AMA's Moving Medicine video series amplifies physician voices and highlights developments and achievements throughout medicine.

In today’s episode of Moving Medicine, AMA Chief Experience Officer Todd Unger talks with Leanne Chrisman-Khawam, MD, MEd, an assistant professor of social medicine and director of the Transformative Care Continuum program at Ohio University Heritage College of Osteopathic Medicine in Cleveland, who shares advice for medical students on their rank order lists in preparation for this year’s Main Residency Match.

Watch the AMA's "Road to Residency" video series.

Speaker

  • Leanne Chrisman-Khawam, MD, MEd, director, Transformative Care Continuum program, Ohio University Heritage College of Osteopathic Medicine

Moving Medicine video series

AMA's Moving Medicine video series amplifies physician voices and highlights developments and achievements throughout medicine.

Unger: Hello, this is the American Medical Association's Moving Medicine video and podcast. Today I'm joined by Dr. Leanne Chrisman-Khawam, an assistant professor of social medicine and director of the Transformative Care Continuum Program at Ohio University Heritage College of Osteopathic Medicine in Cleveland, Ohio. Dr. Chrisman-Khawam will share advice for medical students on their rank order list in preparation for the upcoming Main Residency Match. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Chrisman, thanks so much for joining us. This is now the second Match that will happen that reflects the impact of the pandemic. Is there anything that you learned or saw from this past year that's going to help inform your guidance for medical students in the coming year?

Dr. Chrisman-Khawam: Yeah. I think that we all experience this using a video technology and trying to look at the right spot in the camera and those sorts of things to really share your true self. That's going to be really important in terms of how people perceive you. And so you want to know that if you didn't have a good interview, you may want to call someone or send an email or have that follow-up. Clear communication is so much harder virtually. And so, you may want to follow up with a written or email, well-written communications so that people feel like they're connected to you.

Unger: That's interesting. It's a skill all of us are learning at the same time. Do you have any kind of key tips for folks in regard to that kind of interviews?

Dr. Chrisman-Khawam: Yeah. I think that in particular, utilizing the video portion, doing some practice over Zoom or Teams meetings, or however you can get on, even FaceTime with your family members, with people that you feel comfortable trying to have that normal communication, that normal interaction, it can be tough. And so trying to be your normal self and, do your normal facial expressions and hand gestures, that's really important stuff and really hard to do. So, yeah. Practice as much as you can.

Unger: That's the advice that I give folks when they're talking about how to get better on. There's just no substitute for the kind of practice that you get from doing it. Well now, hopefully we're moving out of this kind of pandemic Match environment. From what you've seen, do you think this kind of upcoming Match period this year is going to be any more difficult or easier? And do you have any kind of specific guidance that you're tailoring for the situation that we're in now?

Dr. Chrisman-Khawam: Yeah, I think that last year was in particularly difficult. So many of our students had limited clinical exposure. Some of their rotations, their core rotations were shortened. Many of them had zero opportunity to do away rotations. So getting that rotation at the location that you want to be is one of those key elements that can really help you know, "Am I a fit here? Are they a fit with me?" And those are actually some of the most important things around residency. You're going to do three to five of the most intense years of your life. And you want to know that you have support systems. People that you work with, colleagues and attendings who are your teachers that you want to work with, and that want to work with you. None of us are perfect. None of us is a perfect match. But knowing that you have someone that you can grow with is the key to having a good residency match.

Unger: Well, let's get into that because the topic here that we're going to go toward is this idea of the rank order list. Specifically, these lists need to be submitted by March 2, which is coming up really fast. And so this very stressful period as students are trying to figure out how to rank programs in the first place. So when offering ranking advice, some people say follow your heart. Is that something that you subscribe to? Or do you have a different kind of philosophy that you impart?

Dr. Chrisman-Khawam: It's interesting. I have a dual philosophy. So I'm all about a pro/con list. So, what I really like is that you'd list those factors from the most in important to the least important for every single program. And then you look at those factors so that you're really comparing apples to apples, not apples to oranges. And then after you've ranked them based on logic that then you go with heart because there's somewhere in your intuitive brain that picks up things that even the logic doesn't. Things that were ... Those intangibles, the way how people treated you on the day.

I remember a place that I went for a residency interview where I walked through the hospital and no one looked at me the whole day. People looked down and they were gruff and I thought I can't work there. Right? And then there was another place where I walked through the hospital and literally, I think almost to a person, to a fault, people smiled at me and said, "Hello. How are you?" Or "Good day," or you know. And I thought, "Wow, big difference." So those little intangibles, your brain is picking up on those. Even if they don't end up on your pro/con list. So at the very end, use a little bit of that heart to get what your brain and your heart know that might not come out your Excel spreadsheet.

Unger: I know one of those factors that people always deal with when they're making decisions like this and they're doing their pro/con list, is this idea of the pressure that comes from dealing with, should I go with a bigger brand name, or something that's "more competitive"? How do you advise folks on the proper strategy for factoring in things like that?

Dr. Chrisman-Khawam: Yeah. You want to be realistic and honest with yourself about your metrics. Don't be going beyond and out of reach. It's okay to shoot for the moon. And those big brand names aren't always what they appear to be. One of the most important things is that you feel comfortable because you don't really learn and don't work well where you don't feel comfort. There's something about the learning brain that needs those base Maslow hierarchy things met around safety and belonging. And so believe it or not, to get self-actualization, we actually need people with whom we can work. And I actually really think that's valuable and important. Trust that more than any brand name that might be that the brand name, the big shiny school with the white towers is the place for you. But if it's not, you will struggle there. And so you really want to feel that fit. Fit is, I can't even begin to tell you how important to your eventual success.

Unger: Yeah. And that's kind of hard to judge. I know people that know me and they think about that hierarchy. You know that food is very important to me but I think fit is probably that real bridge toward what you call self-actualization. Just kind of bridging the basics to a place you're going to want to spend five years. You're at an osteopathic medical school and osteopathic students, they can face some extra challenges in the selection process. What are some of those barriers and how do you advise them to work with that?

Dr. Chrisman-Khawam: Some of it can be biased against the profession. That feeling that osteopaths don't have the same training, which isn't true. They have the same training. Plus I, for disclosure, I'm an allopath working, an MD working, at an osteopathic school. So I know this in fact that we are training students with the same skills plus osteopathic manipulative therapies. So, there's bias. And then I think the other piece is the accreditation exam. I hope that someday we have a dual accreditation exam with the osteopathic medicine as an extra section. That would make a lot of sense to me. But right now, our osteopathic students to be competitive, especially in competitive specialties, really need to do the USMLE which puts an extra burden of cost, travel, potentially and also stress because timing is everything, right? It's an extra time, it's a different written test. So, that's a different thing to study for. And they must pass COMLEX because COMLEX is for their accreditation, their certification. So I think that is an additional burden. It really is.

The other thing is that even within non-competitive specialties, there are going to be competitive places. And so some of those places will require USMLE. And in most cases, I recommend that students that are going into internal medicine and psych and family medicine may not need to take that additional burden of the test. But if they really want to go to some place that's very competitive that may be required. So seeking advice from other graduates of those programs, potentially other osteopathic graduates could be really helpful.

Unger: Any specifics on the rank process for those students? The ranking process.

Dr. Chrisman-Khawam: Yeah. That's a tough one too because they may rank osteopathic and allopathic programs. You really don't want to not rank the places you want to go. And I have seen a few students that get rigged out if they don't put places that rank them high. High enough on their list. So, you want to keep them in your top tier, places that you think might rank you. As long as there are places you really want to go. You never want a single program on your list that isn't someplace you'd like to go. I think that's really important because I've also seen years in which we have students who are heartbroken and now are bound by the Match. And getting out of that conflict could take them out of the Match for a whole year. You know you'd be almost better not to match and scramble or not to match, give yourself another year to be a more competitive candidate and reenter the Match in the following year. So, don't ever put any place you don't want to go. Absolutely.

Unger: That sounds like a very good idea. What do you think about this concept of a letter of intent to let programs know where you're ranking them on the list?

Dr. Chrisman-Khawam: I think it's good, as long as you're really honest. If you're really only going to rank that top one or two and say, "Hey, you are really it for me." and this is why, and be really honest. Then I think it can be to your advantage. Program Directors also talk to each other. So, if you're telling 10 programs that there is, there's a chance that you may be found out and honesty above all else is key. So, I think be honest. Be honest with yourself. Tell that top one or two programs and otherwise, no.

Unger: It's been interesting because I've been here for five years and I get to see this process play out among those students that I get to know through the course of the work here at the AMA. And I know what a stressful time this is. Is there any other kind of pieces of golden advice that you can give students during this potentially joyful and stressful time?

Dr. Chrisman-Khawam: Yeah. I mean, I think that in general, life is a journey. And you really want to be one with yourself and enjoy the process. There is ... you are becoming right now. You're becoming the professional you're going to be. And there's a lot of joy that comes in that time. Gosh, thinking back to my own Match and the kind of growth that I experienced in those first years, both in terms of the place where I was the physician I became, the person I became, the wife and mother I became, that all happened in that place. And I'm so appreciative of the folks that help built me and help me become who I am. So, I think getting in touch with who you want to be is really important. Being a little reflective during this time and really enjoying the ride because this is just this little window in your life. And looking back on it now is one of my favorite, favorite times in life. So, if you don't enjoy it, you're going to miss the gift.

Unger: I guess, perspective is one of those things that you have that others are developing. And I think that's really good advice as they undertake what is a very stressful period. Dr. Chrisman, thanks so much for coming on our show and sharing your perspective. It's been really useful and I hope the folks out there find that it helps them. And for more resources about this kind of journey toward residency, you can check out the AMA. We've got a lot of stuff on the site, including our FREIDA which helps folks evaluate different residency programs. A Road to Residency video series. And there's a lot of information about ranking, Match week and SOAP. So check out ama-assn.org for all of those resources and good luck to all of you who are going through this year's Match. We're going to be back soon with another Moving Medicine video and podcast shortly. In the meantime, don't miss one of these incredible episodes. Make sure to hit subscribe on AMA's YouTube channel and check out all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us. Please take care.


Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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