It's easy to forget from our ivory tower that many Americans don’t get beyond high school, making it less likely their kids will. Those kids who do are at a disadvantage compared to peers with college-educated parents. First-generation medical students are even rarer and face more challenges. These students, like PA1 Julie Vuong, M1 Amanda Litka, MD/PhD student Faith Prochaska, and M1 Holly Hemann, bring valuable perspectives to medicine, understanding a wider range of patient experiences and health determinants.

This week we discuss their challenges, the impact on their future practice, and how learning medicine highlights (somewhat uncomfortably) their own families' health struggles. And while some medical schools are going tuition-free, this hasn’t increased low-income student enrollment or primary care graduates...and seems to have done some harm.

Its Our monthly roundup of news from the margins of medicine! M1s Fallon Jung and Taryn O’Brien, M2 Jeff Goddard, and MD/PhD studnet Riley Behan Bush are on hand for our monthly news roundup. Including news that presidential candidate and anti-vaxxer Robert F. Kennedy’s brain was ‘eaten’ by a worm and his love of tuna sandwiches. Virtually all healthcare providers globally suffer from a clinical psychiatric disorder. Beethoven really liked lead-sweetened wine, which is probably why he was so sick and deaf. And a Tesla Cybertruck owner smashed his own finger with his vehicle’s frunk to prove that his vehicle’s frunk couldn’t smash his own finger. And can we guess what the shitty life pro tip from Reddit is? Plus lots more observations and revelations from the margins of medicine!

“I honestly have had the most relaxing time I’ve had in forever, and for anybody who’s like, that’s ridiculous, just wait.” The most charitable definition of a hot take is a position taken in order to generate conversation. The more usual definition is a position taken to create controversy (and clicks). Dave asked his co-hosts to come with some hot takes, and it’s up to you to decide which definition they’re using, but PA1 Conner Lieser and M1s Radha Velamuri, Amanda Litka, and Sri Nandakumar offer their hot takes on how hard med school is, the admissions process, shadowing, advice from more advanced students, and more. [Dave's co-hosts were all doing medical student things on our usual recording day, so enjoy this previously released episode!]

M1s Fallon Jung and Alex Nigg, M2 Jeff Goddard, and MD/PhD student Riley Behan Bush hear listener Megan's request for more news on critical healthcare changes from our overlords in the courts and the government. Riley shares insights from her lab work as she works toward finishing her PhD. This episode unpacks the FTC's move to ban non-compete clauses for doctors, a pivotal Supreme Court case on Idaho's abortion policies, and new consent requirements for performing invasive procedures that I guarantee you didn't know were being done on anesthetized people.

Medicine isn’t always kind to its disabled practitioners, but let’s change that. In 2023, a group of Iowa med students founded our chapter of the Medical Students With Disabilities and Chronic Illness, a group “working to remove barriers for students and professionals with disabilities, increasing representation of diverse perspectives in medicine.” M1 Holly Hemann, MD/PhD student Faith Prochaska and PA1s Olivia Quinby and Julie Vuong discuss their lived experiences as students navigating disability and chronic illness. They illuminate the essential support systems, the process of securing necessary accommodations, and the powerful sense of community among students facing similar challenges. And they look critically at how these personal experiences enrich the medical profession and underscore the urgent need for inclusivity in medical training. Their personal stories of coping with PTSD, ADHD, daily vestibular migraines, and celiac disease show how these experiences are shaping their medical journey. They also discuss what colleagues present and future can do (or must do better) to understand and support those who face barriers due to their physical and mental conditions.

It’s a freestyle episode…can’t we just have a rambling conversation? Sometimes it’s nice to just sit down and have a rambling conversation. That’s this episode, with MD/PhD students Madi Wahlen and Sahaana Arumugam and M3s Jacob Hansen and Jacob Lam. We discuss the non-weighty topics of why people don’t know they shouldn’t stare at a ball of fusion in the sky, niche online community drama, a Texas transplant surgeon accused of manipulating transplant lists, everyday things that might not be things someday, why Dave doesn’t yet want an electric vehicle, the co-hosts plans for their futures beyond seeing patients, and so much more that is barely relevant to medical school. If you don’t like this kind of episode, do we have a solution for you--https://theshortcoat.com/tellus!

Occupational Medicine offers a great lifestyle, scope mix, and early-career satisfaction. Matthew Kiok, MD, MPH tells us he's found the perfect specialty. Occupational Medicine is one of those careers we're exploring in our sleeper specialty series--those which you might not immediately think of when you're considering a career as a physician. Dr. Kiok tells M1 Fallon Jung, PA1 Julie Vuong, and M2 Jeff Goddard that he has great work-life balance and a satisfying scope of practice. He makes a difference in peoples' lives by keeping them safe in their workplaces or assessing work-related injuries, even testifying as an expert in court. His experiences highlight the unique challenges and rewarding moments in his chosen career and insights into the complicated relationship between doctors, employers, and employees. He offers advice to those considering a similar career path--and he even gave us his email address if you want to ask him more about it! What a guy!

Are you better off as a surgeon or in palliative care? MD/PhD student Jacqueline Nielsen, M2 Hend Al-Kaylani, and M1 Fallon Jung play with personality to see if their path toward choosing the right medical specialty should be dependent on their personality traits. From the introspective nature of psychiatry to the rapid decision-making required in emergency medicine, Dave and crew explore how tests like The Big 5 or Meyers Briggs might influence their specialty choices. Some question the scientific validity of most personality testing, but the Big Five has some evidence behind it, so Dave also created a custom GPT to analyze their test results and suggest best (and worst) specialties for all of them. This episode also touches upon the broader implications of these choices on personal satisfaction and professional success in medicine. Also, we ponder our consumption of news and its impact on mental health and the Kate Middleton mystery's hold on the world.

M1 Fallon Jung, PA1 Olivia Quinby, MD/PhD student Faith Prochaska, M2 Jeff Goddard, and special guest Dr. Peter Kaboli dive deep into the heart of rural medicine. We kick off with a candid discussion about growing up in small towns and how these experiences shape our understanding of community and healthcare. Dr. Kaboli, an expert in rural health with the Veterans' Administration, shares his insights into the nuances of rural medicine. We explore the multifaceted challenges and rewards of practicing medicine in rural settings, from the importance of forming deep connections with patients to navigating the scarcity of healthcare resources. Telemedicine, workforce issues, geographic barriers, and the digital divide are central to the art of medicine in small towns and on county roads, sometimes requiring innovative approaches to healthcare delivery.

Speaking up for your patients will have profound impacts. Short Coat Savannah’s previous work in mental health settings exposed her to situations where she had to report abuse. She left us a message at 347-SHORTCT asking us to talk about patient advocacy. MD/PhD student Riley, PA1 Faith, M1 Jeff, and M3 Happy–along with some of our faculty–look at what doctors actually do to advocate for their patients in that situation, as well as other more common situations. Plus, Jeff licks an elephant to right an old wrong.