(a post written upon re-entering, but published upon beginning intern year)
Dear reader (or should I say, dear diary, since I’ve been treating these blogposts a certain way), in the past month, I have re-entered. It is (in my personal view) kind of ridiculous, and telling, that “re-entry” is the consensus term for the process of coming back from research years, a PhD in the case of MD/PhD programs, to medical school. I take issue with the term for several reasons, least of which is that my lab was literally across a pedestrian walkway from the medical school, in a clinical department, with an MD principal investigator. Moreover, MD/PhD is commonly advertised as a highly “integrated” path, or is it? I’m sure any MSTP[1] grant’s WordCloud consists of “integration” surrounded by a bunch of minuscule scribbles that vaguely read “physician-scientist” and “vertical integration”. What am I re-entering exactly if this whole program, nay career, is supposed to be woven together with intention and to synergistic pedagogical and vocational effect? Finally, it just doesn’t feel that way. As many a PhD student can attest, I feel like I’ve emerged from a 4.5-year deep coma where time stopped, or rather became extremely elastic with axes tethered to experimental progress and writing (nearly paused during lab meetings, I have to add), never turning my productivity into the singularity (thesis, publication, advisor signature) that will time-warp me into post-defense bliss on the opposite side of the universe. Personal interactions turned into weird power dynamics with alien beings who live on their own planets and speak their own languages (immunology, anyone?). All the while, I orbited generations of medical students from afar as they tread the rarified grounds of the school of medicine, followed by clinical sites, followed by match days and graduations that got increasing painful, with faces decreasingly familiar. Every once in a while, as I pranced around the medical school with my white Styrofoam ice boxes, I’d bump into a classmate who is now a PGY17 and a great-grandparent. So perhaps I am re-entering, in the sense that I’m tumbling back into the real world (medicine, relative to academia, but perhaps less so relative to normal people with “normal” jobs), with associated elevated pressures and atmospheric friction causing severe heating and discomfort. Add to that the awkward and uncomfortable ties and double gloving and undersized jackets that indicate exactly how little I’m prepared for this. Anyway, we could do better with naming.
If I learned anything in medical school, it is that to complain outside anonymous queries is unprofessional, so I’ll stop here. Despite what you may be thinking, I have been and still am really enjoying the process. Third year of medical school as a returning MD/PhD, especially at the beginning, and provided one is honest enough (read, straightforward, not filter-less…), has the added benefit of being able to tell your teammates on the wards: “Hey, I am really excited to be here, but I have not seen a patient, let alone asked a patient to “tell me more about this” in a few years! Can I have some guidance? Watch first?” I fully embraced this strategy, and it relieved much of the pressure. It certainly helped that my program provided a couple of weeks of ungraded internal medicine at the beginning of this “re-entry,” which means no need to impress anybody during the limited time on their team to get a good evaluation. Rarely did anyone verbalize or otherwise express surprise or disappointment at my confession, except for a few unsolicited opinions on whether basic researchers are lousy doctors. In fact, in the rare times where I felt confident enough to interview/present/chart my way independently with a new resident or attending, they often had feedback about particular formats they wanted to see, and I’d often pickup on those particularities as I’m shadowing them. Therefore, I plan to pursue this strategy (with modification) going forward; the gist being to ask for expectations and feedback early on, and to be honest about what I know and do not know. That being said, knowledge of cold hard facts, and at scale, is necessary in medicine. It does not osmose into your brain on the wards on its own. And you cannot wax academic and exclaim “This is an interesting question!” then proceed to answer a completely different one on a topic you know. I cringe internally at the rare sight of a PhD in clinical training who implies they are above learning or doing something otherwise required of their medical student or resident colleagues (you are making the rest of us look bad!). Therefore, to avoid getting in an uncomfortable situation, I found that disciplined studying needed to be done, often independently and more intensely than MD-“only” colleagues, often earlier in the rotation, to be able to be knowledgeable enough to understand what’s going on, and secure enough to be honest without looking like I’ve never been to medical school, or heaven forbid, that my particular field is not God’s gift to humankind. The undergrad/M1-2 strategy of studying the week (night?) of the exam, no longer flies after re-entry (ha ha ha).
I want to end by saying that I don’t think physician-scientist trainees are not special. And we sure do love hearing it! After all, the dual-degree selection process selects, above all, for people who want to earn two degrees, do more, be “better”, and contribute to something larger. There’s nothing wrong with ambition. But we are not just doing the extra work, we signed up for it. Along the long and winding road, whether taking off or re-entering, there’s a risk that the continuous drive to do more turns into entitlement about reaping the benefits. I hope I have avoided that during my training, where giving myself excuses would have rarely impacted others. It shall continue be my goal as the stakes rise.
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Michael Sayegh, MD PhD
[1] An MSTP grant is granted by the National Institutes of Health to the bestest group MD/PhD hosting institutions to fund student stipends and medical school tuitions