Feb 21, 2018

Interview Transcript

Dr. Samuelson: The most satisfying thing about my life right now in my profession is that I have patients and patients are different than friends, many of them are also friends. But your patients take you into their life, they trust you, they let you know things about themselves they wouldn't tell anyone else, and you become a critical part of who they are. And then in turn they become a part of who you are. And boy, that's the most satisfying thing about my life. I'd never give that up.

Dr. Chan: Today, we're celebrating our 100th episode, 100 of "Talking Admissions and Med Student Life" with our special guest, Dr. Wayne Samuelson, Interim Dean of 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 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, Dr. Samuelson, Interim Dean of the Medical School.

Dr. Samuelson: Thanks. It's nice to be here.

Dr. Chan: So, Dr. Samuelson, let's start at the beginning. Why did you decide to become a doctor? Let's talk about your journey, your path.

Dr. Samuelson: Oh, this is a strange and bizarre story. It began when I was I think in fourth-grade. I had read a book about engineers. I think it was called ";Engineers Did It," and it was this fascinating book about how engineers built bridges and skyscrapers and stuff. And so I read that and I decided, "Boy, I want to be an engineer." And so I went through the library at my school and read every book there was on engineering, and there weren't very many.

And after I had gone through all those books, I was pestering the librarian and she said, "Why don't you try reading something else?" And so she just handed me a biography. She said, "Biographies are great stories about people." And she gave me a book about Joseph Lister. And what I learned is that Lister was a young surgeon from . . . he's practicing in England from Scotland. The surgeons back in those days didn't wear white. In fact, they wore kind of dark coats, and they operated while they'd wear these coats and the surgeons' value, or his experience, and his qualifications were kind of judged by how much crud he had on his coat. So that was immediately appealing to like a 10-year-old guy that you could wear blood and guts and crud all over your coat and people liked you for it.

But Lister noticed that most of the people or at least half of the people that he did amputations on were dying of infection. And so he explored that, and the long and short of things he read the papers by Pasteur about bacteria and figured out how to use they use disinfectants in the OR and became the father of disinfectants. And the culmination of his career was he got to lance a boil on Queen Victoria's backside.

Dr. Chan: Oh, wow. I didn't know that.

Dr. Samuelson: So, in that moment, I thought, "Wow, I want more of this."

Dr. Chan: This is when you're 10?

Dr. Samuelson: I'm 10.

Dr. Chan: Most 10-year-olds want to be firefighters or police.

Dr. Samuelson: Yeah. Well, you know . . .

Dr. Chain: You want to lance boils.

Dr. Samuelson: I had older brothers, and they were premed students at the time. And there was a course at University of Utah called Comparative Vertebrate Anatomy. And that meant that you dissected a cat and a shark and few other things. And my brothers would bring home their cats to study at home, and they would lay them on the kitchen table. This horrified my sisters and just thoroughly enthralled me. And so I would sit and study with them. So I learned a lot of anatomy helping them.

What I also learned is that if you wrapped up a towel and put it in a big plastic bag about the size of a cat, I could chase my sisters any place and they would leave. So I was thoroughly indoctrinated, and by the time I got to be a teenager, one of my brothers was working in a lab here at the university. And one of his jobs was to go out to the slaughterhouse and harvest adrenal glands from the cattle as they were being taken to the slaughter. And occasionally, a pregnant cow would come through there, and he was able to pick up these bovine fetuses. And so he'd bring them home, and so then I practiced dissecting them.

So I was a total nerd back then, as if something had changed, and I just got more and more involved. My father was not a physician, and he was an expert in vocational rehabilitation and had been one of the founders of that movement in western United States and specifically in Utah. And so I got a chance to see people overcoming different kind of strategies and health problems. And that I think also contributed to it. So, yeah, I go way back. I was really a classic nerd, and after I learned about lancing the boil on Queen Victoria's butt . . .

Dr. Chan: You were committed.

Dr. Samuelson: . . . I was committed, and I never really thought about anything else.

Dr. Chan: Well, it sounds like if you're practicing on bovine fetuses, you were destined for surgery. How did you choose your field once you got to med school? How did that happen?

Dr. Samuelson: Well, I thought I wanted to be a surgeon, and I had a chance to observe some surgery before medical school. And I had access to shadowing before any of this stuff happened. I found that surgery was kind of fun to watch, but not very fun to do. It was not as intellectually engaging. Now, both of my brothers are physicians. One is an internist, one was a surgeon. And the orthopedic surgeon was fun to hang out with, and I would go to watch him in the operating room. And the noise was incredible, and the bone chips and the power tools and all that other stuff. And so I thought that it was kind of fun, but it was not unlike working on a car at home or building something. And I found that engaging, but the patients were always asleep. And so I think it was more the human interaction that slanted me away from surgery and into my field, which is internal medicine. And probably also that I don't think three dimensionally very well and I can't tie knots very well. So I really didn't have the native skills to be a good surgeon.

Dr. Chan: So picking internal medicine while here at the U and then where did you go for residency and why?

Dr. Samuelson: I did an internal medicine residency at Duke University, and I'd received some advice that will sound horrible to people nowadays, but turned out to be really good advice for me. My adviser in medical school said, "You want to go someplace where you'll see a lot of patients, where you'll work really hard. Don't worry about sleep, you can do that when you're done. It's only three years." And so I took his advice, and I was able to get into a really intense, very good internal medicine program at Duke and exactly what he predicted. I saw lots of patients. I had a chance to do a lot of stuff and didn't get a whole lot of sleep, but learned a lot and really, really enjoyed it. And the process of that I discovered that I really liked that atmosphere and found it really engaging. I enjoyed my intern year greatly, probably one of the most satisfying, fun years in my entire career.

Dr. Chan: So this is back when residences were truly residency. You lived in the hospital.

Dr. Samuelson: Well, I didn't live in the hospital. It just seemed that way. I had an apartment, a wife, and a child that I would go home to frequently, and we were allowed actually to sleep at home. So you'd get your work done, and on the call nights I'd go home about 3:00, 4:00 in the morning and then sleep in my own bed for a couple of hours, which made it very restful, get up and have breakfast with my then two-year-old daughter, and come back to work. And so it was actually pretty fun. But yeah, you spend a lot of time in the hospital.

Dr. Chan: Yeah. How was that going from Utah to North Carolina? How was that? Was it a jump, a transition?

Dr. Samuelson: You know, it was not as big of a jump as I thought it would be. The hospital is the same. I found this medical school prepared me really well. I was quite intimidated when I first got to Duke, because there were people from all the Ivy League schools and Johns Hopkins and big name places, and they didn't mind telling you that, you know. I felt like I was kind of the barefoot boy from the mountains, but I'd been prepared well, and I found that I was very comfortable working with the other people. And that was very, became clear that Duke valued the training that I gotten in medical school, and there were a lot of Utah people that had gone to Duke and matched there.

So that part wasn't [difficult 00:07:57]. The culture was kind of fun. You don't really get the culture of the environment until you've been there for a couple years. My wife really loved it, and we ended up staying there for 15 years after we only planned to do the three-year residency. And really came to enjoy the South and came to enjoy the people, and really came to enjoy the East Coast beaches. So . . .

Dr. Chan: Yeah. Great sand out there, great beaches.

Dr. Samuelson: Oh, yeah.

Dr. Chan: So, and then I think you decided to specialize. So walk us through that. I mean, how do you come to the lungs, correct?

Dr. Samuelson: Yeah, yeah. Well, in my case, my specialty found me. When I did my first third year rotation in internal medicine, my attending physician was a nephrologist, Dr. Ramirez. He was a really fun guy. He was a smart guy, and he liked me and gave me the chance to do some additional things. And so I really got heavily invested in nephrology. I loved kidney disease, and I loved kidney physiology, still do. And I was really impressed that the nephrologist were really excellent doctors. So I thought I wanted to be like that. I wanted to be a good doctor, and I wanted to be able to deal with really fun stuff.

And then, so when I went to Duke, one of things that attracted me about Duke was they had a very good nephrology division, and then when I got there, I had a chance to rub shoulders with these crackerjack nephrologists and stuff. And then I saw patients that were a little challenging to me. Dialysis patients are tough. Dialysis is an amazing technology that really extends life and does a lot of good things. But patients are not necessarily happy while they're on dialysis. And it started to impact me. I became as unhappy as my patients.

And then I did a pulmonary rotation and discovered asthma. And asthma was fun, because people get really sick and then they get really well. They can turn around really fast. And I found out I enjoyed pulmonary physiology, and then I did some intensive care stuff and the intensive care units were just fun physiology labs and that Duke was kind of the purview of the pulmonary division. And so I asked if there was a spot for me in pulmonary, and there was, and I've been happy ever since.

Dr. Chan: Yeah. That's great. And was that two or three years?

Dr. Samuelson: Well, when I did it, I was able to get into a kind of a short track program. I was able to get an individual training grant, which allowed me to do an extra year of research. And so I did two years of research in a clinical year, which back then was kind of opposite of the norm. And then, because Duke had some ins with some people, I was able to kind of use one of those research years as a third year residency. So I got kind of a hybrid, and I got through what would normally be six years in five years.

Dr. Chan: Wow. That's great.

Dr. Samuelson: So it was helpful.

Dr. Chan: It sounds like you're very happy stuck around Duke.

Dr. Samuelson: Oh, yeah. Duke was a great place.

Dr. Chan: Teaching. It sounds like you're the asthma expert.

Dr. Samuelson: Well, at Duke I was kind of the second asthma guy, but I was the first cystic fibrosis guy. Adult cystic fibrosis clinics had not really been developed then, but the Cystic Fibrosis Foundation really wanted that, because there was an increasing number of adults with the disease. And adults have adult problems and pediatricians were less well equipped to deal with those kind of issues. And so Duke was coming up for renewal of their CF grant, and the Foundation had indicated they expected them to have an adult clinic.

And so my boss called me in one day and told me that this would be a great opportunity, and it would be certainly good for my career to take over 120 adults with cystic fibrosis. And I was perceptive enough at that time to realize that what he was saying was that it would be bad for my career not to do it. And I was uniquely qualified to do this, because I was the most junior person in the pulmonary division and everybody else had other things they could do.

So I took that on, and it really turned out to be good. It was good for my career, and I learned a lot. Those kind of patients can teach you a ton of medicine. And my initial clinical research efforts were mostly in CF. And just I had a great time, was the backup asthma guy. But when the opportunity at the University of Utah came up and they needed somebody with asthma, the thing that helped me get this job was that I had had experience in starting a program and starting a clinic, which they needed here. And so it worked out well for me.

Dr. Chan: Yeah. I mean, that's the question I get the most, Dr. Samuelson, is like, "How did I get my job?" How did you get your job? I mean, how did you become dean of the Medical School? I mean, how that . . . I know there's a series of events, but like, how did you go from Duke? It sounds like you're very happy treating CF, and now you're in charge of the medical education of 500 students. How did that happen?

Dr. Samuelson: Well, it's a series of sort of unrelated, but I guess in reality it's closely related events and probably some funny decisions on my part. I was very happy at Duke. The University of Utah Pulmonary Division did not have a strong clinical presence, and they were brilliant researchers. And they had gotten a grant from the American Lung Association to study airway injury, but as a condition of keeping the grant they had to have an asthma program for both adults and for pediatric patients. And so I was recruited to set up the adult clinic, and it was a really attractive job.

First of all, Dr. Hoidal, who recruited me, is a world-class researcher and highly respected throughout the world. And so to have a guy like that ask you to come work with him was a tremendous compliment, and it was almost irresistible. I came and had a chance to use resources to build the program and a clinic the way I wanted. And then the next year they hired a pediatrician, and he had the same sort of thing. And so we had a good relationship.

The year after that, we brought in somebody to be a lung transplant, Dr. Cahill was a lung transplant expert. So it was just fun, and it was growing. I really liked it, and I remember telling my wife that I was exactly where I wanted to be and the condition was perfect. About that time, the Medical School had been having its usual difficulties with some people in the community over who gets admitted and who gets turned down. And the grandson of a legislator had been turned down to our Medical School, but had been accepted to another very good medical school. And this was felt to be evidence that our process was biased, and so the state legislature conducted a very intensive two-year audit of the admissions process.

Dr. Chan: Back in 2002, 2003.

Dr. Samuelson: Back in 2002. Yeah. And so, in the middle of all this, the then Dean of Admissions had decided she had had about enough. And they were hard on her, and they were hard on the school. And our application numbers were dropping, and so they decided, "Well . . ." She quit. So they decided if we're being accused of being biased against white males from the predominant demographic in Salt Lake City, maybe we ought to get one of those people to be our Dean of Admissions. And so, in the midst of this great happiness, I'm really enjoying myself in pulmonary medicine and no prior experience in administration, I allowed them to appeal to my vanity. And they gave me the job as Dean of Admissions. And my first task was to get us through this audit.

And so, after we did that and I thought, "Well, it's time for me to go back to pulmonary," then there was another crisis. And once again I'm very vulnerable to flattery. And so they convinced me to stay on, and eventually one doctor, Vivian Lee came and she asked me to take on the education admission, and I became a vice dean. And when Dr. Lee left last May, and Dr. Betz came back, who had worked here previously and who I'd known, asked me to take on the interim dean role, and here we are.

Dr. Chan: Wow. It's phenomenal. So it sounds like a lot of opportunities arose, and you took advantage of the opportunities. And you just happened to be at the right place at the right time.

Dr. Samuelson: I think it's mostly being in the right place at the right time, or sometimes I think it was the wrong place at the right time. But yeah, I had never anticipated, back when I was reading about Joseph Lister lancing Queen Victoria's boil, that I would end up as an administrator. I did think that I would end up as a real doctor.

Dr. Chan: So I mean, looking back, Dr. Samuelson, what are some of the changes you've seen? I mean, you went to med school here many years ago, and now, like you said, you're in charge of the educational mission. Like, what are some of the biggest differences you see between the two curriculums or the student body or anything like that?

Dr. Samuelson: Well, there's a number of important changes, and I think equally as important is some things that haven't changed. So when I was in medical school, we basically went to lecture most of the day, and, in fact, I just recently saw the latest "Star Wars" movie. And I reflected on the fact that the only time I ever cut class in medical school was to go see the original "Star Wars" movie. It was a matinee, and about 14 of us just sort of skipped out and went to see that.

Dr. Chan: Did you do any cosplay when you went to the recent show or . . .

Dr. Samuelson: No, no.

Dr. Chan: Okay. I thought I saw you in costume.

Dr. Samuelson: Yeah, yeah. Well, I thought about it.

Dr. Chan: It was someone else.

Dr. Samuelson: I couldn't quite get into my Stormtrooper uniform.

Dr. Chan: So this was back in the original "Star Wars."

Dr. Samuelson: The original "Star Wars" the very first one.

Dr. Chan: 1977.

Dr. Samuelson: Yeah.

Dr. Chan: Okay.

Dr. Samuelson: So I was a second-year student. Yeah. It was a good time. We, in our clinical rotations, had a lot of clinical responsibility. The patients were ours. Faculty did not come on the floor for rounds in those days until we'd made rounds with the residents. So faculty were not even allowed to be on the clinical floors until about 10:00 a.m.

Dr. Chan: Interesting.

Dr. Samuelson: And so you felt like you had lot of independence. That's changed a bit, and that's dictated by external factors. The University of Utah was then and is now very strongly oriented towards giving you clinical skills, and so that really hasn't changed very much. The curriculum format back then was almost exclusively lecture-based, and they used to show Kodachrome slides for everything. And what I remember of my first two years is mostly the words, "Can I have the first slide, please?" They'd turn the lights off and flash something up, and I'd go to sleep. That's why I didn't cut class, I needed the rest. But nowadays we realize that there's lots of ways for students to acquire information, and many of them don't involve sitting in a lecture. So we've moved our curriculum more towards helping students become self-learners and explore resources there. And I think that's improved things quite a bit.

Dr. Chan: Like team-based learning, case-based learning.

Dr. Samuelson: Team-based learning, case-based learning, all those sorts of things that are very useful. The other thing we've done, that was a big change from the dark ages when I went to medical school, is introduce clinical . . .

Dr. Chan: Experiences.

Dr. Samuelson: . . . clinical care and experiences very early in the curriculum. I did not touch my first patient until I was at the beginning my third year. That was in physical diagnosis that was sort of truncated, and then you'd see a couple of patients with a preceptor, and then you go on to the wards. Our first two years were very much like being in chemistry or physics as an undergrad. You'd come in, sit down, take notes in the lecture. Sometimes they would have clinical correlations, but not very often and they weren't really very clinically oriented.

Whereas now, we believe strongly and I think it bears out that people who want to be physicians should start being physicians early on. I think the commitment to excellence is the same now as it was then. We were very clearly told, back when I was a student, that we were expected to be good doctors, and that the University of Utah was known for raising good doctors. And wherever we went, we would remember that we were from a place that had committed to making us good doctors. We've tried to hold on to that.

Dr. Chan: Yeah. That's excellent. I like what you said, to me, like it seems everything just seems harder today because of the amount of information and like, you mentioned, like the different learning styles the students have. So again, like I went to school here late '90s, early 2000s, and I remember it was like review books. Like everyone had these review books -- blank, made ridiculously simple. I think they still have those. I see that every once in a while.

Dr. Samuelson: Yes, they do.

Dr. Chan: But nowadays, the students they have like these apps, and they have all these files and all this information. And I just think it seems harder now, because I just remember like, back in the day, it's you had like the printouts, like they had the PowerPoints and you took notes, and you had some references, and that was it. But now, it's like this ever expanding universe. So . . .

Dr. Samuelson: Oh, you're right. And one of the things that I think we've learned as educators is that students are very capable of educating themselves and each other. And so the role of faculty now as I think is to serve mostly as a guide. Students rarely need somebody to stand in front of them and spew information that they can get other places. And frankly, some of the lectures that you find online are far superior to the ones that we can deliver here.

But the role of faculty is still important, because I think we need to make sure that with all this information that's out there we're helping our students find what's relevant, what's correct, because there is misinformation that abounds out there.

And then one of the things that I think we are obligated to teach, that was never even thought of back in the olden days when I was in medical school, is that you will practice medicine as part of a team, in conjunction with other healthcare professionals, who are also learning their profession, and being able to work together is really critically important. And I think that's an emphasis that we have in our curriculum that clearly was absent in my day, but I think it's very important going forward. It's more efficient, it's higher quality care, and it's, frankly, a heck of a lot more fun.

Dr. Chan: Yeah. I agree. Last question, Dr. Samuelson, what does a dean do all day? I mean, what's your day, what's your routine like? Because again, some people ask me that all the time. It's like what does the dean do all day? I mean, what's your schedule?

Dr. Samuelson: Well, yeah, the dean goes to meetings, a lot of meetings. Sometimes they're good, sometimes they're bad. I sign a lot of stuff. I listen to a lot of complaints. But I'm very fortunate in that I've been able to structure things such that I still get a chance to just see people I like, patients and students. I have the chance on a couple of evenings a week to supervise medical students in a clinic out Midvale, which is very satisfying for me, and I learn a lot from very smart students. And they work with other healthcare professional students out there.

I have continued to see asthma patients. So two afternoons a week I still have a clinic at the University, which I do to remind myself that this is why I went to medical school in the first place. There are just things that have to be negotiated. You have to figure out resources.

We were talking earlier about making arrangements to expand the library's availability for study hours and things like that. That's the product of a lot of different meetings. Finding the resources to make sure that our practical experiences are done well, that our clinical skills area is open and available, that we're finding places for students to do their training as our class size expands. That's the kind of stuff that I really spend a lot of time doing, and while it's important, it's not nearly as much fun as teaching and as taking care of patients.

Dr. Chan: Yeah. I mean, Dr. Samuelson, the best advice you ever gave me was, as my career has blossomed, to never give up treating patients, to always maintain that part of my background, my training to treat patients. And I think I love hearing how it sounds like you have time still to see patients in clinic, and that's fantastic. I think like that's the best advice you ever gave me.

Dr. Samuelson: Well, I had a good mentor that promised me that I would never regret insisting on clinical time. And so, as a condition of every administrative job I've taken, I've always made very clear that if I'm willing to do this, then I have to be able to hold on to my patients. And frankly, I'm at that stage of life that nobody likes to talk about, where the hair is thinner and more gray, the waistline has expanded. But the most satisfying thing about my life right now and my profession is that I have patients, and patients are different than friends, many of them are also friends. But your patients take you into their life, they trust you, they let you know things about themselves that they wouldn't tell anyone else, and you become a critical part of who they are. And then, in turn, they become a part of who you are. And boy, that's the most satisfying thing about my life. I'd never give that up.

Dr. Chan: Yeah. I love how you said that and, to me, yeah, treating and seeing patients, I feel it makes me a better educator, it makes me a better administrator. So I enjoy that variety I have in my life. It sounds like you have it too.

Dr. Samuelson: Oh, yeah. That's great.

Dr. Chan: Yeah. Cool. Well, let's end on that note. Thank you, Dr. Samuelson, and we'll have you come back on maybe for our 200th episode.

Dr. Samuelson: Okay. Thank you very much.

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 thescoperadio.com.

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