes, exactly.

Dr. Chan: So you go around and interview at all these different places, and then you submitted your rank list last month. What kind of thought process? Like walk me through your . . . You don't have to like explicitly lay out your rank list. What kind of things did you kind of think about?

Alex: Yeah. So I was looking for . . . I think, for me, I have loved my experience here in Utah, but I was also understanding of the fact that moving on to different places has been a really positive thing for me. When I was applying, I think it was really helpful that I was from Boston and went to Utah. I think a lot of programs saw that as a strength, that I would be willing to move somewhere. So I got interviews on the West Coast, the East Coast, middle of the country. So, to me, that was a positive to not necessarily stay in the same place.

So even if I want to come back to Utah potentially as faculty, I thought it was important to apply broadly.

And so I think, ultimately when creating my rank list, it came down to places that I was going to be happy. Again, I was looking for places where not only would I be going for three years of residency but potentially three years of fellowship. And for these physician-scientist programs, they can even offer some bridge funding as early instructorship position.

So again, I'm looking at potentially six to eight years before even applying for faculty positions. So I wanted to pick a place I was going to be happy. So that was kind of the biggest decision. Where could I be happy? Where could my family be happy? Where could I have a good commute to the program? And also strength of program was really important.

Dr. Chan: And do you kind of pick a mentor, or a PI at this stage or more, or is that kind of down the line?

Alex: I think it's a little bit down the line. I'm not totally sure what fellowship I want to do yet, but kind of even interviewing along the way, I met potential mentors who seemed really great. So I think once I get to a program, it sounds like they have really good . . . Or I ask this question a lot about what kind of systems are in place to find mentors and that sort of thing. And so I picked programs that had really good track records for mentorship. And talking to students is another great way and something that I always encourage people to do, is just ask around, ask for help.

Dr. Chan: Yeah, word on the street, "What do you guys think? Yeah, what's going on?"

Alex: So I hope to use my own advice and ask for help once I get there.

Dr. Chan: Fantastic. So what's harder? Waiting for match day, which is coming up, or waiting for those mice to age?

Alex: Oh. Oh. I think waiting for the mice to age because I have no control over that. I mean, I have no control over match day either, but at this point, it's just exciting. I have a lot of places I'm really excited about.

Dr. Chan: Awesome. Awesome. And, like, with all this going on, I mean, like you've had a very busy, fulfilling academic career even up to this point.

Alex: Yeah.

Dr. Chan: How do you take breaks? What do you do to relax? What do you do to refocus? Because you got so much stuff going on.

Alex: Great question. I think balance is super important. This is definitely a marathon, not a sprint. Not that medical school is a sprint, but the M.D.-Ph.D., I mean, 9 years, 10 years, I can definitely tell that my perspective is different than some of my classmates.

So you just have to take those moments for yourself, whether it's taking a weekend vacation or, you know, when I was interviewing, I took a couple extra days at each place to kind of just make sure not only do I like the program, do I like this city. You know, when I'm here, and I think fourth year is a little bit easier than third year, but even during third year, you know, during my surgery rotation, I was able to work really hard and then take, you know, all three of my vacation days on a long weekend. So for me, that was better because then I could kind of get away and relax and do something fun.

And then the daily stuff, you just have to . . . I take my dogs on hikes, I go running, you know, I try and read books, but that, honestly, can be hard.

Dr. Chan: Yeah, books have nothing to do with aging.

Alex: Well, yeah. Usually, you're trying to read up on the patients for tomorrow and stuff like that, but you just take your moments and try and find balance in your life because I think it's really important, especially now that I'm 10 years into this.

Dr. Chan: Ten years? Wow. That's a long time. Long time.

Well, Alex, it's been great having you on the pod. I wish you the very best on match day.

Alex: Thank you. Thank you.

Dr. Chan: I'm very excited to hear where you end up. It sounds like you will probably be outside of Utah?

Alex: Yeah, you know, not that I . . . This place is fantastic, but I like kind of looking for the new adventure around the corner. So it's been really fun for me moving from Boston, and I'm excited for where we'll head next.

Dr. Chan: Okay. Well, thank you Alex. Appreciate you.

Alex: Thank you.

Announcer: Thanks for listening to "Talking Admissions and Meds Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school. A production of The Scope Health Sciences Radio online at thescoperadio.com.