Chantal Young, PhD, shares what to do to maintain wellness and minimize stress after you submit your rank-order list and wait for Match Week. Dr. Young, director of the Office of Well-being at the Keck School of Medicine of the University of Southern California (USC), also dives into some coping mechanism for those who don't match.
- Chantal Young, PhD, director of medical student well-being and director of the Office of Well-being at Keck School of Medicine of the University of Southern California
- Brendan Murphy, senior news writer, American Medical Association
- Todd Unger, chief experience officer, American Medical Association
Unger: Welcome to Making the Rounds, a podcast by the American Medical Association. In this episode, we continue our Meet your Match series with guest Chantal Young, PhD, director of medical student well-being and director of the Office of Well-Being at Keck School of Medicine, University of Southern California. In today’s episode, she’ll share ways that you can take care of yourself during the long wait anticipating Match Day. Here’s AMA Senior News Writer Brendan Murphy.
Murphy: Hello and welcome to Meet Your Match on Making the Rounds, a podcast by the American Medical Association. I'm Brendan Murphy, senior news writer for AMA. Today we're going to talk about that painful and arduous waiting that happens between submitting your rank order list and waiting to hear back on Match Day. Our guest today is Chantal Young, who will be sharing with you how you can maintain wellness during that wait. Dr. Young is director of medical student wellbeing and director of the Office of Well-being at Keck School of Medicine of the University of Southern California. Thank you so much for joining me today, Dr. Young
Dr. Young: Brendan, thank you for having me. It's so nice to see you again.
Murphy: Yes, Dr. Young has worked with the AMA news team on many stories. We're excited to have her in a different form, but with similar and expert advice. She's certainly well versed in the medical student wellness arena. So to get started, can you offer some insight on your role in wellness and how you work with medical students during the Match process?
Dr. Young: Sure. So I am half of a two-person team. I'm one half of that team that comprises the Medical Student Well-being Program at the Keck School of Medicine at USC. So I work with another clinical psychologist, her name is Maria Giuliani. And together we serve about 750 medical students. And I used to provide one-on-one therapy or counseling services for students, but in recent years I've moved into more of a administrative, teaching, leadership role. So now Maria does most of the one-on-one work, but I want to speak from both our perspectives.
So from my sort of bird's eye leadership perspective, I'm working to advocate for systems changes to our curriculum, our policies and procedures to try to make medical school a more sane and humane experience. And then Maria's perspective is in more intimate settings with students where they really open up emotionally about what med school's really like.
So we're working from both ends to improve the student experience. And the first thing I want to say about the Match process is that it is really a metaphor for more than just the Match. It really means something. How do you deal with uncertainty, not knowing what's going to happen in your life, not always being in control of what's decided and maybe most importantly, how do you deal with disappointment if it comes. So those are the bigger life questions that we're helping students with. And if you like, I can also get into what we do on the practical side to support students during Match.
Murphy: We'd love to hear about it.
Dr. Young: Great. So on that fateful Monday where students are notified about whether they matched or not, Maria and I set aside protected time to meet with students one-on-one that day if they want to. And if they matched, we try to help them shift gears into celebrating. I mean, they probably just matched into the specialty of their choosing. Wow, you've accomplished the goal of becoming a physician in that field of choice regardless of the location. So taking some time to celebrate and some second guessing or kind of buyer's remorse of their choices is normal during that time. And we try to help them not let that drag them down.
If students don't match, the SOAP process can sometimes keep them pretty busy and distracted and they may or may not want to meet with us right away to emotionally process what's going on. And we tell them it's totally fine to make the choice to keep all that bottled up for the short term just to get yourself through that week and keep functioning.
And then sometimes after SOAP is over, that's when we'll meet with students to start working through what this experience meant for them. And if they do want to meet, they can feel reassured when we tell them a little bit about what's going to happen during SOAP or if they don't end up matching at all. And first and foremost, we want them to know their lives are not over professionally or personally if they don't match and they're still going to be fully supported by us no matter what.
And the last thing I'll say is that when students get that letter telling them where they were matched, we offer some support for that moment too. So sometimes there's a lot of pressure on that moment. Schools will have joint events where students open letters and that can be kind of pressure. It has to be an idealized moment like, oh wow, I'm so joyful. But we like to say there are many ways to do that. We could be available to sit with you as you open the letter in our office. We could be on Zoom with you so that the student's at home with their loved ones, but we’re there. Or it could be a totally private, calm, quiet moment. It's really your moment and your way.
Murphy: You offered a lot of great insight there. You discussed SOAP, which offers me the opportunity to plug that the next episode of this podcast series will be about the process of what to do if you don't match. That includes of course, SOAP, which is the Supplemental Offer Acceptance Program. This year's SOAP opens on March 14. Looking at this period before SOAP and hopefully you don't end up in SOAP, but there are certainly many potential outcomes and many positive outcomes. Do you notice an uptick in stress for students between rank-order list submissions and Match Day?
Dr. Young: Yes, there's definitely a high level of anxiety for many students during this window of time, which I try to validate as really normal and really understandable given the perceived impact and the actual impact that this decision has on students' lives both personally and professionally. And I've noticed that sometimes the anxiety about the rank order itself seems to be rooted in the fact that there may be no perfect way to do the ranking. I mean, sometimes there are just competing pros and cons. There's no one perfect site. Maybe students are just not 100% sure which path they want to take, or maybe they do really want one site in particular and then are worrying that they won't get that site.
But there's just kind of an uncertainty about it all that makes students uncomfortable. Many of us in academic medicine are used to feeling in control and being very intentional with what we decide. And then as we get a little closer to Match Day, I notice the anxiety increases then too because it's hard to wait and not be able to do anything after hitting that submit button. Especially for those of us who are kind of doers.
And on a serious note, the sense of powerlessness that comes in this time can be especially challenging if students have a history of trauma or feeling stuck and trapped in relationships or situations. And it's also hard for students who have just really tightly scheduled themselves for years and then might have some difficulty with the lack of structure. All the free time, feelings that we avoid for years can come up during those periods. So we're there to support them through that.
Murphy: So what do you do? How do you recommend students pass this time without obsessing about this major life event on the forefront?
Dr. Young: So once you press submit on that list, you are done. You get to release all sense of responsibility over this process. And for a small window of time, you actually get a break, like a true break from medical school where nothing is required of you. That is precious time. So, spend it worrying if you need to, but you might also start a journal, start a fitness routine that you want to carry into residency, go out and socialize, maybe explore the city that you live in that you might be leaving for residency.
This is a time when there's nothing to do, so go out and enjoy your life. And in particular, I like to suggest that students do things for other people during this time. So be of service, become a mentor for a younger medical student. Sign up to clean a highway or serve food to people in shelters.
Just get out of your head, get out of the very narrow mind that is only thinking about self. And if you can, get out of the med school bubble and spend time with other people, other activities, other locations that are not in medicine. It just helps us remember there's a whole world out there and it's okay to ask your colleagues to discuss or not discuss Match, whatever you need at the time. And organizing something for your classmates too, like a hike or an outing can feel good because it can feel like a very competitive time, and so being inclusive and collaborative rather than competitive can be a real relief.
Murphy: There is just a measure of anxiety that comes with this process. There's certainly going to be a measure of anxiety when things have left your control. Do you just recommend that there's a part of that that is accepting the anxiety is there?
Dr. Young: Yes. I think you just said that so well. I think students and all of us do have to radically accept that there are times in our lives that are just challenging and scary. And there's nothing wrong with students for being anxious during this time. It's just inherently anxiety producing. So the one thing I really don't want students to do is to be anxious and then get hard on themselves for being anxious. A better way to be with that anxiety is to bathe it in compassion and care. Maybe even experiment with “Is there a way for me not to hate my anxiety but to love it?” Because what does anxiety really mean? It's a deep need and it's a deep longing for safety and security for that good future and that good life. Anxiety is just trying to ensure your happiness and at the same time, students can balance that with not fully buying in to anxious thinking.
So it's good to question your worst case scenario thoughts. I find often in my life that I will feel like there's a sense of impending doom and then everything turns out fine. So most of the things I have spent time worrying about never come to pass. And then different things do happen that I could have never anticipated. So I try to help students sit with their fears of failing, of disappointing other people, of feeling shame for not getting what they wanted and to redirect those fears and use that energy to do something good for themselves.
Murphy: Accepting the anxiety is one thing, heightening it is another. And I'm guessing you see that as less productive. What behavior should students avoid?
Dr. Young: Yeah, heightening it is definitely less productive. And there are some things we all do when we're anxious that are probably not going to be as helpful. So any kind of impulsive behavior to cope with anxiety, like drinking more, smoking more pot, increasing sexual behavior that wasn't your habit before, or just staying up really late watching TV and then sleeping in really late or texting your ex or distracting ourselves through overeating or not treating our bodies well, all of that has a short-term function, but ultimately just adds to anxiety and stress. So I'd say if you can go into this window of time with the intention to keep your self care where it is or even higher and having a sense of fun and enjoyment and relaxation without impulsive behaviors, that's ideal.
Murphy: What are the beneficial outlets? Who should students talk to if they want to share these anxieties or just blow off some steam?
Dr. Young: It's so important to be talking about it. Definitely come talk to us, come talk to the well-being or mental health professionals at your school. If you feel comfortable talking to certain peers you can do that. In some sense other students understand what you're going through better than anyone, but you can also keep in mind that some of them may not want to talk about it. They might not want to focus on it during the time that they have free or they just might be feeling like super insecure themselves. So I would also consider connecting with friends outside of your medical student group who you know can be with you.
I might also add just something else that's coming to my mind, which is that some guidance for our faculty and staff around this or loved ones of medical students who are sitting with them during this time. What I've found with faculty is that we often want to give premature reassurances when students are stressed. Sometimes we'll do this thing where we say, "Oh, you matched in Ohio. Ohio's great. I know a great restaurant there." That wasn't what this student wanted and they're feeling sad and frustrated.
So just creating space for them to air their disappointment and just sitting there with them in that is so valuable. I mean, you might be the only person who can do that, who cannot fix their disappointment, their sadness, their frustration, not try to combat it with positive encouragement, but just be there and say like, "Wow, I hear how disappointed and sad you are. And that makes sense and I'm so glad you're sharing it with me."
Murphy: So on an annual basis, the match rate for U.S. DO and U.S. MD seniors is somewhere between 90 and 95%, usually toward the higher end of that. How do those facts play into the way you coach people to bide their time?
Dr. Young: Right. Not only do most applicants match somewhere, but the vast majority of applicants end up in one of their top three spots. And it can be reassuring to remember that. So sometimes I do say it to students, but at the same time, a lot of our students are perfectionists and high achievers, so we actually try to limit particular expectations because it can make it seem like anything less would be a failure. So what we actually encourage students to do is to be open to all potential matches and to discover hidden possibilities, hidden gems in each match that it might have to offer.
And we also try to help them sit with the idea of failing at something, at anything, whether it's Match or anything else in their professional life or their personal life and work with them on what kind of person do you want to be when you are faced with disappointment, both internally and externally, how would you like to respond?
Murphy: However unlikely, applicants do go unmatched. What do you tell students when that happens for them?
Dr. Young: So it does happen and first and foremost, students need to allow themselves time and space to grieve. That is a big disappointment and a big loss. And I would say just to be exceedingly gentle with yourself, seek positive support from people you know make you feel safe and not judged. And that's also the time to go ahead and reach out to your school's resources if you haven't already. When students haven't matched, they should watch out for shame or blame or any kind of maladaptive coping that might want to come up during that time period. And certainly if you have any feelings of hopelessness, that's when you want to talk to a professional.
We are also at Keck working with student affairs faculty and staff to become more comfortable with that grief and loss themselves so they can be present with non-matched students in that time of need. And again, not try to fix the situation with platitudes.
Once students have moved through that initial grief and shock period, what they can start to remember is that this actually is not the worst thing that can happen. This is not life or death. This is not their physical health or well-being. They can reflect on other times that they haven't met goals or were faced with disappointment and how did they deal with that then? What did you learn through that experience and maybe looking into the future, what is your future self 10, 20 years from now going to have to say about the fact that you didn't match? We try to help students determine who's going to be helpful to talk to about not matching and who isn't. So they can kind of draft almost potential conversations with their family, their friends, but also faculty mentors, classmates to share that they didn't match.
Because often students are really anxiety ridden just about sharing the news, and then students can ask upfront for what's going to be helpful from their audience and what isn't. Students can focus on taking on a new goal, whether it's communicating with their SOAP contacts, exploring new options, looking at a research year. But one really lovely thing we try to do is connect students to other students, residents, physicians who also didn't match so they can kind of see that evidence and reassurance that it really can turn out just fine in the end, even if there's this bump in the road.
Murphy: You mentioned drafting a list of who is helpful to talk to and some of the people that are helpful. Who isn't helpful to talk to?
Dr. Young: So I think who isn't helpful to talk to is going to differ for every student. For some students actually talking to their family may be less helpful than they wish it were. Sometimes students come from cultural and family backgrounds where there's a tremendous amount of pressure to match, and sometimes families and communities don't understand the ins and outs of the SOAP process or the fact that you can just attempt to match the following year and life is not over.
So if it's the case that talking to your family might actually not be helpful, we can work with students on how to communicate the news to them in a way that does not open the door for future conversation in that moment. We do recommend that students try to talk to some of their peers. Sometimes students feel so much shame that they don't want to say a word to anyone, and that really is not a good long-term plan.
However, students can think about which of their peers are going to be encouraging and motivating and not make a bigger deal out of it than it needs to be. But also, the people who will get that it is a moment of tremendous disappointment. And then students can also think about which faculty mentors are and are not helpful for them to talk to. Again, at that stage, you want someone who's going to be encouraging, and we do create a list of residents and physicians who did not match at their first attempt that are sometimes really good people to talk to in those moments who can explain how they got through it and thrived in the end.
Murphy: You talked earlier about looking for the hidden gems, and that's a great approach I'm sure, but some students are going to match and not have their ideal version of events. What do you tell those students? How do you help them cope?
Dr. Young: For students who maybe don't get their first pick or their second or their third, first of all, we try to be really mindful of language. So we don't talk about "top specialties" or "top residency sites." We try to use language like specialties or sites that put a greater emphasis on test scores or specialties that have a lot of applicants for fewer spots, but it really is not that one is better than the other. The other thing I try to talk to students about is that without a crystal ball, it's kind of impossible to know what the ripple effects are for each site choice. You're going off a fantasy and an assumption of what you think is going to happen to your life with each site, and there could be some accurate aspects to that, but you really just never know.
I'm thinking of a personal example actually, which is that I really wanted to match at the UCLA counseling center for my postdoc year, which is for psychologists, kind of the equivalent of medical residency. But on the interview day, I was having a very off day and I totally bombed, and I was not offered a position there. And so instead, I went to Kaiser Permanente in Northern California for my postdoc, which was not what I wanted to do, but when I was there, I met the single best group of colleagues I have ever worked with to this date. I loved that job. I still have connections with people there even though I moved away back to L.A., it was more than 10 years ago now.
I am so grateful I had that opportunity, even though at the time I thought it was the failure. So you just don't know and you can grieve what you lost, and then as you move toward acceptance, start to celebrate wherever you are going and whatever special opportunities might be offered there.
Murphy: Do you have any other advice about biding time between rank order deadline and Match, or just generally approaching these final few weeks of this process for students?
Dr. Young: Yes. I mean, if I may, I'd like to just speak directly to any students who may be listening. You are so much more than Match Day. You are expansive and magical, and you are loved, so please give yourself permission to enjoy what is actually a very exciting time of life, to reflect on the big questions and be with people you love, and if you need to worry, then schedule some worry time and then have the rest of your day free of dwelling if possible. Because what's at stake here, really? It is not your worth because that is not touchable.
Murphy: I'm sure our student audience will find that advice, the bit of levity you offered, to be very helpful. Thank you so much for joining us on this episode in our Meet Your Match series, Dr. Young.
Dr. Young: Thank you so much for having me.
Murphy: I'm AMA Senior News Writer Brendan Murphy. We'll see you next time.
Unger: You can subscribe to Making the Rounds and other great AMA podcasts anywhere you listen to yours or visit ama-assn.org/podcasts. Thanks for listening.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.