#18 Cardiothoracic Surgery Resident Interview - Lifestyle, Competition, and Entrepreneurship

so welcome to another episode of the Zach highly show today I have the honor of being with Jason Han so Jason Han was born and raised in South Korea until the age of 10. he came here with his family and attended Columbia University and Perlman School of Medicine where he was the student body president he's currently a cardiac surgery resident at the hospital of the University of Pennsylvania and the vice president of tsra which is their National governing body he's broadly interested in communication Education and Leadership especially as it concerns patients and staff he's written a column for the Philadelphia Inquirer for seven years and has written essays for the New England Journal of Medicine the Journal of American College of Cardiology and many more so the way I started off these episodes is reading about statistics around cardiothoracic surgery specifically because that is your specialty and then if you have any inputs or insights or thoughts about those so okay burnout percentage 35 compared to 47 average that's pretty good em actually tops that at 60 and public health is at the bottom at 26 when asked would you stay in your specialty again Durham and Ortho win at 99 and 97 uh surgery is in the middle at 83 percent that's pretty good and Internal Medicine especially I'm thinking about going into is at the bottom at 63 the median salary of an academic or associate professor at an academic institution is 339 000. the the median salary for a general surgery salary is 445 000 and the median salary for a CT surgeon is seven hundred and twelve thousand dollars uh the hours training a week or the hours working as in attending every week is 51 hours generally general surgery is 60 hours and CT surgery gets a little bit higher at 62 hours in regards to training the average step two score is 248 for surgeons compared to 245 and then overall training and this can change a little bit I think we'll probably discuss this is five years research year and then maybe two years of the fellowship going into CT surgery but I know there are different residency Fellowship paths to get to the CT surgery so first off any of those statistics stand out to you anything you want to mention or talk about yeah well thanks thanks for having me here thanks for coming on I really appreciate seeing you when I take in those statistics yeah I think this is a small comment but it's so funny to me that we're talking about average step two scores because when I was applying it wasn't something that we really thought about or averaged you know like we we simply based everything on step one scores you know like that's that was and then I think about when I started applying a residency and that was already seven years ago wow so uh it's been some time but uh I mean the statistics that you read out to me are really interesting to me because I think it it points to the the passion and the intensity of cardiac surgery right I mean it's commensurate with the fact that you're working more hours than probably an average physician or or even a general surgeon um there's a high degree of unpredictability in your schedule because a lot of the things that we deal with are emergencies right so you operate on a patient at at any point somebody may call you and say hey this patient doesn't look good has to go back to the or tonight and that could be 1am right so there's some there has to be some passion behind all of this and I think that ties into the burnout rates that we're talking about as well I mean I've been training as a cardiac surgery resident for for six years now as I mentioned and and and the moments when I feel burnt out and the moments that I feel really rewarded are uh have a gray sort of way of overlapping with each other and I'll go into that a little bit further it's not necessarily that when you work more you feel more burnt out you know the moments that make you feel burnt out um May sometimes be during the weeks that you have worked the least because you feel like you've been most you know disengaged from the kind of personal fulfillment or growth that you're looking for it could be paradoxically that the the moment that you feel the most engaged in your career is is the week where you worked non-stop right and then did this operation all night and then you walk away from it thinking like wow like this is why I'm so in love with the field right so there's some paradoxical element of how I think about burnout because especially in a high intensity field like this you know burnout can be actually cured with finding more personal engagement if you find the right ways of getting that person there right so so maybe the things that are asked you know getting people to feel um more engaged about the field are not necessarily cutting back um you know cutting back hours but leaning in a little bit more in moments where you think that it's going to be very meaningful um for me like being able to spend the extra hour with a family member even after a long operation and then knowing how they feel about the whole thing is is an extra hour of reward you know so in that sense I tie those two statistics together you know there may be more hours um but then at the same time it doesn't mean that people feel more burnt out it could mean that people want to keep on staying in this field because because that's what they signed up for in the beginning I think they were making passion based decisions yeah no that's really interesting and I want to point out two things what you said lean in that's the fourth time I've heard this expression with people and I'm stealing it now from people because it's such a good expression and I wish I was kind of I kind of thought when I had my first clinical rotation ever right was OB GYN I didn't think I was going to be an OB GYN yeah but someone told me two days in you know just lean in Just Go For It Be it every procedure learn as much as you can about Obstetrics and Gynecology and you're going to have a much better experience and I think I did so so take that in mind people I think I think it's really helpful the second thing I want to ask about is you're at one of the top institutions in the world right you personally does that play into burnout or feelings of burnout at all is it a competitive feeling are you trying to be one-up colleagues or anything like that or is that not true no honestly I think people who tend to go into cardiac surgery are competitive by nature but it doesn't necessarily mean that you're competitive against your colleagues because at the end of the day I know that people are you know competing over many different things in the field of surgery right they may be eventually in their careers competing over volume they may be competing over outcomes they may be Computing to see who has you know more high impact papers and whatnot you can compete about anything but really the only competition that matters at the end of the day is how much as a field you can provide high quality care to your patients right so when I think about competition um from day one I think it's really about getting all of your colleagues to secede succeed at the same rate yeah not succeed but succeed um and I say that because at the end of the day no matter how good a surgeon you are you're never going to be able to do as much work as two well-trained surgeons competing at a high level um and and that's more important to me I think as we think about treating disease because we are going to face shortages in the future right so the competition I think has shifted in my mind from hey can I get to that training spot and can I be uh the quote-unquote best resident to like how can we get everyone in this program to succeed in the way that will ultimately benefit the field long term because if you think of it that way then the day-to-day competitions among people among trainees becomes pretty meaningless like you're competing against something so much larger um and there's also technical elements of competition every single day where you just want to be better you know like you we talked about this phrase leaning in literally every day of surgical residency is walking into situations where you may not feel 100 comfortable like I think by definition surgical training is like oh I'm not sure if I'm 100 ready for this and then trying to figure out how you can feel like you've had growth by the end of the day yeah right and that's an inherently uncomfortable process like every single day I wake up and I'm like oh I really hope I get through this case and do a good job and I think if it were something that I could just walk into and not worry about then perhaps I wouldn't feel as driven at the same time so it's a necessary part of training but you're constantly competing against your former self like on a day-to-day basis and I think that just goes on for the rest of your life beyond training because the surgeons who really care about that aspect of their of their you know craft we'll keep on asking that question even after they become attendings yeah at that point no one's going to look at your your operating you're operating and then be like hey like you messed that up except for yourself you know so there are surgeons who keep on going down that path for 30 years and the operation that they're able to perfect at the end of their career is a beautiful thing right because it's somebody who's obsessed over how to do this better for a long period of time and and that really shows yeah and I think you need that difficulty for growth right I think there's a couple papers that show at around the 85 percent difficulty Mark is when this kind of magic happens when you learn the best when you're performing the best and maybe you even get in the flow state which I'm sure you're familiar with so you have a kind of different career a different background than some people you know you you're a writer you're doing all these different now you're doing this modern surgeon thing which is really cool which we'll definitely talk about later but my question is how do you do these other things and Medicine did you ever think I want to be a writer full-time and not do medicine or was it you know this is just a thing on the side I'm gonna do you know I think I've always had a very entrepreneurial personality like even in college I wasn't necessarily in the pre-med groups I was trying anything and everything that I was interested in so I mean my college activities were like something entrepreneurial a little bit of student government a little bit of cultural organizations an acapella group and in fact way back then my pre-med advisor looked at me and said are you sure you want to become a physician because you haven't really done like the standard activities so I think that's par for the course for who I've been you know my whole life and uh the reason why I get interested in all of these types of side projects is because I think that you know even though medicine and surgery are a highly sort of if you can think of it as like a highly specialized and isolated craft you have to make it relatable to society in some way right I mean at the end of the day it's a human practice you're treating human you know you're treating people and you're you're guiding them through a very fundamentally Human Experience you know if you if you're not thinking about the other types of ideas that affect those on a day-to-day basis and I think we're losing touch with that aspect of our care you know so for me like when I think about doing uh written Pro like writing projects or media projects I'm not necessarily thinking that this is something that takes me away from my surgical practice so I'm trying to think about the gaps within surgical practice that I'm trying to overcome through those projects because I really think that what we need more than anything right now in the practice of surgery is to be able to connect with our patients more deeply whether that be through you know sort of understanding their emotions better or communicating about their disease processes better or you know like helping them get through complications or even navigate more difficult aspects of their post-operative care you know like that's that's where I think surgeons could do more so all these conversations that we're having right now to me relate very deeply to my Surgical Specialty so are you seeing issues when you communicate to patients they just is it they simply have no idea what's going on do you see other Physicians doing this where's where are you seeing the gaps specifically I mean honestly I think cardio surgery has really Advanced to sci-fi levels of technical sophistication I mean even if I'm having a conversation with an educated audience probably me even I wouldn't know he's hard a lot of people would be shocked to know what we're actually capable of right now right I mean the kind of progress that's been made in the field like the whole concept of how you know heart transplants happen and mechanical Hearts became available different valvular Technologies and and the level at which we can carry out these Advanced procedures with the kind of outcomes that we're having still feel kind of sci-fi to me right but it's incredibly Technical and nuanced and I think as the technology in the field Advanced at a very rapid rate you know sometimes maybe you know what we need to do is communicate with the people who may be requiring these services and explain to them what's going on right I mean maybe 50 years ago people used to come to their surgeon and then it used to be a much more you know much shorter conversation but now just to have a basic conversation about what open heart surgery you may need and what you might see afterhand you know you know after the procedure and then what kind of devices are involved and what kind of labs we're following I mean that is an entire medical school curriculum right so so how can we get them just educated and involved enough that that we feel like we're walking them we're walking with them side by side as opposed to just kind of asking them to sign up for the procedure and then and then seeing if they feel better I think I think that's where we're trying to to get better at this whole thing and I want to bring up something that and you're familiar with Dr okasani something he told me in when I was talking to him and which it's kind of stunned me at first because I I didn't even think about this but he told me he thinks the clinic is the most important place the most the most place where the most important decision is the biggest chance for mistakes come in and it was just stunning to me and I guess it kind of makes sense because that's the place where you're signing people up for these surgeries and you have to explain to them listen there's maybe a five just randomly maybe there's a five percent chance you could die yeah you're putting your life in my hands right absolutely I mean I completely agree with uh with benga and then he's been a mentor figure to me for for over 10 years um the clinic is the least appreciated and the least researched aspect of what we do as surgeons without a doubt but but I think it's the highest impact as well those conversations with a patient and their family set the tone for virtually everything that follows their expectations how they can plan around it so that they can get back to their lives safely like all of these things need to be answered in a way that I think meets certain type of criteria you know I uh if let's say that you and I we're both busy and all of a sudden we needed to have surgery right I mean that's a very complicated thing to fit into your life because all of a sudden now you're saying how can I meet this deadline and how can I keep on doing the things that I like to do how can I tell my family so that they're not concerned about me Etc how do I balance all of that so that I can keep on living my life to the best extent possible that's a really complicated thing to think about right like if it were me I think I would want a very detailed plan uh oftentimes I think the plans that we're providing families is a is is too Curt of aversion to be able to allow something like that to happen because you're given 20 minutes right on average right right it's a very short conversation and oftentimes I think you know people are not able to go fully in depth about what to expect about every detail because well that's that's a lot to open up in a conversation because that'll lead to a question after a question after a question and you don't really know what the appropriate amount to cover in that conversation is you know but uh but that's something that we need to work on and just not studied at all right because like who thinks about the clinic and and that kind of process as as the main quote-unquote job of a surgeon and we don't really think of it that way and it almost worries me even more when you think about the dichotomies and the conversations different levels of educated people are going to have with their physician right if you go into the cardiothoracic surgeon and have a discussion with the cardiothoracic surgeon about the surgery that's going to be done on you it's going to be a very different conversation than I have which is going to be a very different conversation than someone who never went to college yeah you're totally right and you know uh I can only I can almost imagine reading a transcript of one conversation versus another depending on an educational level and you both have 30 minutes and depending on that like the amount of stuff that you can cover and the kind of questions that you can ask how nuanced it is will vary tremendously right but but at the end of the day that's how we carry out both of those situations right now huge gap huge gap really interesting let's talk more about you though so you're telling me in uh undergraduate you weren't really sure about medicine when when did the thoughts come in when was the decision made yeah you know uh I always liked science and biology and and I thought that I was always leaning towards medicine but I didn't necessarily want it to be a narrow path you know I one of the reasons why I like medicine the most is because you know no matter what kind of interest you may have there is a bridge to medicine right I mean we think of going to medical school as this big step towards specialization but really like you can think of studying medicine as a way of opening up your opportunities you can still go to med school and become somebody who's interested in in in Media or writing or entrepreneurship or business or anything right I mean it just gives you a way of connecting with that kind of material in a different way so I never really thought of going to med school as necessarily a way that a place where I have to fold these on their interests and then focus on one thing more specifically I mean obviously it requires a certain amount of time to keep up with a medical career but uh but yeah I uh my interest has sort of vaguely been around medicine since I was younger and then going into college and then by trying out all these different things and then knowing that I wanted to incorporate it into my medical career only cemented it further and then uh that's that's sort of how I approach my residence training as well and at each step of the way I think the the balance shifts a little bit more right I mean in med school I had a little more time than I do now and then surely for the rest of my career as a surgeon it'll it'll be that way keep shifting in that direction but but it's it's interesting to keep that alive yeah and I love that answer because I think it's it's bold to make that answer in a way because I think a lot of people feel they need to say you know patience are my life which I'm sure they're very important and things like that but it's like I had this amazing interaction with a patient and things like I'm thinking back to my Medical School interviews right now but really honestly and I'm going to be truly open for the first time in a long time here on this podcast though okay um but I have the same feelings I think the MD the medical education is a great opening point it doesn't it's not a narrowing point it's an opening point for you to get interested and learn about all these different fields because Healthcare is always going to be there right and it's always going to be important to people so it's a fantastic fantastic thing to do and it doesn't necessarily need to be like you know I'm going to be with patients all the time we need people who are going to be doing other aspects around making patient and Doctor interactions better around making devices better for patients around making new drugs all these things it doesn't necessarily have to be even though it should be a good reason why you're going into it that you're going to be a clinician with patients I completely I am you know a lot a lot of people think of medicine as a as a scientific Pursuit a lot of people think of surgery as a technical Pursuit but you and I both know that it's so much more than that and it just said a lot of those other aspects don't get focused on enough I think but there's I mean simultaneously there's a whole lot of room for improvement in those areas yeah so if you're thinking more broadly in the field of medicine and surgery I think I think it's actually a strength yeah yeah no I agree 100 so CT surgery first I realized I never asked you the question what is CT surgery yeah it's a it's cardiothoracic surgery you know uh in this country the training pathway for both Fields cardiac which is dealing with the heart and the major blood vessels in the chest uh and thoracic which is dealing with all the other organs in the thoracic cavity such as your lungs and esophagus and Etc are are combined specialty so we call it CT surgery and it's a this is what someone was explaining to me the other day it's a residency not necessarily a fellowship so there's multiple ways of going into the field um and I won't get into too many details but you can either go into it straight out of med school which is a commitment you know like like we talked about earlier you're signing up for a potentially six to eight year residency in a highly specialized field straight out of med school I think that requires really asking yourself if this is what you want right um versus you can go into a general surgical residency finish that training graduate from it and then apply to a fellowship in CT surgery which is a two to three year experience in this country so there's two different ways of going about it broadly speaking there is this integrated pathway where you dive straight into it and then there's a general Surgical and then traditional Fellowship pathway where you gain a broader set of skills and perspectives along the way and then reapply for more specialized training what did you do I went straight into it yeah and uh you you preface the decision you need to do a lot of thinking and a lot of personal thought what was your thinking what were your personal thoughts making this decision yeah I mean you know you this reminds me of the whole burnout conversation in the beginning like the thing that you do every single day has to fundamentally rejuvenate you and you may not understand why it's rejuvenating you but when you're in the OR and you're operating like you got to be happy I think I think a lot of people look at the field of CT surgery and it's a complicated question right there's a there's a high salary there's a lot of power and respect that comes with it undeniably I think because of the nature of your work and uh there's certainly room for things like you know personal glorification um self-importance Etc there's there's a lot of incentives for considering a field like CT surgery but I mean at the end of the day you have to ask yourself am I in love with the image of CT surgery or am I in love with CT surgery because for me the only thing that really should guide you towards that decision is when you're in the OR and you're watching an operation or you're in an operation and you blink an eye and you look up at the clock how much time has gone by you know more than you expected or less than you expected and I think we've all been in situations clinically where you look up at the clock and you're like I can't believe it's only been 10 minutes yeah as opposed to wow I can't believe an hour has gone by like yesterday I did two operations you know it started at something like nine in the morning and then by the time I scrubbed out it was three in the morning right um how much did you sleep last night because you wait three in the morning is this morning right yeah yeah yeah so I I slept about four hours before coming here this morning um thank you this is a great way to start a Saturday um I guess I guess my point is when you're in the or like you don't feel like if you're really engaged at what you're doing before you like you don't feel hunger or fatigue until the moment you scrub out and and I think that's that's the kind of intensity and the engagement that that I'm looking for in my career you know that's why you keep coming back to it for more right because you're like you you get into that zone and then you just you're just in that you know Flow State kind of thing the whole time and uh and and yeah that's the kind of that's kind of decision making that went into my CT surgical you know you know career choice because because there's obviously a lot of sacrifices that have to be made along the way right I mean I sacrificed four hours of sleep that I could have had more last night well you also sacrificed another two or three to come in you know I mean you could have slept more at home yeah and and those are things that that you think about and then you ultimately make a decision that this is the primary thing that that gives me more gratification than necessarily the sacrifices that I'm making because the sacrifices even if you're tired or at times not able to make the events that you want to or have the flexibility that you want to people live with sacrifices in all aspects of their lives right no matter what kind of career you choose you're going to be contending with that yeah but the primary drive that you that you find in going to a specialty it has to be I think really authentic and to ask yourself that requires a pretty significant degree of self-awareness because because you're gonna need to put yourself in situation where your sleep deprived for a week and then ask yourself wow do I still have operating or is it like oh I loved it when I was really well rested and then I find myself like kind of not as into it as I'm making these sacrifices these are all things that that you learn about yourself at early stages of your training yeah and and they're hard questions but you need to be really honest with yourself about them and was it in how did you decide in medical school was it did you make the decision uh because they often tell us you know do you want to be in the LR or do you want to do medicine that's the first thing you should think about did you have an experience in med school that's like surgeries for me the or is for me uh was it kind of a slow decision like third or fourth year you're like kind of are scrambling to make the decision or how did you come to it yeah you know honestly I know that's the most common advice that's given yeah I personally don't subscribe by that the or versus nanor thing yeah um because if I didn't go into CT surgery I think my second choice specialty would have been Psychiatry or neurology right and I think it's about it's about the questions and the anatomy and the physiology that make your brain tick at the end of the day like I think if I were having a really interesting conversation related to somebody's psyche Psychiatry or or or you know thought process and and making them get from point A to point B helping them get from point A to point B that's in my mind something as intentional and precise as a surgical procedure it's just that you're not necessarily using your hands right so the environment plays a big role but I I really wanted to be attuned to what kinds of things that I liked thinking about yeah you know uh CT surgery at the end of the day the operations when they're going smoothly and you're following everything that's going on in the or there's nothing quite like it got it you know but uh but it wasn't like an or versus notor thing for me I see I see so you had a a clinical experience was it third year that you're just like this is this is it it was even before that even before that yeah I took a so as I mentioned like my pre-med advisor looks like my application said like you know maybe you should take a year out because I'm not convinced that you want to become a doctor right now so I I ended up looking for a job in serendipitously through a friend of a friend I ended up working for uh cardiologists and CT surgeons at Columbia which is my alma mater yeah so at the time I was in introduced to the field for the very first time and then to understand what I was doing clinically I went to the are a couple of times to watch one of the surgeons there one of the surgeons who's you know highly highly revered in the field of CT surgery and as I was watching that operation I just couldn't believe what I was seeing right I mean the way that the sutures were so fine and the hands were moving so quickly like that was it was mesmerizing yeah and then once I once I had that experience I think I came into med school trying to really answer that question as I mentioned earlier of I know I find it mesmerizing but is the entire field and the lifestyle in the career something that I can personally sustain and be happy in yeah and I and I spent four years answering that question yeah now it's an important question to answer because I think a lot of students right I was speaking to I remember my first year of medical school there was a student who was 20 years old and what they do they do this Penn State program and they go directly through and I think it's good and bad right if if you know exactly what you want to do and you've done this personal analysis like you did that says I'm going to be a CT surgeon or I'm going to be an internist or I'm going to be a psychiatrist I know 100 then that's perfect but I think a lot of people just go through the motions and I think it's something that I've even fallen into because you know you just go to undergraduate then you go to med school then you're going to pick this residency because you're told to pick a residency and before you know it you're in a fellowship and you've been training for 10 years and you're not really sure what you want to do so I think think it's vital that people take this thought and take this really in-depth thinking of what their life is going to be like after they make this decision and that's one of the reasons I do this entire podcast right because I want people to know what the life is like that they're signing up for because we don't think I don't think I got a good enough view I didn't speak to as many I didn't even know cardiothoracic surgery was a thing until a year ago yeah and now you're going to go into it right exactly I'm going straight into it so it's so it's so it's crazy I mean this I think this is a reflective process yeah like what you're doing here it's in part you're having a conversation but with all this information you're reflecting on who you are right because going into med school being pre-med being success successful in school and then applying to a highly competitive program etc for the rest of your life it feels like a checklist experience you're sort of you know checking things off and then getting to that next step you could get through the whole thing without ever really thinking about who you are as a person you know if you if you want to just keep on following the roadmap of something and following what people tell you is the right thing to do you have to force yourself to keep questioning while you're doing something and is this something that resonates with me who am I in this process in this environment like those are questions that you need to ask yourself by reflection I think that's the reason why I write you know I uh in the same way that you're exploring these ideas through your project I uh for me when I write it's a way of taking all these jumbled ideas and patient experiences and difficulties of residency and Etc taking that all and putting it on a piece of paper and then coming up with a clearer version of self-narrative that makes me feel like I I understand myself a little bit more at the end of the day or at least gives me a road map to who I want to be better as a person you know so yeah so I think we're all engaging in some sorts of these activities that help us feel that way it just uh it takes work it's almost like a meta-analysis of yourself it's it's tough it's tough so let's talk about the The Residency the training a little bit can you tell us about it like what year one two three four five and six and seven eight nine ten eleven twelve like yeah yeah absolutely broadly speaking you know I think most of the experience in residency is clinical there are some programs that build in a couple years of research it's not mandatory but a lot of people who are interested in Academia tend to take some research time but clinically speaking you know we we like we believe that we have a graduated experience right so when you're first entering into a surgical residency you still need to be a doctor so you're taking care of patients on the floor you're seeing consults you're trying to understand the disease process all this time you're you know reading textbooks or whatever you know nowadays people are just engaging in more digital education and then taking in information and just you just become more nuanced as a thinker in that space and a provider and then over time you keep on making your way into dor and then you get your hands moving you're starting with very basic components of a procedure you're learning to close skin and once your skin closure looks perfect then you close the next most important thing and then Etc et cetera et cetera and then that Journey continues until one day you're doing a skin to skin operation and it doesn't the experience is not as smooth and graduated as I make it seem right now in this conversation some days it comes slow some days you're finding yourself in a really really steep learning curve but whatever the case I think it just you're trying to get yourself from somebody who's just an outside Observer into the field into somebody who feels ultimately comfortable driving the ship in that field right so and that's a that's a huge amount of responsibility that's laid on your shoulders by the end of the whole thing um going through it personally right now um the the way that it works is that you you kind of every single day you're assigned a couple of cases um you know depending on what level you are you find appropriate levels of complexity and difficulty so maybe when you're starting out as a senior level trainee you're getting yourself into an operation that's more bread and butter quote unquote and cardiac surgery um and then as you find yourself at the at the final stages of your training you end up going into the the highest complexity cases the ones that you may have to realistically deal with in a couple years as an attending so uh that's that's how and what year of training are you in I am six out of eight six out of eight got it yeah and do you do because you went cardiothoracic surgery from the beginning so are you doing more general surgery things in the kind of first couple of years and then one is the transition to more CT surgery kind of stuff yeah so for the pathway that I'm in yeah um CT surgery is sort of infused throughout the entire thing from the beginning yeah you have General Surgical and you know some vascular fundamentals that you need to criteria that you need to meet yeah but beyond that you know Cardiology education uh meeting our colleagues in different sort of cardiac related sub-specialties such as EP or Interventional Cardiology et cetera that's all incorporated into our training from early on because the idea is that more and more uh the the idea of a cardiac surgeon is somebody who's a comprehensive specialist who not only learns how to sew but is UN you know is aware of how the broad heart team quote-unquote care of a patient can take place and that requires being able to be fluent in many different languages and I think six to eight years of training gives you gives you that which I've really enjoyed in the last you know as I'm growing into that role how many hours a week are you working um it's variable yeah can you give me a Range yeah I think I think at the moment I'm working somewhere between 70 to 80. okay yeah and it depends on the rotation that you're on sometimes it's less than that sometimes it edges more than that yeah but I think think overall it averages out to about that amount yeah yeah well last night you were there until 3 A.M right yeah that's a lot and did the hours get better as you go through as you get later in your career in residency or are they kind of standard throughout it's interesting that you asked that because that is definitely a way of thinking about residency you know I I talk to people who are in plastic surgery or Urology or neurosurgery who say that things get lighter as they become more Chief level because you know they don't have to in-house as much or something like that but CT surgery I think is one of those maybe unusual Specialties where it's just going to get harder as you go through I see yeah I mean and I say that because fundamentally as you get more trained the more operative responsibilities and patient care responsibilities that you have right as you are able to be the the resident or the fellow who's able to get through these really tough cases overnight let's say a type A dissection comes in overnight and and by by Nature the person who's very senior is going to be the one responsible for coordinating that and then going to the or and staying up online to do it right so more and more as I get higher my levels of training the more responsibilities I have my shoulders and more hours yeah yeah and you're in a very competitive program you're in a very competitive program beforehand um do you have any because you've clearly you're clearly very smart and you've clearly excelled in your career what do you do do you have any specific tactics of uh kind of staying ahead of the game during residency or anything like that like speaking to Dr okassania for example he said he had an Evernote list where he'd keep track of every single uh procedure that an attending would do and he'd write down their notes as well as his notes and then he bought a thick textbook that was just like surgery like cardiothoracic surgery and he'd come home and every night no matter what he'd read three or four pages of the book just like front to back do you have any similar strategies or any techniques or anything that kind of keeps you because you're again in one of the top one two three programs in the world like how do you how did you get there how do you stay there what are your tips and tricks credits to him for being able to come home at the end of the night what are you doing for me uh so some elements in my answer are similar yeah like so for instance so much of preparing for surgery and learning surgery is about what you can do beforehand right because if you think about going into what is inherently a highly overwhelming and stimulating environment there's only so much you can learn from that right like think about some of the situations that you've been in in your life whether it be sports or music and you go into a lesson or performance you're not taking away all of it your mind can only handle so much learning yeah in that one experience and you don't want it to be overwhelming because if you feel like you're so far behind and out of touch then then you kind of enter into this period of blackout where you're just trying to keep up with things and you don't necessarily feel like you're learning you're just emotionally overwhelmed um so you want to prepare as much of that as possible and I do think it's possible to prepare a lot of the cognitive and Technical aspects of surgery before you go into the or I mean we do that with virtually everything else that we do that's a performance um whether it's you know music or or you know whatever sport you play you drill different aspects of it before you put it all together so for me that's always been a big part of my training like even early on I strongly believed that things that I'll be doing I don't know tens of thousands of millions of times in my career like tying a knot or throwing a suture um handling needles like I wanted to be able to play with that in the same way that somebody might just you know kick around the soccer ball or something before while they're growing up you know like if you get that kind of stuff more comfortable in your hands early on then when you're in a case you're not worrying am I gonna drop this needle and am I gonna look silly here like you're trying to get your hands to to move more autonomously with some muscle memory so that if unattending tells you next time you throw that Stitch you need to think about a different needle angle that that's a more sophisticated takeaway that you can have from an operation because you are able to take some of that emotional load of being technically unprepared out of the way right like if you think about training in that way you can go into an operation being as prepared as possible and walk away from it with five to ten really high yield takeaways in each case so uh I think that's how I look at it every time I go into the same operation I know what I'm prepared to do I tried to run it through my mind I try to practice the needle angles at home on some sort of a simulator and then I go into the case and then maybe the five mistakes that I think I could have I can do better next time I make a list of that and then over time for any operation that list gets shorter and shorter and shorter because you find it very manageable to walk away from a case and approach or address a few lists of things that you felt like you were overwhelmed to handle as opposed to being like wow that entire operation that just kind of flew by and I'm not really sure what just happened yeah it's a different experience I think you can prepare so much before going to a case yeah yeah and I love the specifics so can you tell me do you have a note taking app do you have a notebook what do you have yeah you know honestly I don't have anything high tech or sophisticated when it comes to stuff like this yeah what I do have is a simulator at home that I spend a lot of time designing and thinking about yeah so that the needle angles that I'm working with at home are are precise because then what I do is I walk away from it and I say Stitch number four in this anastomosis I need to practice that right like that's the kind of takeaway that I want to have from a case because then I can go home I can put let's say you know a coronary Graft in this location and then I'm trying to sew it to this location I position quote unquote the heart in the simulator in a per in in a right location and then now I know I can just practice that Stitch over and over and over again and tomorrow I want to do the same case Stitch number four is is better and then now I say uh Stitch number four is better but Stitch number eight that needs some work you know like that's kind of like how I think about my note-taking yeah I don't list every detail of an operation because I think that information exists but you just need to keep track of where you are in your growth as a trainee by by making very specific feedback points for yourself feedback in general I think is something that is lacking in surgical training in a highly specific and actionable way so you kind of have to give yourself these these guidelines you know to to focus on one aspect your biggest weaknesses and then to overcome them how is the feedback from attendings and things like that or there you know before I came into med school my impression of surgeons and the or was they'd throw things at you and they'd yell at you and things like that how's your experience quite that malignant but the Styles can be highly variable yeah uh you know obviously feedback comes in all sorts of flavors some people can be really kind but then it doesn't get you thinking in the way that you want it to be or like and some people can give you feedback in a way that you don't think is necessarily constructed yeah right so uh oftentimes the pain points for trainees on how they can get better are I think oblivious to attendings unless there's a conversation that takes place so you might go into a case thinking wow this is like where I really want to get better yeah and an attending surgeon may be walking into the same case not thinking about the same kinds of high yield points where you wait what as what you're looking for you know getting getting that to be on the same way same wavelength I think is is something that kind of needs to happen in the in the field of surgical education yeah more conversations maybe yeah yeah yeah so we talked about kind of academics quote unquote and clinical training outside of that how do you maintain because I forget if you said but you you said you maybe felt near burnt out before but never felt completely burnt out is that correct I mean there's been some moments where I've definitely noticed burnt out and you know like it's it's a challenging thing like people talk about burnout all the time they don't know how to self-diagnose it yeah right I mean so you may be burnt out and not even realize it until you're two months in yeah and then uh and then you have a different experience that kind of gets you back on the course resilience in many ways I think is flirting with burnout again and again and figuring out a way to stay afloat right like because you're becoming aware of what makes you feel that way and then what makes you come back from those experiences so uh yeah I mean burnt out is something that I have experienced personally okay it just the symptoms are not so obvious to you when you're in it it's it's a gradual entrance yeah you know and before you know it you're like am I burnt out am I just tired I'm not really sure what are the symptoms uh I think some of the some of the symptoms of burnt out for me is going into an OP going to your day-to-day work not feeling the same amount of excitement as before you know because because I know and I'm feeling really awesome in my training process you go into your job every single day believing this is the best job in the world and I think in CT surgery there's many reasons to to feel that way right like you you want to walk away from it thinking like wow I've done some really cool work today um some not all days make you feel like that and then if that's happening consistently and it makes you less excited about preparing for a case or reading about materials and CT surgery well then maybe those are sort of subtle signs of burnout that you're experiencing that you might just want to shoe away as thinking that you're fatigued um but yeah it could be something more Insidious than that how do you come out of it how do you specifically come out of it you know I think I think part of it is up to you and I think part of it is up to the environment that you're in got it um I have been in environments where I go back to it and then I come home feeling rejuvenated every single day and there are people without a doubt in any specialty in any sector that can make you feel that way during this working process right you're always going to work with people that you love to work with and also people that you find it challenging to work with and depending on how that works you gotta figure out a way to navigate that landscape because that's realistic yeah you know like never at any point in your career are you going to be working in a hospital with colleagues that you all get along a hundred percent with with staff that all you know that all cater to your needs and Etc like not every day of training or your career is meant to be designed for you and I think that's a very realistic portrayal of what the world is yeah um so you have to figure out a way to to balance those aspects of things and and and for me thankfully like they they they come one after another you know they kind of they balance themselves out over time and you kind of have to figure out a way of of hanging in there when it's challenging and then really enjoying it when it's fun and so that's that's all I can really say yeah yeah do you do anything like meditation or walks or um what did some people say it's like uh yoga or uh I was talking to an emergency medicine doc the other day he says he surfs occasionally anything like that yeah you know honestly uh sometimes I think people think of Wellness as a prescribed set of activities and therefore a lot of the educational or administrative projects that are directed at resident Wellness are sort of like see this counselor or try these activities and Etc and I think sometimes it works but sometimes it misses the mark because what you're doing is not fully understanding where that burnout is coming from and just prescribing a set of activities that you think are just generally good for that as I mentioned earlier the pain points are not necessarily obvious to to an outside Observer sometimes leaning in more and working harder is the prescription that you're looking for sometimes a good conversation with an attending that you respect to help you get through the the conundrum or the the thing that you can't understand to help you get past that that's what you're looking for to to to overcome burnout right so to me like it really depends on understanding what that person is stuck on before necessarily thinking about something like yoga or meditation I mean I I don't do yoga regularly I can't stay disciplined enough for it I I tried meditating I fall asleep yes you know uh I like watering plants and boarding around the house honestly for some reason like ever since I was a kid you know my dad used to take me like gardening and stuff in this lot that that he had in in South Korea you know it was a very very industrial environment so his company used to have this like small lot where we used to grow tomatoes and stuff and I even now when I wake up on a Saturday morning um I I water plants yeah and I put on music and it's extremely calming and I just kind of like approach my day that way you know how many plans do you have uh many enough that I can't tell you the exact number on top of my head I think something like in the 20s or 30s so is your immediate family in the in the US now entirely so not anymore okay so when we came over here when I was 10 yeah uh we settled in Jersey okay and then my mom came over but my dad still had to keep a job in Korea so in actually in Korean culture that's a very common phenomenon okay so he never fully came over and then my brother and I went to college and then my mom went back to create a join him got it you know thinking back I used to say like I spent half my life in Korea and half my life in the states as more time goes on obviously that becomes skewed yeah uh so yeah that was already more than 10 years ago wow so they live in Korea okay uh stepping back how is it being an immigrant in America because you were in lived in Korea for 10 years right no one in your family I don't know if you have any younger brothers or sisters was born in America correct no no I have a younger brother but yeah he was he was just a couple years younger when we came here so uh being an immigrant in America it's really interesting sometimes when I enter into an or yeah I feel like I'm getting flashbacks to my immigrant experience and I say that because like fundamentally you're entering a new environment with a different culture with a different language with people who perceive you as entering into their ecosystem um so a lot of it is about kind of learning to observe first before you assert got it and I think that that really brings me back to the mindset of being an immigrant yeah and when I was growing up obviously being an immigrant is a complicated experience and the way that I feel about my Korean identity to this day is complicated I don't even there were times in my life where I was like I need to reject that to become fully assimilated and there are times in my life like right now you know where I'm like I should I should embrace that yeah as a part of my immigrant identity you know and um and when I enter into an or I get flashbacks of that because there are some people who go into an or and then I think you know want to be able to assimilate it as quickly as possible but don't understand really have different styles of doing it for me it's kind of like the first time that I showed up to my fifth grade class you know before I say anything I'm observing it three times yeah and then maybe before I do something on my own um asking is this something that's helpful for me to do for you guys right so in that way in the way that I kind of I guess gradually learn to integrate myself into this community I'm trying to integrate myself into the or culture so I see many similarities between the two how do you feel about that personal and peripheral observation that's being done three times before you make a decision or do something right because most people would think they come into a room they say whatever they think they do whatever they think do you think it's a good thing do you think it's a bad thing or do you think it's just a thing that is um at the moment I think it's just the thing that is that has certain negative consequences yes it's it's protective in some ways for a reason I think right I mean when somebody comes into a cardiac surgical or oftentimes before they ask a question there's so much they need to take in like before they touch the bypass tubing that's on the field you should probably you know really understand what's going on here and what what it's secured to because there's five liters a minute of blood flowing through that thing right at the same time I do wish that the field of surgery in general could be more accessible that's one of the things that I really try to stress when I talk to a med student or somebody who's interested in going to the field of CT surgery I say stop addressing me as somebody who's so distant from you if you have a question about the field one day or if you have if you need advice about how you can apply into it and stuff just text me like you're texting a friend because I do think that perception drives a lot of people away from the field of surgery hierarchy yeah the hierarchy this feeling that the person who's 10 years ahead of you is you know a different at a different stage of Life fundamentally than you are I mean sure they've been in the field much longer but we should have people who are accessible and relatable in the field of surgery yeah like period I think it just makes everyone feel more comfortable in the eor when Med students come into the operating room they can ask questions without feeling like there will be consequences or potentially getting yelled at right or judged these are important things that we have to intentionally tease away because the stereotype right now unfortunately which is probably based on some aspects of reality is that people are going to be scared coming into an or it's inherently a scary experience and that's why I say like like immigration I understand what it feels like for that second year med student to come into a CT surgery or for the first time because I can see the trepidation in their eyes that I probably had when I was younger immigrating right so for them to to feel more comfortable means that as a as the person in charge of that room you have to anticipate their anxieties and then make that make it intentionally known that that you are accessible and that you are a person not just some like figure in the sky yeah exactly like I you know I think more and more surgeons should try to make themselves as human as possible in the eyes of society you know I know that there's many conversations or narratives that are based around surgery to make it seem like it's Larger than Life or more than human but it doesn't have to be any of that kind of stuff because you're just you're just people doing a particular kind of work and the more we try to separate ourselves from you know just just performing our work as people the less accessible we seem yeah no I love that and I I hope people adopt that and I've had good experiences at Jefferson and I'm sure you've had great good experiences as pen but I've heard different experiences but I really love that and hopefully many doctors and surgeons will adopt that mindset and I think it's honestly I think it's going that way yeah I think talking to I mean you're only 10 years back and I was talking to some attendings who were 50 years back they see they've seen changes right dramatic changes it's going to keep going in that direction what is the best thing about CT surgery the best thing about CT surgery yeah um there's no other profession in life I think where you go into your job somebody is really seriously in need of the care that they need to like essentially live longer and live without pain they enlist you for your specialized set of skills that's what the hospital expects you to do that's what your employer expects you to do you go into the OR and you perform an activity that's like the favorite thing in the world for you to perform you feel confident in it you have fun doing it and then you do that for eight to however many hours and then you walk out of that operation you get to tell the family that everything went well and they get to end the most anxiety provoking chapter of their lives and you get to go home feeling you've done some good right I mean how many jobs in the world do you simultaneously get to have that kind of meaningful connection with somebody to perform a technical procedure that makes you feel like you're having fun and you're really enjoying it and then walk away from it knowing that you get to do that every single day and simultaneously it's a job that's well regarded in society and and well compensated right like there's very few things like that in life right I mean I can think of certain jobs that that may be better compensated but doesn't have the human element or the service element I can think of jobs where you know you may have more of a human component but you don't get to be as procedural or technical or get to feel like you're learning on you're working on your craft and get to be creative and get to be focused on your performance and et cetera those are all fun things right it just ties to together in a perfect way in balance that if you set up your practice right you get to feel that for a 40-year career wow like what else is there like that yeah that's amazing so the Counterpoint to that question is of course what is the worst thing about CT surgery the worst thing about CT surgery is that no matter how good of a day you have you're always open to the possibility of being humbled by something unpredictable you know like you may think that you have done a perfect operation and then for some circumstances outside of what you thought you could anticipate the patient may have a bad outcome or just as much you know you can go into an operation feeling like you have the plan for it the perfect plan for it and then walk away from that operation wondering did I do the right thing here right like that's that's a part of your everyday thought process and just as how those questions can be extremely stimulating and rewarding it can really drive you to feel a lot of stress on a day-to-day basis and that's just a part of your job going forward and I do think that the growth of a surgeon is balancing that and making it something that you're okay with every day and but it's it's not I think the stress level is not necessarily something that everybody wants to feel on a day-to-day basis right some people want to have operations where you do not have a risk of going back in the middle of the night because a graft went down or you're exsanguinating into the chest right like you wanna some people want to minimize the the chance that you have to go back with a phone call in the middle of the night et cetera and then and then worry about outcomes and then worry about whether you did the thing that whether the operation you performed earlier may have technically failed in some ways um but for us that's a part of our day-to-day job yeah tough question here because I'm asking you to look five years into the future I want you to imagine that you finished your training and your three years as an attending after these three years as an attending I give you a hundred million dollars tax-free it's in your bank account do whatever you want with it do a continue practicing full-time do you B start practicing part-time do you see switch careers entirely and maybe do I don't know something random or do D go live on the beach with your wife and and soon to be family yeah um I will be frank if if I win 100 million dollars yeah um I'm definitely gonna still practice full time because money doesn't change the fact that like I'm gonna enjoy what I do right now the most yeah you know it's not like all of a sudden I can say oh I can finally switch to that specialty that's less well compensated because I have a financial cushion um at the same time with that money there's just so many things that I want to work on that I can't fund right now as a resident but I one day imagine that I will be able to fund as an attending like for instance if I wanted to work on an idea for a new device or an instrument in the or because some of the tools that we use in the or have not been innovated in over 100 years right I mean they're named after surgeons that you know lived 100 years ago right so for instance knowing all the things that we know about ergonomics and the importance of you know surgeons Health long term in terms of neck neck neck pain and and spine health and and wrist health and Etc like why have not why have we not innovated those things meaningfully in the last hundred years and I I have ideas about them I just can't do them because of money really but over time I imagine with something like that you can just spin out so many different ideas that you can work on right I mean there's Limitless possibilities in terms of how you can change the field in some ways entrepreneurially speaking so uh I think that's what I would do I think I would just have a lot more money to be able to you know start projects that's exciting that's exciting and you did start a project right can you tell me a little bit more about actually I want to take a step back I want to see if there was an Inception to this idea was there ever an encounter and ever how did you know that people were more interested about learning more about surgery and like kind of the way specifically technically maybe these things work yeah uh as I mentioned earlier I've been interested in this idea of simulation for a long time in surgical education but even beyond that as I mentioned as you start thinking about different types of career paths and you know looking to the startup world look into the media world you realize that there are so many different opportunities to elevate your field right so one of the things that I notice is that media is a fundamental component of so many different things that we do as as human beings whether it be fashion or sports or food whatever it is there is a space for people to have discourse to elevate the culture and the challenge the culture and have those types of nuanced conversations what we're doing right now is an example of that in surgery there's no mainstream place for something like that and it's mind-boggling because it's something that uh I think is quoted to it's quoted to be something that almost everybody in life is expected to experience at some point or at least have their loved ones go through it the number is something like more than 100 million surgical procedures performed in the U.S wow on an annual basis so if you think about how Universal it is it's as important as Sports and food right but people don't understand what it is that they're entering into until until they have to be a part of it in a serious in a very very serious way and and the fundam and the subject matter is fundamentally very interesting right there's when you're watching somebody so or thinking about the needle angles and the different ways that things come together it is Artistic in some ways and it is performance driven in many ways right if you're looking at it not necessarily as this isolated sub-specialty but as a concept and a craft in and of itself it's really cool right and I think sometimes we lose how cool it is because we don't have the space to talk about those types of things and combined with my co-resident who's also from like a documentary Making background John Kelly and this med student Josh Chen I know Josh yeah we we essentially just ended up setting up a studio in in my place and then seeing what kind of videos we can make in surgery that might be interesting and Illuminating to to a general audience and that's sort of where we started as a proof of concept and you know I the first time that I realized that there might be something here is when we made this video that is not even really surgical it's kind of para-surgical because what we did is we we came up with this random exercise where we wanted people to think about using forceps as something that you build dexterity in so much of what you do in the OR depends on what you do with your with your non-dominant hand holding forceps to expose tissue to handle delicate tissue to position it in a certain way driving the needle is easier compared to picking up something exactly in the position that you wanted to and laying it down a certain way so with the forceps we came up with this random idea uh called a rice transfer you know we set up like a little circle on a wooden board or actual rice it's not an acronym yeah yeah real rice and then and then we were like you know before you pick up real human tissue like maybe you should work on your dexterity and we came up with a list of exercises but one one thing in particular this rice transfer for some reason I guess resonated with the rest of the world probably because it was kind of bizarre and it was kind of interesting at the same time there were like a bunch of surgical residents for some reason picking up rice and moving it over with forceps yeah it's more challenging I think than it seems right because it's a small grain that's sort of irregular in shape unless you pick it up well it pops off and you have to move it in an angle where it kind of lines it into a place that you're looking for so we posted a video of a rice transfer challenge essentially where we were timing ourselves as we were moving you know 12 to 15 grains of rice from one location to another and then it took off on Tick Tock in a way that I did not anticipate how many views is early on I mean I think over that weekend I think we hit 10 million views oh my God I know that's insane and a lot of people were people that would never be interested in surgery otherwise right like kids yeah like watching this and being like yeah why are surgeons doing this and and what is surgery anyway you know some of the questions to ask some sometimes you know nurses at work come up to me and say hey like my kid at home really likes watching your videos and they have no idea what I do at my job yet but they're like oh that seems kind of fun yeah and I think that's what surgery has the potential to be in the eyes of society um and then we don't realize just how much of a an impact you can have in somebody's procession of surgery until you try to fill that space yeah right I mean these are not MediCal examples but people frequently say that when Top Gun came out Military enrollment went up significantly right and this whole Formula One documentary is amazing marketing making the whole thing you know all of a sudden popular in the United States a market that they have not been able to enter for for so many decades right so for surgery what is the image that we're projecting currently and how much of a role can we play in making that seem fun and cool yeah right I think that's fundamentally what I've been trying to do with this project you know I the project is called the modern surgeon and uh at the moment we're essentially a social media and multimedia driven project trying to fill that culture and the media space of surgery definitely needs to be filled it's almost like a casual intro to surgery and then people can maybe delve deeper to learn more about the nitty-gritty things than the rice shot maybe I should try yeah we'll have to invite you yeah to our studio one day I'd love to do that and get you doing there's a bunch of challenges I'm gonna fail though and it's gonna be it's going to hurt my crowd immensely because I'm not going to be able to do anything it's going to be really bad so let's take a step back let's take a more General sense of kind of lifestyle and stuff like that yeah do you have any tips for people going through the whole career of medicine and this could be anything this could be lifestyle this could be finances this could be relationships anything anything that you said wow I wish someone told me about this when I was starting a career of a long career yeah no I mean uh I think in general the way that you can feel about your career and the contentment that you can derive from it is entirely up to the choices that you make you know in the mindset that you decide to Harbor yeah and I don't think I don't think we talk about that enough we always focus on like the objective realities the number of hours the policies and Etc like I did well I mean I think that's a great starting point but how you choose to structure your career and the choices you make and the lines you draw learning to say no like those are all things that are at the end of the day some things that you need to think about and then intentionally make choices about right and and those things are far more challenging than navigating just the policies right so for me like so many times in my life I've wanted to wish away time and what that means uh in the context of Medical Training is that like I kept thinking I can't wait to be done with med school so I can start this surgical residency and I can't wait to be done with training so that I can become an attending and sure enough if I keep thinking like that then I'll say I can't wait till I'm not a junior attending anymore so I can have a different set of you know roles and I can't and then I'll say I can't wait to be a chief somewhere so that I can work on these projects that I've been meaning to since 20 years ago if you keep thinking like that you're always going to postpone the meaningful impact and the happiness that you can derive from the day-to-day decisions right now right like residency has to be an enjoyable thing and not a means to an end right and you have to realize it yourself like when I go to work every single day I'm not thinking uh okay count down how many more days until I'm done training I'm thinking this is a day of my life it's a it's a huge component and a chapter of my life right you can't wish away a decade of your life you gotta make each each of those days feel great to you and that's the only way I think you can really find gratification and happiness long term in a surgical residency and and it part of that comes with figuring out the pace at which you want to go I mean there used to be time paradoxically where I was like oh I have this free time that I can be productive with so that when I produce something it'll make me happy but I mean really sometimes I think back on that especially as I'm you know spending time with my wife at home and expecting a baby boy I think really maybe the key to happiness is the opposite of that the moments that make you feel so engaged in the things that are present in your life and family that you're not even really asking yourself am I being productive at this moment maybe I was thinking backwards the whole time yeah you know like and there are going to be I think those moments where you fundamentally shift the way that you think about your life and work and and those are the things that make your day-to-day like more or less happy more or less meaningful more or less engaged and you navigate that so uh so yeah I think that's how I look at that balance yeah no that's interesting and if you were talking to first year of medical school Jason would you tell him anything I think I think that's what I would say yeah be more patient yeah you know I I know that my first year med school self was so impatient trying to get to where I wanted to be 20 years but I think at that time I could have just told myself to to not look at it as a means to an end you know like the the experience of a med school I and I know most Med students at some point think oh God I I can't believe you know I have to spend all this time learning all these different materials and stuff all these rotations that that I may not ultimately end up going into I know that I want to be a cardiac surgeon so why am I on an OB GYN rotation Etc I've been there right but uh all of it is just part of the experience and you get to go into it with a totally open mind yeah and finding some sort of Fascination and something that you didn't expect or you can kind of go into it with a closed mind and keep pushing away time OB going labor and delivery experience during med school was one of the most gratifying experiences in my entire four years of med school it was uh but I don't think I would have had that experience had I been so impatient to become a cardiac surgeon yeah lean in I think I love that I love it I'm stealing I'm saying in every podcast now forever lean in you gotta lean in so into the nitty-gritty stuff if I'm a third year second year first year medical student and I know I want to be a CT surgeon how can I make myself the most competitive the most able to match into a competitive residency program yeah and that's a really good question because more and more it feels like we're asking Med students to be prepared earlier and earlier and I have comp complicated feelings about that you know like it really shouldn't feel like an arms race on the first day of med school needing to come in knowing what you want to do and then building your resume that early on you know I really wish it weren't like that because it like I said that kind of forces you to make decisions earlier and not be open-minded throughout the entire process but speaking nitty-gritty yeah like practical advice wise if if you're thinking that you are interested in the field of CT surgery I think there are three things that you need to focus on early as I mentioned you need to get yourself in an operative environment and know who you are and then really understand whether the flow of the operation and all that stuff is something that becomes more familiar and enjoyable to you or not like you got to really answer that question for yourself because that's that's the hard part about choosing while you're understanding who you are as an adult like you're also trying to figure out that you're not too far behind on the other aspects of your application that will make you competitive CT surgery is a highly academic field by Nature right so even though a lot of people can ultimately end up in private practices training is conducted at mostly academic institutions right so you have to think about what kind of research experience you may want to have because I mean the goal is not to have a long CV to get your foot in the door the goal is to prove to somebody that you are interested in making the field better and patient care better and the questions that you may be asking or the projects that you're involved in therefore can be broad but it means that you want to engage with it as something more than just a check box yeah right so you have to go to an interview and say you know I looked at the field of CT surgery this is something that means a lot to me I think I can make the field better in the long term by answering these questions and maybe you're somebody who's interested in research using data sets maybe you code and can come up with an app that makes practicing surgery easier maybe you're somebody who's going to liaise like you said like we talked about earlier in some sort of like a more broader entrepreneurial sense but you got to have these types of ideas and and kind of start playing with them yeah and then seeing what you can make happen with them because a lot of the things that you have to get you know you have to do to get to the point of CT surgery is is not scripted right no one's going to give you a roadmap and say Here's how to become a competitive Internal Medicine applicant like there's probably more scripted ways of doing that than for CT surgery it's such a it's such a niche thing yeah there's only you know at least the kind of program that I'm in there's only like 30 to 35 spots in the country every year no one's going to tell you the right formula for Success there's there's going to be highly variable opinions about that but that means that you have to get yourself in the door early and listen to all these different types of opinions and think to yourself what is my role in this field and every step of it is going to feel like you're being the go-getter because no one's going to be inviting you into CT surgery interest group conversations where you're you know expected to attend yeah you're going to be sending those emails and you're going to be making those phone calls so I think a lot of as I mentioned being in an operative environment um having some sort of academic interest budding early on and then finding the appropriate mentors for that and then networking so that you can steep yourself in the kind of advice and conversations that you want to have in this field early on are the are the three things that you should do early yeah that's really helpful now switching from the seller what if I am the buyer and I'm interested and maybe I'm in my third or fourth year of medical school and I'm extremely competitive you know I'm top of the range how do I how do I decide what Residency program I want to go into specifically we're talking about CT surgery do I opt for how do you I guess I want to know how you make the decision say you know CT surgery should you always do the residency that's just CT surgery from the get-go should you do the general surgery one and this is like a seven part question and then how do you decide which programs where to train yeah um controversial yeah you know uh I'm partially biased towards this long residency experience because it's been so helpful for me um I see pros and cons both ways you know you have more years and time to learn Cardiology cardiac surgery vascular surgery things that you may not if you're doing a traditional general surgery residency doing a lot of other different types of operations and then coming into it having a more shortened accelerated experience and introduction to CT surgery in two to three years so I think in that sense it gives you more time it gives you time to understand the research landscape of cardiac surgery and it gives you more time to network with cardio surgeons around the country so I think I think in that sense it's highly beneficial to to be in an accelerated program at the same time I think general surgery gives you uh just by the nature of General surgical training your Indy or a lot already before you ever make a decision about going to CT surgery you lead a team because you've been a chief resident and you've made sacrifices like real sacrifices that Med students I think can never fully understand during a three-month sub-i you've made that for the past seven years and you still want to be a cardiac surgeon because you're like well this makes me happy right there's there's a level of maturity and leadership in that that I could not have simulated no matter how hard I try during med school and that comes with some really important sense of emotional stability something that can prevent burnout and nutrition long term for your career you know so in that sense I think there is a huge benefit to coming in with a lot more experience under your belt in terms of thinking about how to choose programs you know I always I always tell this to applicants you know when you first start applying to programs you think that the right program that you choose is going to determine ninety percent of your career trajectory but really it's the other way around like the programs determine 10 of your career and you determine ninety percent that means you have to understand what kind of learner you are there are programs that may be slower in terms of operative volume but every single day you're going to have you know more one-to-one attending time more opportunities to discuss the case before and after you know there's not as much volume so you don't necessarily have to feel like you're rushed in any sense or jumping from one place to another you're going to be in that operation learning one thing and then going home sleeping processing like those are really valuable learning opportunities and then there will be places where you know it's going to be very very busy and then maybe a lot of the stuff that you have to do you have to fight for you know you may be thrown into situations where you may not have necessarily felt like you were 100 ready I think that's part of any residency but there's different styles of training that that you have to know what you're more comfortable with you know like if you're the kind of person who wants to be you know a little bit overwhelmed every single day and you're that's your happy State then then you just you choose a certain type of program if you're the kind of person who wants 100 structure then you choose a different kind of program and I think you got to know that about yourself if you're if you're the buyer yeah I think you kind of learned to categorize programs into different buckets based on that you know is this is this the kind of program that that offers that kind of structure but I know that I may not necessarily be having as much unstructured free times for growth well maybe that's you maybe they put you on a course um I think a lot of general surgery residencies kind of like that because it's been around much longer and they have a formula for success that's that's maybe that's the path that you're comfortable with maybe the opposite is true for some people I will also say that the importance of good colleagues and good culture cannot uh be overstated you know I uh like we don't think about how lonely CT surgical residency training is right if you think about it most programs have either a one one resident per class or two right you're already lonely right you're going from you're you're having stressful days you're going to different ORS you have to liaise with hundreds of people who expect you to perform at a certain level you go to many different hospitals you know and all of this you have to do kind of alone right and most days you may go to a hospital and then you come home and then you never really had a chance to connect with your co-residents because they're all under separate rotations doing separate things like think about how lonely that could be yeah especially when you come home and you feel like you haven't had the best day maybe somebody gave you criticism that you're not you know Pro you're not able to feel comfortable about or maybe you're feeling like you made a complication that that you just want to talk to someone about yeah right so you gotta have people around you who can help you process that and you know CT surgery training we talked about it earlier highly competitive oftentimes terms that are sort of thrown around like you know swimming with the sharks and Etc like can you really show vulnerability in front of the people around you and trust that they're not going to take advantage of in some way but instead be supportive that's that's a really tough question to ask yourself in a program and you don't want to find yourself in a situation where you get there thinking that that's the kind of culture that you're walking into but then not necessarily what you end up finding once you get there like these are really important questions I mean because you're spending how many hours in a week 160 or something like that 80 hours or in the hospital and then you have to sleep sometime right so most of your Waking Life is in the hospital yeah yeah you really have to enjoy the people that you're working with I mean otherwise you know if you're not laughing in the OR and if you're not laughing when you're transporting patients to the ICU at three in the morning because you feel tense around the people then wow that's that's tough yeah you don't want to you don't want to perform your life's work at the expense of being comfortable in a community yeah right you want to do those things simultaneously yeah it's super important sorry go ahead no you're totally right the cult the culture is advancing in that direction so I think uh more and more we're trying to make collegial characteristics one of the most important things that we look for a team player more so than a superstar necessarily right so Society is expecting that hospitals expecting that your colleagues are expecting that so that's becoming something that's on the Forefront of our minds as opposed to an afterthought yeah what are the characters characteristics hate that word of someone who would excel in CT surgery yeah that's really tough I mean that sort of depends on the philosophy yeah like teamwork is definitely one of them without a doubt and then going into the future like you not only have to be able to do well in an operation but you have to be able to make your team feel a part of something something safe yeah and something open if you can't do that I think in this day and age your staff are going to refuse to work with you you know like you don't want to happen people refuse to work with people unofficially right I mean like I'm sure you've been in situations where you're probably like oh I don't look forward to working with that person today and you don't want your staff to feel that way about you right because then every single day you're kind of making it obligatory for someone to work with you yeah you want them to feel like I love my job and I can't wait to work with this surgeon tomorrow I know tomorrow's going to be a good day so tonight I'm not going to stress about it that's the kind of like leader you want to be as a surgeon um and it's going to be expected I think more and more of surgeons in the future other characteristics um and I think about this a lot because I think about the deficits in the selection process for surgeons a lot right now right like we have a standard interview and we read an application to get a sense of whether you you know want to become a surgeon or whether you be a good surgeon in 10 years time right but if I were to think about three exercises that I think surgeons should be able to do in order to perform their jobs well and maybe I would even want to ask them during an interview is one I think I would give them an objective that they need to accomplish and a set of tools to do it and I would say figure out the best way that you want to do this and I'll check Ben check back with you at the end of the day and then you tell me what you came up with what does that require you to do you have to fundamentally think about how you're using your tools what goal you want to accomplish and then optimize the path to it so that you're not necessarily repeating your steps you're not you know coming up with an imperfect product like that that's a mindset I think of performing an operation that's important throughout your whole career two I think you have to be able to get people on your side to accomplish something it means starting conversations with staff you've never met before you got to do that again and again and again and again right I mean so much of my residency experience is about meeting a bedside nurse for the first time asking a set of questions that takes time for them to answer and then suggesting that maybe we tweak something or maybe we can like try these things and then and then check in with you later again you know like that's that's interpersonal yeah more than it is surgical so you know I I always thought it'd be fun if we ask an applicant you know here's a challenge for you you know you're obviously not from this Hospital during this time period your goal is to go to a floor that you've never been to and then maybe you can get a group of five to eight nurses to take a selfie with you you know like I know that sounds kind of completely unrelated and benign but I mean what is your job as an intern on a databases it's that right hey hey my name is Jason it's nice to meet you I'm a surgical applicant I may be a resident here one day I know this is really yeah like not what you're expecting but can we do mine like can we Corral maybe five to ten people together here and then and then do something yeah you know that's that takes that tastes like subtle interpersonal skills yeah that a lot of stereotypical surgeons would be really bad at like you can't go into a floor at a random hospital and be like hey everybody like I need you to stand here right now because I need this to get into my dream residency people aren't going to respond to that right and you want to be able to understand these things about about applicants and surgeons I think early on like these are the these are the nuances that make you an effective resident yeah you know so um if I were to re-envision the the application process I think these are the questions I'd be asking yeah no that that's really interesting maybe you will maybe one person maybe speaking of the future what are your long-term plans where do you see yourself in 10 20 years yeah I mean technically speaking I want to practice in academic adult cardiac surgery yeah and these are you know distinctions that you these are decisions you have to make in your career you know when you go into cardiothoracic surgery you think about whether you want to become cardiac heavy or thoracic heavy whether you want to be in an academic environment versus a non-academic environment although the lines between those two things are becoming more and more blurred you can be you can be in a traditionally non-academic hospital and still have academic aspects of your career like research being involved in natural societies doing projects teaching fellows etc those are becoming more and more blurred and so therefore I think I just want to have academic components to my career I don't know what setting quite yet yeah and then you decide whether you want to do adult practice or congenital I think that comes with a lot of different specific questions as well um if I'm answering more vaguely about my long-term goals um I think the goal is to be in an environment where you can feel like you're giving yourself to a very meaningful Arc both at an individual level but also in the longer term in the community you know so you can answer that in a lot of different ways maybe it means being at a high-powered hospital with a lot of resources and doing really complex cases and for some people I think that's that's what they want to do right some people advancing the career means taking the most complex operation and then and then getting somebody through it that's really important because maybe maybe you are that patient one day and you need to go to somebody who only likes to think about the coronary artery position in this in a highly you know complicated disease redo setting or whatever right for me I think I want to be somebody who approaches my career a little bit more broadly in terms of the kind of services that I can offer and I say that because ultimately that's more versatile not only in highly specialized settings but also in you know low resource settings where you may not be the aortic surgeon or the lvad surgeon but you need to be able to perform a lot of different varieties of operations well for an underserved population simultaneously I think I want like I mentioned earlier I think I want a significant academic or research component or entrepreneurial component to my career that focuses on that human aspect of either being a surgeon or being a patient or being a family member so a lot of the things that we're not looking at right now we already talked about the other projects that I'm involved in but the clinic right who's studying that right now is there a room to have conversations in a way or you can make each pre-op consent process or or you know ex setting expectations and Etc can we make that more uniform in terms of quality among different surgeons and what are the aspects that you're looking for what are the words that that we choose in an operating in an operative setting that has negative connotations that we can all get away from and how can we clarify our communication so that patients are walking away from it thinking the same thing that we're telling them yeah we you know I know that these are aspects that we focus on more broadly in my particular field we just have not gotten there yet that's a barrier and I and I want to focus on more and more of that so that people in the world can when they're thinking about surgery it doesn't become just this intimidating thing that their mind shut down to as soon as we throw technical jargons out there and they can't follow it but rather it becomes something that they want to engage with yeah that's really important and I think that's another Gap the clinic I think it's a huge huge gap um two more questions and then we're out of here yeah extremely important question probably the most important question of this entire interview uh what's your favorite music to listen to in the OR it is an important question um my favorite music is something that I'm not able to play right now in the or because I think everyone would kind of fall asleep to it and honestly I you know I like classical music in the OR and and I say this because composer of specific um it changes when I was growing up I liked big complicated things like Debussy and Chopin and Rachmaninoff more and more you know as I get quote unquote older I just like like simpler even some things that I used to find kind of formulaic like repetitive you know fugues that are put you know by Bach or simple melodies by Mozart some pieces by Beethoven I I don't know why my brain is changing in that way you know when I was growing up my mom used to take me and my brother to a a concert like I don't know once every two months or so and then I used to sleep through them all the time and she used to wake us up in the morning for school with classical music blaring so I hated it you know I hated that concept but as I get older there's something calming about it you know we talked about Flow State in theor you know there are music that disrupt that flow State and there are music that intensify that flow state for me classical music and even neoclassical music really really deep in that flow State like it's it's stimulating you can kind of keep Tempo in your mind and almost kind of get a sense of progress throughout the song in a way that I can't when I'm listening to the top 40 soundtrack or the same Taylor Swift song for the 50th yeah yeah exactly I uh I don't get to play that music right now but one day I will why don't you get to play it the attending commands it or what I just think it's a very quick way to become unpopular yeah yeah well I guess I can't say that right the whole teamwork nine thing we discussion right exactly like you know at the end of the day if you're with a team at 1am and you're closing a chest yeah you want to play music that get everyone feeling good and energetic and not necessarily something that that you just enjoy yeah yeah but but one day I think for at least the core components of operations where I really enjoy I think I will line it up with classical music yeah there are stories of Surgeons who who understand exactly how many minutes it's been in their operation because of where they are in a symphony you know like that kind of stuff is that's cool it's fun that's cool and you haven't gotten to do it yet you haven't played classical music in any procedure yet uh I do sometimes okay good yeah good good good good usually if the patient requests it yeah I'll just say oh cool perfect you don't you don't give them some money under the table be like a question or something like let's do it one day one day we'll get it perfect well this has been really really helpful do you have any closing words or any closing thoughts for it could be people in general it could be medical students who are interested in surgery it could be classical music enthusiasts anything at all yeah I I don't have any words for classical music enthusiasts but but people who are interested in surgery especially Med students I want them to think you know there are stereotypes about any field and the first encounter with any field is stereotypes you know like you're gonna watch nowadays you're gonna watch Twitter videos that highlight that stereotype comedically you know um or factually and and sometimes you're going to be tempted to make decisions about your life based on The Stereotype that's been set before you don't make your decisions based on stereotypes that were set before you think about the stereotypes that you can set by changing the stereotype entering the field you're interested in right so if surgery is intimidating to you like don't let that turn you away from it think about the potential that you get to have in it by being being who you want to be as a surgeon like one day because you didn't run away from this intimidating stereotype you're gonna talk to somebody and they're gonna say oh like maybe it is possible to be a warm nice surgeon that goes against the stereotypes that I've been taught in TV perhaps but it gives them a realistic career opportunity and a possibility right so um I've worried about this thing my whole life I still think about this question all the time because the culture of cardiac surgery especially is is complicated and challenging so I don't want to downplay or sugarcoat the experiences that you may have it's going to be challenging but by holding on to your values and not necessarily turning away from it you get to change that stereotype and I think that's what's really exciting about entering a field that may initially be intimidating yeah now that's fantastic thank you so much Jason and we can find you at the Modern surgeon on Instagram Twitter YouTube all these places and you want to give your personal Twitter as well as Jason Hahn MD yeah on MD Twitter perfect well thank you so much Jason this has been really really helpful thank you I had a great time talking perfect

Channel: The Zach Highley Show

Views: 23,653

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Id: 9XPTfeGS8i4

Length: 93min 44sec (5624 seconds)

Published: Mon Jul 31 2023