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Episode 125 – Guinn, fourth year medical student at University of Utah School of Medicine

May 29, 2019

“I ended up getting involved with Planned Parenthood and volunteered at the county jail where I taught sex ED. I also volunteered with the Rape Recovery Center and worked on the crisis line. Those are the main community things I did, it changed a lot of how I ended up thinking about my career and what I wanted to do.” Guinn did not get accepted her first application cycle. After taking her post-cycle feedback to heart, she was able to really strengthen her application and in the process gain some personal insight to her own interests in the health care field. We discuss perfect timing on Guinn’s acceptance, what it’s like to create new boundaries with family when it comes to time, best practices for medical school study habits, and finally, matching with a spouse in the PhD program.

Episode Transcript

Dr. Chan: How do you use your post-cycle feedback to strengthen your application for next round? Do you have to redefine your study habits for medical school? How do you set boundaries with your families surrounding your limited time? And how do you strategize the match with a spouse in a Ph.D. program?

Today on "Talking Admissions and Med Student Life" I interview Guinn, a fourth-year 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: Welcome to another edition of "Talking Admissions and Med Student Life." I have a great guest today fourth-year med student Guinn. How are you doing?

Guinn: I'm doing well.

Dr. Chan: Post-match.

Guinn: Post-match.

Dr. Chan: We're not going to talk about where you matched until the end, kind of like some suspense. All right. So Guinn, let's start in the beginning. When did you decide to become a doctor?

Guinn: You know, I think I had thought about it for a while. When I was a kid, I always thought I'd be architect. But I think like pretty classic pre-med, started taking science, really liked that. I did have a family member who was a physician. And so I think probably like a lot of people who have parents that are physicians, that's just kind of in your mind, something you might want to do because you're seeing their career and what they like. And so I thought about it, got into college, really started enjoying the sciences, but really felt like medicine was how I wanted to practice those sciences. And so kind of solidified it by my first or second year of undergrad.

Dr. Chan: Okay. So I want to break that down because you grew up in Utah, right?

Guinn: Yeah.

Dr. Chan: Where did you go to undergrad?

Guinn: University of Puget Sound up in Tacoma, Washington.

Dr. Chan: So why there? How'd you end up there?

Guinn: I always . . .

Dr. Chan: I don't know if they have a large presence in Utah or they have a lot of alumni running around. Like how'd you end up up north?

Guinn: I was like a very naive 17-year-old and was like, "Oh, I want to go to a liberal arts school," if I even knew what that was. And the Pacific Northwest sounded cool. And so that was kind of like where I ended up looking and then got there and ended up really liking it. But it was, you know, I kind of thought back on that like it was, I don't know, maybe silly. I think I could have gone anywhere or . . .

Dr. Chan: Did you go on a campus tour?

Guinn: Yeah, I went and looked.

Dr. Chan: I assume they have nice looking buildings and there's like . . .

Guinn: It's beautiful. I think they catch everyone on the campus. It's gorgeous.

Dr. Chan: There's a Pacific breeze from the ocean and coffee and seafood. Yeah.

Guinn: And the Northwest is really cool and very different than Utah. I wanted to spend some time outdoors and just those lush forest areas are pretty entrancing.

Dr. Chan: Okay. Well, were you the only one from Utah up there or . . .

Guinn: No, there's actually quite a few people that end up in that area, or Lewis & Clark or Portland State. So quite a few Utahns kind of end up there.

Dr. Chan: Okay. So you're up there and loving the sciences, solidified your decision to go to medical school, and then what happened next?

Guinn: Definitely kind of like got on that train, started checking all the boxes, everything I thought I should be doing. I ended up taking the MCAT pretty early. I applied trying to go straight through, so I guess that would have been at the end of my junior year kind of coming into my senior year. Applied not to a ton of schools, but definitely was wanting to come back to Utah and to Salt Lake City. Interviewed here pretty early, and then kind of went through the process. I had . . . didn't end up actually . . . I don't think I got any other interviews. Like I only interviewed at Utah.

Dr. Chan: So how many applications did you fill out the first time?

Guinn: Ten, something like that.

Dr. Chan: Okay, 10-ish.

Guinn: Ten-ish.

Dr. Chan: And got one interview offer.

Guinn: Yeah.

Dr. Chan: All right. So part of you is like, "Okay, that's okay." But you would have been better to have more interview offers?

Guinn: Yes.

Dr. Chan: Okay.

Guinn: I definitely felt kind of surprised and disappointed, but I like really wanted to go to Utah. So I was excited about [inaudible 00:03:29] there and going there. And waited to hear and then in March, I think it was March, April, I'm forgetting now.

Dr. Chan: What year is this?

Guinn: This was 2014 after I graduated and got waitlisted. And so then was waiting. And then I think in June is when I heard that I like didn't make it off the waitlist and was kind of needing to figure out what I was going to do next year and definitely felt like I would reapply.

Dr. Chan: Okay. And I think at that time, and we still have this process in place, I think you got feedback.

Guinn: Yes, I did.

Dr. Chan: Okay. So a good pre-med team advisor up at UPS.

Guinn: Yes.

Dr. Chan: All right. Okay. So what was some of the feedback? I don't know if you could remember?

Guinn: Yes. No, I definitely remember.

Dr. Chan: Okay.

Guinn: I had good MCAT scores, but not great, and I had really good grades. And so I think I was feeling very surprised, like, I hadn't done better in the application process. I think that might be common for a lot of people, kind of like, "Oh, well, like, I do well academically, so like I should get into medical school."

Dr. Chan: And everyone on some level does well academically, yeah.

Guinn: Exactly. And so you look at your feedback, and I really felt like a lot of it was like really valid. And so it was definitely . . . it was like a hard process, but it's like a really good learning process. So some of the things I got, one was that a lot of the volunteer work I had done, I think looked superficial, and when I like really reflected on it, I think it was. Like I was definitely I was super . . . I just wanted to do really well academically. And so I think the volunteer things I did were definitely to kind of to check off boxes and they weren't really like . . . I just wasn't that invested in it. And I really took that to heart.

So I had moved back to Utah after I graduated, and so I ended up finding a few different things that I wanted to do in Salt Lake that would actually engage me with my community. And so I had kind of . . . I'd ended up taking this Gender Studies class my late junior or senior . . . I guess, it was early in my senior year, which was totally new for me. I had just taken it because I liked the professor, but thought that would be weird, and then ended up loving kind of women's issues and women's health issues. And so I ended up getting a volunteer with Planned Parenthood, and I volunteered at the County Jail where I taught sex ed. And then I also volunteered with the Rape Recovery Center and worked on the crisis line with them. And so those are kind of the two main community things I did. And it like changed a lot of how I ended up thinking about my career and what I wanted to do.

Dr. Chan: That's excellent.

Guinn: So that ended up being really cool.

Dr. Chan: Yeah. And then for people, I mean, did you just cold call them, or did they have like a website where you can kind of click on boxes and volunteer?

Guinn: Rape Recovery Center had boxes and you could like fill out an application. It takes a while though to get everything in place.

Dr. Chan: Background checks and all that stuff, yeah.

Guinn: All that stuff. And then similar with Planned Parenthood, I think it's different now. At that time I filled out an application and then could immediately start volunteering at the jail. It takes a lot of hoops to actually get into the jail, but I could start that process immediately. I think now they have you volunteer as like an ambassador or something first before you can get involved with like more of the program side of things.

Dr. Chan: And did you change your strategy? Did you like apply to more schools or different schools?

Guinn: Yeah, I applied to . . .

Dr. Chan: And did you get more interview offers the second time around?

Guinn: I did, yeah. So I applied to a lot more schools. I think more like almost 30. I applied . . . like I hadn't done any of the Texas schools. I applied to like all of the Texas schools. And then I think I ended up getting five or six interviews, but I interviewed at The U early and then got into The U. And I had gotten one other interview to date by that time, and then when I got into The U, I ended up canceling my other ones because I wasn't as excited about them as I was Utah.

Dr. Chan: Okay, all right.

Guinn: I just accepted Utah.

Dr. Chan: So looking back, I know, you know, bittersweet, didn't get in the first time, but do you feel that was a good year?

Guinn: For me . . .

Dr. Chan: For kind of not jumping right from undergrad into . . . essentially it created a gap year I get the sense.

Guinn: It did create a gap year.

Dr. Chan: Okay.

Guinn: It did end up being beneficial. You know, I guess, in a lot of ways, the way I've ended up . . . So I actually ended up meeting the person I'm now married to in my class. And so I can't actually think about that year without getting . . . I'm not even particularly spiritual but without feeling like things happened for a reason because I don't know that we would have met if I hadn't got in the first time. So one it was a good growing experience. But two, I like can't think about the entire thing without thinking about that, because it just feels very, I don't know, how things were supposed to happen.

Dr. Chan: Yeah, it kind of just worked out for the best.

Guinn: Yeah.

Dr. Chan: Timing.

Guinn: Timing, yes.

Dr. Chan: A lot of what happens in life is serendipity, timing, a little bit of luck sprinkled in, so . . .

Guinn: Yeah.

Dr. Chan: All right. Yeah. From my vantage point, yeah, when you hit my radar, I remember I worked on that feedback. I put a lot of good notes in there. And then I'm shocked by how many people don't listen to my feedback and just keep on doing what they do. And I remember at the committee when your application came up, they were very like, "Wow, this is a really strong application. Like, wow, she really did a lot of great stuff after graduating." So I think that was very pivotal and like just the growth that you demonstrated and showed the committee was really impressed by.

Guinn: Well, that makes me happy. It would shock me that someone who didn't let you into medical school was telling you what to do to get in, that you wouldn't but . . .

Dr. Chan: You know life is funny. All right. So you start medical school. So this is the fall of . . .

Guinn: Fall of 2015.

Dr. Chan: 2015. You know, and one of my favorite questions I ask Guinn, is, you know, people have this view of medical school. It's kind of interesting, like, you know, when you're outside and you have this view of medical school, like you kind of like think "Oh, it's like this, this and this," and then you start medical school. I mean, what . . . did it meet your expectations? Was it harder? Was it easier? How would you describe, you know, those first few months?

Guinn: The first few months are really overwhelming, and they were very different. You know, I went to a small liberal arts school, so like the big classes and the amount of information was just very different than my undergraduate. But in some ways, it was a lot the same. And I think one of the things I definitely learned was you might think it's more different than it actually is. So you start medical school, and frequently, you know, they'll do little things with the upperclassmen and they'll tell you how to study and all this stuff.

And kind of you're just like overwhelmed with all these like advice and tips and resources, which are very great and awesome. But it also you kind of just look at these people and go, "Oh, well, you've been in medical school for a year and you're telling me that I need to do X, Y, Z thing." And to study totally differently and medical school is so different and I'm going to have to do everything differently.

So I looked threw everything I had done at undergrad like out the window and was like, "Oh, I need to do Anki flashcards and I need to do everything online and I need to do all these things." And that didn't actually go very well for me and like my first test didn't go that well. And I kind of had to go back and like, "Wait, I do know how to study. I have done this before, and I have been doing this for a long time." And I went back to a lot more of kind of what academic strategies I had done in undergrad and that works better for me, you know, obviously incorporating new things, but remembering that you know how to be a student and you're still just a student.

Dr. Chan: Did you feel that coming from a small liberal arts college you were prepared?

Guinn: Yeah.

Dr. Chan: Okay.

Guinn: Academically, yeah.

Dr. Chan: Because I, you know, I've talked to a lot of people and sometimes I go like, "My undergraduate career is more like, you know, these seminars or essay tests." And all sudden you pivot to this culture where there's multiple choice everywhere, and, just like you said, like the volume of information it's pretty fast-paced and . . .

Guinn: It was different. I think I probably took one multiple choice test in college. So definitely, that was different, but I, you know, I was a science major. I think that was helpful. I'd seen a lot of biochemistry . . . I was a biochemistry major. I had seen a lot of biochemistry before, and I had memorized things for biology, so it wasn't too different.

Dr. Chan: Yeah. And sometimes I wonder about the culture, because, you know, I go out and do these presentations where I talk to a lot of different pre-med groups across Utah. And I kind of tell like, "Look, you know, like this is the best and brightest from BYU, from Utah State, Weber State here." But also and you're a part of this cohort, there's all these people that grew up in Utah, went out of state for college, and they're coming back and they're super smart, too. So you put everyone in like this environment where, you know, there's just like type A personalities for the most part and people want to excel and do well. So I think it just makes for a fascinating culture. I mean, what were your impressions?

Guinn: No, I think it was. So at Puget Sound, I was like, you know, a "type A person," sat in the front and I think everyone kind of viewed me in that way. And I sat in the back row of medical school for the first two years. So you're like . . . I think your peers' perception of you and I just felt a little different. I think I went from being the like, in some ways, I think I felt even maybe like a little looked down upon or something, like I was super career driven or something like that. And then here, that was kind of the norm, and I actually felt like on the more relaxed side of people.

Dr. Chan: How'd you find balance?

Guinn: In life?

Dr. Chan: During medical school?

Guinn: During medical school?

Dr. Chan: Yeah. Because the academic part can be all-consuming if you let it.

Guinn: Absolutely, yeah. I think like a lot of people, especially in Salt Lake, I tried to get outside. And so especially in the first two years would always try to go skiing or hiking, you know, once a week or something like that. And then other exercise things throughout the week. One of the things I found challenging was actually being back home, in that I'm really close to my family. And my partner's really close with his family. And we love that and love spending time with them. But that was like a time commitment that I hadn't had in undergrad because my family didn't live there. And so family expectations and, you know, you want to spend time with them, but finding that balance that was pretty hard, but I did try to spend time with them but still, like, set some boundaries about what I had time for and what I didn't.

Dr. Chan: Okay. Well, you mentioned your partner. Can we say his name?

Guinn: Yes.

Dr. Chan: Jake. All right. So let's hear that story. So what did you guys, like when did you appear on each other's radar? You know.

Guinn: We met at the social at Poplar like the Saturday before medical school started.

Dr. Chan: Okay. So orientation week, okay.

Guinn: And we actually have a ton of mutual friends going back forever, like our parents know each other. His like next door neighbor was actually my brother's college roommate in Montana, randomly like all of these connections, but we'd never met. So I like knew who he was, but I had never met him.

Dr. Chan: So you had heard of each other . . .

Guinn: Yeah.

Dr. Chan: . . . but didn't know each other. Okay. So was it love at first sight, or were you guys friends first or . . .

Guinn: Jake should tell the story. We were friends first.

Dr. Chan: Okay.

Guinn: I was not immediately interested, but Jake was apparently. And then we started dating in maybe October.

Dr. Chan: Okay. So right there during first year?

Guinn: Yeah.

Dr. Chan: And did you guys keep it kind of like secret for a while? Because I know like there's like this weird kind of dynamic.

Guinn: It was super weird.

Dr. Chan: Yeah, this dynamic, because like, for those who don't know, like, so med school, like, one of the cool things about it, and also the challenging aspects is, as a class, you kind of march through the curriculum together. So you see each other every day. You start doing rotations together. So dating each other can get tricky at times, because sometimes couples get together and stay together, but sometimes they don't. So there's this dynamic. So what was it like in your class like?

Guinn: I was very concerned about this concept of, "Oh, we're going to be in the same class for two, you know, and like very much together for the first two years. What if we . . . things don't work out and it's going to be super awkward?" And it just really wasn't like a thing at all that was . . . like, now looking back, it seems really silly to have worried about. You know, the class definitely had little . . . would tease us about it and things. We were the only couple that got together in our class, which I think is kind of unusual. So it didn't end up . . . it wasn't too weird. A little weird at first.

Dr. Chan: Okay. Did you guys like sit together and study together? I mean.

Guinn: Yeah, we spent like every hour together. We would study in the same space. We didn't do a lot of actually studying together, but we'd study in the same areas. And then we'd sit together and kind of do things the first two years, but spent a huge amount of our time together before he left to get his Ph.D.

Dr. Chan: And that was my next question. So he's on a different track.

Guinn: He is.

Dr. Chan: He's on the MD-Ph.D. track. So how would you describe that to people who don't know?

Guinn: Yeah, so you do two years of medical school. And then you step out to get a Ph.D., which takes three to five years. And that can be in anything. Jake's is in biochemistry. And then you reenter medical school for the third and fourth year. And it's for people that, I think, for the most part, want to do a large, a lot of basic science kind of in their careers, but also some clinical practice.

Dr. Chan: So you started this journey together and the first two years you were together, but then he kind of goes off in this direction and you go off in the other direction.

Guinn: Yeah, it was different.

Dr. Chan: How was that? I mean, how did you navigate that?

Guinn: It was hard. It was super hard, and third year you're so busy. So you just went . . . I went from seeing him like every second of the day to definitely not during third year. He would try to work kind of when I was working so, you know, I think a lot of lab people or some amount of lab people end up kind of working later in the day and then they like work later at night. But like for instance, when I was on OB, Jake would drop me off at labor and delivery at 5:00 in the morning and go into lab, and then he was like ready to leave with me at the end of the day. So that worked well.

Dr. Chan: Okay. So there's a perception that when you get your Ph.D., there's like a little bit more flexibility in the schedule.

Guinn: That is true.

Dr. Chan: Okay.

Guinn: I always thought it like our classmates always say these things like, "Oh, is Jake, like, so relaxed? Like, how is that?" And it just like drives me nuts because he works so hard. So it's definitely it's a lot of time and it's a lot of stress, and it's a very different stress but it is more flexible.

Dr. Chan: Okay. Because like, yeah, like there's like experiments running and research protocols and like sometimes they run at night. So, yeah, it's good old badge card access to get into the lab.

Guinn: Absolutely.

Dr. Chan: All right. So if I had talked to you at the beginning of med school, because what I remember about your application, I would have said, "Oh, I think Guinn's going to go into OB-GYN or something similar." Talk about how did your career choice evolve? And like, how did . . . and how much did third-year kind of factor into that? Like, how did that evolve?

Guinn: Third year was the most of it. So yeah, I had kind of developed this interest in reproductive health, reproductive justice, women's issues. And I think I thought that that meant I should be an OB-GYN, like, "Oh, these are my interests. Therefore, I should be an obstetrician-gynecologist." And those definitely are my maybe social interests, but kind of third . . . end of second year and then third-year starting I realized that academically and kind of professionally I really loved internal medicine. So it was one of my first rotations. I think it was my second rotation third year, and I just loved it. I loved how we thought about things. I loved working through problems. I really like the breadth, just every different patient, every different type of organ system. Big long medication lists, I think, freak a lot of people out. I like loved it, think about all these different things, how they interplayed.

Dr. Chan: Big long rounds.

Guinn: Big long rounds. I was like totally fine with that rounding forever.

Dr. Chan: Yeah, rounding internal medicine is notorious, yeah.

Guinn: And so I just loved it, and I liked my OB rotation a lot as well. I had that later in my third year, and definitely, you know, I think you hear a lot of people like, "Oh, I thought I would love this and I hate it." I did not hate it at all. It was awesome. It's amazing. But internal medicine just seemed like a much better fit for me. I was a lot more excited about it.

Dr. Chan: So OB-GYN and internal medicine was kind of neck and neck for a while, or is it just like internal medicine was just so . . .

Guinn: It just kind of took over.

Dr. Chan: Took over, okay.

Guinn: And I think because I had thought I was going to be an OB for so long, I like held on to that. But I felt really good and secure about my decision.

Dr. Chan: So you decided to go into internal medicine. What was your strategy at the start of fourth year when it comes to match?

Guinn: It was a little different than I think a lot of people's, because I . . . yeah, it was just different. I think a lot of people have the option to maybe go anywhere. Because Jake's in the MD-Ph.D. program, I obviously have the option to go everywhere. But that was a huge consideration is where he would be and how we were going to work through that. And so I knew that I thought I really wanted to go to Utah. But I also really wanted to seriously consider my options and not get in this place where either I put all my eggs in the Utah basket, and that doesn't work out. Or, you know, 10 years from now I'm like, "Well, I stayed in Utah for you, and I could have gone somewhere else."

Dr. Chan: I would be worried if you talked like that in 10 years too. Sounds like some progeria going on, Guinn. You should go see an internist about that. Yeah.

Guinn: Perfect. So I wanted to feel really good about it and that was also the advice. You know, it's kind of, I guess, a little funny. So in internal medicine, they're really awesome about working with our medical students here and like do a lot of advising. And so I was sitting down with the program director and assistant program directors, and they talked about where you want to go, and you can be really open and honest. But it was kind of funny, because I was like, "Oh, well, I want to go here."

Dr. Chan: I mean, yeah. I mean, from a strategy, did you just show all your cards? Were you just so honest with them going, "You know what? My partner's here."

Guinn: I did tell them that in the beginning.

Dr. Chan: You are my number one.

Guinn: And that was advice, you know, I got from our Dean Adam Stevenson kind of about where I should go or like how I should go about it or how people had kind of done that in the past. Being like upfront about it, but not super in their face, or acting like you for sure thought you would get in here, you know, anything like not being I don't know the word, not humble, I don't know, something like that. So talked to them, told them what I wanted, but then I kind of like laid low and did my thing for a while. And then at the end, when I had like finished all my interviews, I kind of came back and said, I did end up telling them that I was ranking them number one.

Dr. Chan: So how many programs did you apply to?

Guinn: I applied to 16 programs.

Dr. Chan: Sixteen?

Guinn: Mm-hmm.

Dr. Chan: Okay, and how many interview offers did you get?

Guinn: I got interviews at 13.

Dr. Chan: Okay, and did you go on all?

Guinn: And then I went . . . No. I went to eight.

Dr. Chan: Oh, you went to eight.

Guinn: Yeah. So I kind of did a lot of like eight programs, maybe like five programs I was like very interested in and then some reaches, and I didn't really get interviews at kind of like my more reach schools. And then some schools I like wasn't as excited about. And then at Utah, they interview all the students going to the University of Utah first. And so that was my first interview, which was kind of nerve-wracking because that's where I wanted to go.

But I did that first, and then I had my other interviews in November, December. And then kind of towards the end of December, you get all this stress because everyone's talking about like, how many interviews you need to go on and what you need to do, and there's this huge fear of not matching. But I felt confident in the programs I had interviewed at that like I was going to match somewhere. And I did, I felt good about Utah. I didn't want to put all my eggs in that basket, but I felt pretty good about it. And so I ended up canceling a few of my last ones just kind of on a money, time, soul sort of thing.

Dr. Chan: When you interview at other programs, did you also share, you know, like the existence of Jake and how he's back in Utah? Or is that something again, you didn't really share because you didn't want them to, like, rank you lower because of that? Do you understand what I'm saying?

Guinn: Yeah, No, I do. I was super like wigged out about it. I just thought I was going to get all this like questions, yeah, they weren't going to rank me or something. I like even thought about like not wearing my wedding ring or something. But no one actually cared or asked me. So that like wasn't an issue at all. In San Diego, I interviewed at a few programs there. And that was kind of a city we identified, like would maybe work for a transfer or whatever. And so, when I was in that city, I did kind of tell them, and it was like this is one of the cities that will work for us. And at some institutions, I just didn't mention it, because I kind of felt like it was none of their business.

Dr. Chan: It wasn't germane.

Guinn: Yeah. And they might rank me low or something.

Dr. Chan: Okay. And then you mentioned San Diego, so I get the sense you were kind of focused in the West.

Guinn: It was geographical, yes.

Dr. Chan: It was geographical, but then also you mentioned transfer. So did Jake do a little bit of like research into like what programs . . .

Guinn: Yeah, we did.

Dr. Chan: . . . would even accept transfers because I know . . .

Guinn: So I guess even The U on our website we say we don't accept any transfers, but sometimes they will for like special circumstances.

Dr. Chan: Yes, special circumstances, but priority is given to those whose partner matches into a postgraduate program.

Guinn: So if like I had matched. If I wasn't from here and had matched here, then you would give maybe preference.

Dr. Chan: Preference to someone, but they still have to meet all our criteria, etc., etc. There's still a process. Yeah.

Guinn: So we kind of looked. But we were kind of like, well, we'll probably be able to figure this out like at any of the places if that works. There was one school, so UT Southwestern, I interviewed there and really loved it. That was actually kind of hard. I like really liked it there and thought I might want to go there. And that was a place we thought Jake could transfer the last two years, but maybe even in the middle of his Ph.D. There was a lab that was very similar to his lab. So we were kind of trying to figure that out, but it's hard to like get, you know, full steamrolling on something that you don't know is going to happen yet or not or you're not even sure if you want to happen yet.

Dr. Chan: Okay. So these programs, they e-mail you the love letters? I mean, what was your strategy? What was your . . .

Guinn: Oh, the love letter thing totally stressed me out. So you have this big lecture, and basically, at every single interview I went for internal medicine, they would say "Do not send us a thank note," like not only like do not need to, like, but please don't.

Dr. Chan: It will be a mark against you . . .

Guinn: Yeah, and like don't communicate with us.

Dr. Chan: . . . if you don't listen to this specific instruction in this moment. Do not send a thank you note.

Guinn: Yes, and so I'm sitting there, I'm like, "Okay, great. I'm not sending a thank you note. They told me not to." And then you're like talking to people afterwards and they're like, "Oh, God, they say that, but, of course, you send thank you notes." And I had not sent a single thank you note, so I was like, "Well, [crap 00:24:19]. Either this is the worst." And then you're sitting there with Dr. Stevenson and he's kind of going over everything and is saying all this stuff about love letters. And I'm just sitting there freaking out because I was told not to. And I don't know what to do.

And so all the internal medicine people were kind of wigging out as a group. And so we kind of talked to our program director about it, and they felt like that was not something we needed to do. And besides your number one that those were kind of useless. So that was the advice a lot of us got. I don't know what everyone else did. I knew I wanted to go to Utah. Several people had told me I should tell our program director that they were my number one. So I did, and then I didn't talk to anyone else and I didn't send a single thank you note.

Dr. Chan: Okay, perfect.

Guinn: But I was like stressed about it. You just get all this, I don't know, conflicting evidence.

Dr. Chan: So you talked to our own people here in Utah, like you clearly communicated you want to stay number one, number one. Did you feel compelled to like do like extra rotations here to kind of show off your skill?

Guinn: I did and yeah, I guess that was the skill.

Dr. Chan: Or you know, doing more sub-I? I mean, how did you kind of formulate that because you wanted to stay?

Guinn: Early in the fourth year, when I thought that most likely I would want to stay here, I scheduled like all of . . . I scheduled a lot of things at The U for my whole fall. So instead of doing something at IMC, for instance, like my sub-I, I did . . . I tried to do everything here where there was just more people that I thought would know me and the program director and that sort of thing.

Dr. Chan: All right. So going up to February, your rank list.

Guinn: Yeah.

Dr. Chan: So there's a term that it's not the most politically correct term, suicide matching, meaning you only list one program. Did that ever come into your . . .

Guinn: Heck no.

Dr. Chan: Okay. All right. So what was your thought process going in to creating your rank list?

Guinn: I just . . .

Dr. Chan: With these eight programs you met or you interviewed at, yeah.

Guinn: Yeah. I think it would have been hard to be long distance with Jake. But I think it would have been a lot harder to not match. So I definitely I put Utah as number one, but I definitely ranked every program I interviewed at because I wanted to go somewhere. The other places I put I end up putting other schools that I loved, but maybe would have been even more difficult second and third. And then kind of places that were . . . it was actually, no. The whole thing was based on where I wanted to go actually. And some would have been more challenging for us to do long distance. But at that point, I felt pretty good about Utah happening, so it kind of all felt like a formality.

Dr. Chan: Any . . . I mean, like I think it's fascinating because like, you know, I've talked to a lot of couples who did the couple's match. What you went through was very different.

Guinn: Yeah.

Dr. Chan: Any, like, any thoughts or feelings like towards Jake, like, oh, you know, you talked about Southwestern, you could have matched there, you could have gone there, but then like, you know, but he needs to stay here. So like did, like feeling of compromise?

Guinn: Absolutely.

Dr. Chan: And, you know, like and how did you navigate that in a relationship where, again, all things being equal, you guys are equal partners, but like someone is making a "sacrifice"? Like, yeah, how'd you do that?

Guinn: We talked about that a lot. It's the first life decision I've made with another person. You know, we just we got, we met in medical school. We got married after our second year. So everything I've done in my life to this point is it just has been what I want to do and what worked for my career. And so that was a big learning curve and decision was kind of going through that together.

And I was feeling really unsettled for kind of the whole fall. And there was kind of this moment in December where Jake had kind of done a lot more research and kind of figured out that, like, maybe he could move to UT Southwestern, which at that point, I had like really, really liked that school.

And there was just something about him having like made that effort and having it actually like kind of feel more like a choice for the first time, that it just like felt like this like huge, like, weight off my shoulders. And I just felt so much better about the whole thing. And it like felt so much clearer. And so I did . . . we put a lot of thought into that, like do we want to try to rank? You know, I don't know that I would have even matched there. But would we want to rank UT Southwestern work and try to have Jake transfer mid-Ph.D. and do all that? And we decided not to and that Utah felt like a lot better and a lot better for us. But having had him make that effort and have it really feel like a choice, felt really, really good.

Dr. Chan: Okay. That felt very validating.

Guinn: Yeah.

Dr. Chan: Yeah. Because I can see that. I mean, I think it's not uncommon when two people are very successful and have careers and that wanting to stay together. But if one gets a great job offer in another location, it's hard for the other partner to have the exact same opportunity. So the concept of sacrifice.

Guinn: Yes.

Dr. Chan: And I think it's common in all relationships, all marriages, all couples, as they navigate this thing we called life. So I was just kind of curious to see how you and Jake kind of figured that out together.

Guinn: It ended up working really well. And I think it's something that, like you said, will kind of be coming up again and again.

Dr. Chan: Taking turns.

Guinn: Yeah, and we're going to have to work through this several more times so.

Dr. Chan: So February, you submit your list. From February to March, feeling good? Second thoughts?

Guinn: Super anxious. And, you know, they had essentially told me, you know, they can't like exactly tell you, but they'd like essentially told me I was coming . . . like, of course, I would match here. But it's just this weird moment in your life, where your entire future is and it's not really this way, but it feels like it's in a single person's hands. Like when you're applying to medical school, you know, there's like the admissions people, but there's like a whole committee and there's all these like kind of like precedents and things. And there's the same thing for residency. And maybe I'm wrong, but my perception was that the residency program director here could like . . . she I think really likes me, but at some moment could be like, "Oh, I don't actually like Guinn," and like could just change my entire future.

Dr. Chan: Squash you like a bug.

Guinn: Yeah, in like a second. And that just felt so vulnerable. And I did not like it, you know, as opposed to like for the rest of your career if one person doesn't like you, but you're otherwise doing well, that's not going to totally tank you. So that was uncomfortable, but it all worked out.

Dr. Chan: So you adopted a strategy of avoiding like all the power players within internal medicine?

Guinn: Kind of not. I was like involved in this like Women's Leadership Group, and I was like, had invited the program director like to this thing. And then we ended up having like a miscommunication like about the event, and I like wigged out. I was like, "She's going to hate me and she's like going to drop me off her list." But that didn't happen. So that was good.

Dr. Chan: Okay. All right. So match week, Monday, were you stressed at all about not matching? Were you . . . was your anxiety level on Monday higher than on Friday? So Monday, you find out if you matched and Friday you found out where you matched.

Guinn: I felt like I would match.

Dr. Chan: Okay. So you were not worried going into Monday?

Guinn: I wasn't worried, but you still have this like, you know, the numbers for internal medicine and you can look. They have all these things online where you can like plug in like, I don't know, a bunch of your data and see how many people have like matched. So I felt like statistically very comfortable that I would match. But you do get all this like I think just anxiety about like what if? You never know like, that weird things happen? So I wasn't too stressed. I just spent a night, so I sent alarm, woke up in the morning, had matched, went back to sleep.

Dr. Chan: Yeah. Friday, who's there?

Guinn: I didn't want to invite my parents.

Dr. Chan: Why?

Guinn: I felt like I was like most likely going to match at Utah, and then if I didn't, I was going to be like utterly devastated. And if there's anyone in the world who could like make me cry, it would be like looking over at my mom and seeing that she's like, "Oh, like my poor baby," and like feeling badly for me and I would start crying. So I kind of . . .

Dr. Chan: So it was more of a defensive measure?

Guinn: Yeah, I kind of didn't want to invite them, but then I decided they might not love that. So I did end up inviting them and then Jake came.

Dr. Chan: Okay. So you got . . . he came down from the lab.

Guinn: Came down from lab, we opened the letter. I matched at Utah.

Dr. Chan: Okay. I mean, how did it feel?

Guinn: It felt really good. I just felt like so relieved. The whole day, I thought the whole day was a little weird. Like it's a little theatrical or something.

Dr. Chan: Yeah, it's kind of developed into a thing.

Guinn: Yeah. And where I like kind of felt like I was most likely going to match here. It wasn't really a surprise. So the whole thing was a little . . . it felt a little funny to me.

Dr. Chan: Anticlimactic.

Guinn: A little yeah.

Dr. Chan: Okay.

Guinn: But it was still fun to see like where all my classmates were going. You know, that was a surprise for a lot of them. And it was fun to see who else was coming, going to be in Utah next year.

Dr. Chan: Yeah. How big is the program here?

Guinn: Thirty categorical, which means people that will continue in internal medicine for all three years. But medicine is also a specialty where you have preliminary interns who do a year in medicine before they go into something like neurology or anesthesia. And so there's 30 categorical and then 30 prelim students.

Dr. Chan: Oh, okay, pretty large.

Guinn: So my intern class will be 60.

Dr. Chan: Okay. How many fellow classmates from Utah?

Guinn: There is one other woman, Taryn, who is internal medicine categorical. And then there's three or four people who are doing their prelim here next year, which will be fun.

Dr. Chan: And then, you know, match was a couple of weeks ago, a few weeks ago. Feeling good since then? Does it feel weird because you kind of transition from med school to intern year? I mean, how do you . . . I mean, where are you at right now?

Guinn: I'm very excited.

Dr. Chan: Okay.

Guinn: I'm a little nervous. There's this security of being a medical student and not a doctor that's about to go away.

Dr. Chan: Yeah. I remember like the first time I got my contract like, "Wow, I've never made that much money in my life."

Guinn: Yes, a paycheck.

Dr. Chan: And then I think it was like a 30-page document, which is like, it's like a big deal. It's like I'm going to have to just read through this thing and sign it. A lot of it is just very lawyer talky, so yeah.

Guinn: So I'm nervous but really excited. I was on an internal medicine rotation in March. So I was, you know, around a lot of people who are going to be my co-residents or my uppers or whatever, next year. So that was fun. People I'll be working within the future. But I'm really excited.

Dr. Chan: And then I know this is in the future, but have you already thought about fellowship? Is that in your cards? Like what?

Guinn: What medical student isn't always like looking 10 years ahead?

Dr. Chan: Yeah. Thinking about the next plan, yeah.

Guinn: I don't know if I will do a fellowship or not. Right now I think I'm going to do hospital medicine, which does not require a fellowship. And I'm probably . . . I don't think there are any like accredited fellowships, but there are some like kind of optional fellowships for hospital medicine that I would think about. We would like to move somewhere for Jake's residency, and I would kind of like to diversify my training in some sort of way. So I think I will do my residency here and then work as a hospitalist for at least a few years. And then if I want to do a fellowship in a subspecialty or in something, like more work in quality improvement or hospital medicine, I would wait and apply to that until we know where Jake and I are moving for his residency.

Dr. Chan: Okay. Does he know what he wants to go into?

Guinn: He's not sure. And you know, he hasn't done any of the clinical things. If I were to guess, I would say medicine subspecialty, and they have some like accelerated physician-scientist training programs, which I like the sound of. So I would guess something with cardiology or oncology, but you never know.

Dr. Chan: I'm going to pivot right now, Guinn. Let's talk about student government.

Guinn: Yeah.

Dr. Chan: So you're pretty involved. Like what are the kind of different activities you're doing?

Guinn: Right now?

Dr. Chan: Yeah.

Guinn: So I'm one of the student body co-presidents. There's three of us. I'm also part of this group, we've gone through a few name changes, but right now we're going with it's called WEWIL, Women Empowering Women In Leadership. And it's a women's leadership group that started my second year that has been really rewarding and really awesome.

And then as part of student government, but it kind of morphed into its own thing, we also started this peer mentoring program that we call You Crew, which we kind of came up with as an idea to address this . . . a couple of different issues. One, we had a lot of peer mentoring programs that would pop up for like two months and then totally die and fizzle out. So we wanted something we thought might be a little more lasting.

And two, there's this huge divide between preclinical students and clinical students. And like I didn't know a single third or fourth year in my first or second year. And then now it's like, you just don't see them because you're in the hospital and they are in the classes. And we felt like it would really benefit students to actually have some of those relationships and help them network and build more of a sense of community here.

So it was our first year. We've had some successes, definitely some not so successes, but the whole idea was that these little "Crews." It was 100% opt-in, but for second, third, and fourth-year students. And kind of trying to encourage more just organic community within those little groups, but creating a space where they could get together and text each other before their Step One day, and kind of that sort of thing, and then doing a couple of big events each year. And that's been really cool. And we're actually like meeting next week to kind of pass it on to the next group and talk about how they want to take that next year.

Dr. Chan: For a program, yeah, to have sustained success you need to like groom like . . .

Guinn: Yes, exactly.

Dr. Chan: . . . fellow leaders after you carry the touch a bit, yeah.

Guinn: Yeah, I actually I ended up having the class presidents like nominate people in their classes that they thought would do a good job with it and kind of approach those people to take over.

Dr. Chan: So student body president, what does that mean? What does that entail?

Guinn: It's a lot of administrative things. It's a lot of like answering e-mails and making sure everything's happening.

Dr. Chan: Going to meetings.

Guinn: Going to meetings. The main thing is kind of supporting the class leadership and helping them with everything they're doing and checking in and helping them navigate that process. We have three main events we're in charge of, which are our formal and we call it prom.

Dr. Chan: Sweet.

Guinn: A roast at the end of the year, which is always fun.

Dr. Chan: Super sweet.

Guinn: And then elections for the incoming students. And then besides that, it's a lot of what you want it to be. So for us this year, this new peer mentoring program was something that we wanted to do and that we were in charge of and put up. But it could be anything. We're actually doing elections for the new people this week.

Dr. Chan: So from my vantage points, again, like I . . . that's why I love having you on the pod. Like I see, like the official dean's office, when there's an issue or something happens, my vantage point is they try as much as they can to involve student leadership and figure out like what's the student response or what do we need or what are the students asking for? I mean, do you feel that way? I mean, because do you feel like there is a good kind of cooperation between like the official administration and also the student leadership kind of tackle a lot of things?

Guinn: Yeah, I feel like they really try hard to involve us in a lot of things. I think the biggest challenge has been capturing the voice of the medical school and getting that back to administration, especially because we frequently have pretty different voices going on. And so as leadership, you're kind of trying to make sure you're speaking for your entire class or the whole school and figure out what students' responses are. But those can often be very different.

Dr. Chan: Yeah. I mean, if you have 125 students per class, 125 different personalities, different backgrounds, different cultures, different undergrad degrees, different undergrad institutions. I think, Guinn, I think it's really hard for you to, you know, for you as a group to kind of speak for the entire . . . I mean, what do you do? Do you like send out polls? Or do you have like town halls?

Guinn: It's a lot of surveys, and I think we like, oh, we over-survey.

Dr. Chan: Or you just know oh, so and so is really frustrated with this and you kind of approach them.

Guinn: Yeah, we will do some of that. I think an area that we could improve on . . . One hard thing is that the people in student leadership often tend to be the people who are more involved in the school, and then they're also kind of like hanging out with more people that are more involved. And a large group that I think gets underrepresented are people who are maybe somewhat less involved with all of the school things, but still have, you know, opinions about the school. So a thing that I guess comes up a lot is, you know, we got rid of mandatory attendance. So now there's encouraged attendance for some events and not for others. And there tends to be this kind of like dichotomy.

Dr. Chan: Yeah, still people are not happy.

Guinn: Yeah. No one is ever happy. Medical students are not . . . I'm kidding. They're happy, but . . .

Dr. Chan: They're content.

Guinn: They're content. So I think that's something we could do better at is kind of capture, but it's hard to capture the voice of all these different people. And I think more town halls would probably be better. We do a lot of surveys. We do a lot of just like word of mouth. And then try as much as possible to be open and approachable for people to bring us issues. But they don't definitely as often. It's definitely more kind of the student leadership soliciting from other people.

Dr. Chan: Yeah, I think it's age-old problem with leadership, like how proactive do you be versus reactive, right? And, you know, it's hard to be proactive, because sometimes you don't know what the problems are until like there's like a raging fire, but then you don't want to be over-reactive. So yeah, a lot of it's just kind of navigating all of these different personalities and different interests. And there's like multiple organizations involved. And I sometimes feel like the students think like, "Oh, the dean's office can just like wave a magic wand and change something like."

Guinn: It does not work that way.

Dr. Chan: Yeah, it's a lot more complicated than that. And then, especially I think with your experience, Guinn, have you seen like, you know, the different departments are fairly autonomous, right? So they're all kind of part of the med school, but they're also, you know . . .

Guinn: Doing their own.

Dr. Chan: . . . doing their own thing, and like they have different people and different interests. And so it's kind of like how do you build a coalition to enact change? And how do you get the right people in the room and the right discussions going and build positive momentum to do something that's impactful and meaningful? So but it sounds like you've done a great job with like this You Crew and then talk about WEWIL. Yeah, what's WEWIL about? Yeah.

Guinn: So that started. It was my second year, yeah. So Vivian Lee was still here. She was the senior vice president. And it actually kind of started . . . I think it was like an interest of hers and we had kind of talked about it, but getting more female leaders in medicine. More than 50% of medical -- what's the word -- matriculants now are women, but the leadership positions . . . I actually don't remember these numbers, but they're very small. It's like 20% or something.

Dr. Chan: It's not 50%.

Guinn: It's horrible. It's kind of this idea of like, how do we get more women involved in leadership in medicine specifically? And we did kind of a couple of things the first couple years and then this year, I have a really wonderful group. We have representation from like all four classes. And we did a couple of smaller events in the fall, kind of geared more towards mentorship and professional development and kind of cultivating from that way. And then our big event is actually coming up. It's a week from . . . two weeks from yesterday. And that's kind of this half-day conference we're doing and talking about a lot of different aspects. So we kind of put it into a few different buckets, but basically getting a lot of our invested and involved female faculty members here who like people that students kind of identified as mentors and role models and getting them to come in.

We're doing a panel session, and then we're doing all these small groups, talking about everything from kind of career navigation basics, because, you know, we have students from all four classes and we actually also invited some pre-med students this year. So people are in some different phases of the career. You know, a pre-med student could be just about to take their MCAT as opposed to like people who've already matched.

So talking about things like finding your passion and what you actually want to do, or being a mother in medicine, or different leadership styles and what that means. Taking risks, which is something that I think a lot of women maybe have felt like less comfortable with or isn't talked about as much with women as opposed to men. But really trying to take a very positive approach to everything and not just like sitting and talking about all the negative aspects, more just like looking forward.

Dr. Chan: And do you feel it's been positive, like it's been received very positively? Like a lot of like interest?

Guinn: Yeah.

Dr. Chan: Because I think I've heard some students talking about this.

Guinn: We've actually had really a lot of interest and a lot of positive responses. I think it's been really beneficial helping MS1s and MS2s network and kind of gain some mentorship and development in those early stages. And then it's just like this refreshing break. You get kind of down in the weeds sometimes of all of your, like, the daily life of the medical school, and you know, either studying for your finals or boards or, you know, your clerkship things. And it's kind of nice, I think, to take a moment in whatever setting, either this workshop or different things we've done and kind of step back and think, "Wow, like look at these like inspiring, cool, female-identifying leaders. And this is awesome that they're doing these things, and I want to do things like that. And I want my career to look like this, or I want to impact people's lives in this way." And it's really refreshing and kind of gets you re-energized.

Dr. Chan: Something that's always, you know, that I've struggled with is, you know, like the female, the woman medical students, like they, you know, sometimes they're confused for nurses when they start doing rotations. You know, and then, you know, and like, by and large, I think the faculty don't say things that are inappropriate, but every once in a while, yeah. But like patients sometimes, you know, I've been in the room when they refer to a female med student as like Mrs. or honey, you know.

Guinn: I would say often, yeah.

Dr. Chan: Or honey or sweetheart.

Guinn: Yep.

Dr. Chan: Or make some sort of weird, appropriate . . . inappropriate joke, you know, and it's really hard, you know, and like sometimes like, "Oh, what is the administration doing about this?" Like, well, we can create modules till the end of time, but like I don't know how to change a 90-year-old's behavior.

Guinn: No, like society.

Dr. Chan: Yeah. And so there's definitely this undercurrent. I think what you're doing, Guinn, is fantastic. But I just think there's an undercurrent, like society that just is doubtful and is always saying things that are inappropriate. I don't know it's . . . I struggle. Like I go, "What's the best response to that? Like, how do you support someone in the moment? You know, do you correct the person right then and there? Do you pull that person aside?" Like, I don't know. What would you say to that?

Guinn: That's actually one of our workshop topics.

Dr. Chan: Yeah, and did this happen to you?

Guinn: Oh, yeah. Well, one thing, in general, I always try to be really clear about is because being mistaken for a nurse is really common. And it bothers me in that I'm in my medical training and I am going to be a physician. But I like to be really careful about not, in any way, like down talking nurses or anything, like it's so bad to be a nurse or anything like that. So I always like, you know, you don't want to say anything and like, "Oh, of course, I'm not a nurse." Like nurses are wonderful and amazing and work really hard and are very educated. So I always like to be very careful about that.

Typically, I try to correct people. As a student, it's hard because you introduce yourself by your first name, because you're not a doctor yet. So you can say I know some women who introduced themselves as Student Dr. so and so, and that's one tactic some people do. I personally feel more comfortable with their name. I've heard a lot of residents who personally introduce themselves as "Hey, I'm Dr. so and so, but you can call me Guinn."

So those are kind of some little tactics that can set the stage. I remember actually talking to Dr. Lamb about this and we were all kind of complaining about it. And she made some comment like, "Why do you think I wear my white coat?" And that was . . . yeah, it in some ways sucks that you have to or think about it, but in some ways it's also nice to get some little tips about like.

Dr. Chan: Put the uniform on.

Guinn: Yeah. Okay, that's something I could do where people would think of me in that way and maybe my male counterparts don't have to, but whatever, I don't know. That's something you can do. And then the bystander one is one I think about a lot. A common thing on rounds is with a female attending male medical students, and the patient will spend the entire time like talking to the male medical student as opposed to like the female attending. And so thinking about that and what are things you could do, either as the attending or if you're the male medical student, or if you're a male attending, and you had someone kind of down talking to your female medical students, what are things you can say? And I don't have all the answers to that yet, but I think a little bit of it, like a toolbox of little phrases or something you have, would be really useful. So people can come to our workshop.

Dr. Chan: I'm going to have to go to this workshop and learn more. This is fascinating.

Guinn: Things you can say.

Dr. Chan: Just talking about this just kind of triggers a lot of memories and just trying to figure this out. It's really hard, you know, and I want our students to feel supported at all times. And I feel like, you know, what is . . . what do we do? What do the academic centers do? I think we strive for the ideal. We try to teach the students like this is what you should be doing. This what you should be learning. But then like, you know, out there is the world, and it can be a very difficult place. And you know, so when we launch our students into all these different rotations or where they . . . if they're doing, you know, if they're working in these different clinics and volunteering, there's stuff that happens, and I hope we have our students to be very prepared for those moments, but I think it's hard. It's really hard, yeah.

Guinn: I think a lot you just have to learn on the fly or experience yourself and kind of figure out how you want to go about it and then also how you want to think about it. You know, I don't know if some 90-year-old at the VA calls me honey or a nurse, I frequently just don't . . . like I don't care. I don't care. I'm like whatever. I'm doing my job. Give me the information I need. I'm going to check you for pitting edema. I'm going to go on my way.

Dr. Chan: Yeah. I don't think the VA needs to have more training modules. Okay, well, Guinn, this has been fantastic. I've really enjoyed . . . yeah, it's been it's, in fact, just watching you grow over the years, and yeah, I'm just excited for the next phase of your journey. Like you're going to be a doctor in a few short weeks. And yeah, then you're going to start residency and then fellowship and wow, it's just amazing to watch you grow.

Guinn: It goes very fast.

Dr. Chan: Yeah. Cool. Well, thanks for coming on, Guinn.

Guinn: Thank you so much for having me.

Announcer: Thanks for listening to "Talking Admissions and Med 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