3. Surviving Medical School with Dr. Tess Calcagno | The Physician Pharmacist Podcast

🎙️ Join us in today's enlightening episode as we sit down with Dr. Tess Calcagno, a remarkable individual who has journeyed from the realm of pharmacy to the challenging world of medical school. In this candid conversation, Dr. Calcagno reflects on her unique experiences, drawing parallels between her prior pharmacy education and her current pursuit of becoming a medical doctor.

🎙️ If you've ever wondered about the transition from one healthcare field to another, or if you're a budding medical student eager to gain insights into the journey ahead, this episode is a must-listen. Dr. Tess Calcagno's wealth of knowledge and her personal journey are sure to inspire and inform.

📕 Applying to Medical School: Dr. Calcagno shares her insights on the rigorous process of applying to medical school. From crafting the perfect personal statement to navigating the MCAT, she discusses the challenges she faced and the lessons she learned along the way.

📕 International Medical Care: As a seasoned pharmacist and a medical student, Dr. Calcagno sheds light on the global perspective of healthcare. She discusses her experiences with international medical missions and how they have shaped her understanding of healthcare disparities worldwide.

📕 A Year of 3rd-Year Medical Rotations: Buckle up as we take you through an entire year of Dr. Calcagno's third-year medical rotations, including the intense world of surgery. From the adrenaline rush of the operating room to the challenges of patient care, you'll get an insider's view of the life of a medical student.

⚡️For more resources to get started, check out some of our other blog post content!

• The MCAT: Everything You Need To Know

• How Hard is Medical School

• Can you work while in Medical School? The Physician Pharmacist Do's and Don'ts

• 6 Most Common Questions About Transitioning From Pharmacy to Medicine

• The Art of Applying to Medical School (The Pharmacy Student Edition)!

🧠 Enjoying the podcast and want to listen to more? Visit The Physician Pharmacist Podcast for a list of episodes. Here's a featured episode below!

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🥼 Complete Transcript of "Surviving Medical School with Dr. Tess Calcagno"

Podcast Scripts - Tess

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Nathan Gartland

Welcome to the physician pharmacist podcast, a show designed to shed some light on a very unusual pathway into medicine. I'm your host, Nathan Gartland. I'm a licensed pharmacist and second year medical student. I'm also the author of farm data MD and the owner of the physician pharmacist company. Most pharmacy students and professional graduates are aware of the possibility of going to medical school, but very few actually take the leap. We're here to unpack some of these details and open your eyes to the possibility of a career in both pharmacy and medicine. In today's show, we will cover topics related to applying to medical school, International Medicine. A recap of our entire year of clinical rotations, including surgical rotations, introduced USMLE, step two or national licensure exam, and finish up with the medical residency application process. I'm very excited for our third episode of the physician pharmacist podcast mini series, where we will be interviewing Dr. Tess Calcagno, Dr. Koh Cogno, received her pharmacy doctorate from Duquesne University in 2019. Upon graduation, she immediately matriculated into the University of Miami School of Medicine in Florida. She's currently finishing up with her third year of medical school and has a year of clinical rotations under her belt, and is quickly approaching the medical residency applications. Welcome Dr. Tess Calcagno.

Tess Calcagno

Hey, thank you so much for having me on the podcast. It's a pleasure to be here.

Nathan Gartland

Yeah, I'm super excited to have you on the show. And I think we're gonna have a great episode today. And we're just going to unpack a lot of details and share a lot with the pharmacy community.

Tess Calcagno

Yeah, I'd love to let's do it. Right.

Nathan Gartland

So we'll start out with some general questions. Now that we've heard you know, your introduction a little bit about you. Let's, let's hear a little bit more about that. You know, what got you started with pharmacy in the first place.

Tess Calcagno

Yeah, of course. So I'm originally from Central Pennsylvania, I grew up near Hershey, Pennsylvania, specifically. And when I was in high school, I was looking at sort of anything in the health care field. And I was very drawn towards pharmacy, because, you know, I was really interested in chemistry in high school, and they had, you know, the six year PharmD programs. So it seemed like something that was, you know, it would fit like a nice timeline, and I'd have a good career and I'd be able to, you know, enjoy life outside of my career, as well. So I went ahead and took the leap and applied to pharmacy school at Duquesne University with Nate and Pittsburgh.

Nathan Gartland

Awesome. Yeah, I followed a very similar kind of introduction into pharmacy as well, I was heard about the Two Plus Four program. And I liked how you mentioned that the balance outside of you know, I guess outside of work, and outside of your studies, you could get the degree taken care of in a couple of years. And then you'd have you know, a pretty good salary and a very good work life balance. So that was one of the major features that drew me into the practice, as well as the, you know, the classic cliche of how I was good at math and science. So I love that.

Tess Calcagno

Yeah, it's, you know, it's a cliche answer, but it's honestly, what do we have to go off of in high school? Right, so

Nathan Gartland

Exactly. So kind of building on that was was going to medical school, you know, always your plan. It seems like pharmacy was the original, you know, plan, I guess, you know, what, how did you transition into the the idea of wanting to go to medical school?

Tess Calcagno

Yeah, so it definitely was not my original plan. When I first one to pharmacy school, I remember going home, like the summer of freshman year of college, and I was working at this little retail pharmacy, and I was like, you know, I was pretty sure that that that was what I was going to do. It wasn't until my first professional year in the pharmacy program. So like, your one of pharmacy school itself, not undergrad, where I started to see more of the, again, cliche, but sign the science courses, and specifically the courses related to medicine. And that idea kind of came into my head at that point. And then throughout pharmacy school, it was this idea was kind of fed by different experiences that I had, like in the clinics. And just just in class itself, just being fascinated with the information.

Nathan Gartland

Yeah, and I think I'd also like to add to that, you know, to humbly recognize, you know, the mentors that we you know, you I'd like to say like I'd recognize that you serve as my first introduction to medical school. Well, you know, I had been considering the idea similar to yourself, you know, it was only a fantasy in my head. I remember telling you about, are you telling me about your ambitions for medical school while you're on pharmacy based, you know, medical mission trip in Haiti. This introduction along But the work we did on the ground was like profoundly influential in my own decision to seek out care in medicine. So I think, you know, having a mentor, like yourself was super influential. And I know you had a mentor, you know, along the way, that also helped influence your decision,

Tess Calcagno

I think I thank you for that. I feel very honored to be, you know, have served in any way for you. And I know that having somebody where you can kind of see like, Oh, hey, like, it's possible, this isn't like some crazy thing that, you know, you're just kind of coming up with in your head for your own, you know, crazy reasons. But no, this is, this is something that can be done. And I think knowing that, like most applicants, that, that go into medical school these days, they've, you know, they've done something after undergrad, whether that's like another graduate degree, or maybe they've taken a year off for research, maybe they've traveled, you know, maybe they've had a whole different career, you know, so it's, it kind of normalizes, like, this, this route to, to medicine,

Nathan Gartland

certainly. And what I've seen, in my experience is that the PharmD is no longer a destination degree, it seems to be a stepping stone. For a lot of people, it doesn't necessarily have to be, but it's being utilized. Because it's a very recognizable degree, it has holds a lot of merit and status, I think so it's very useful to transition into other fields and use that background.

Tess Calcagno

So don't agree yeah, even you know, outside of medicine, it's, it's a stepping stone for a lot, you know, law school as well, you know, PhD, or maybe like, you know, Masters in Public Health, many things

Nathan Gartland

exactly. And kind of building off of two that I mentioned, you know, our medical mission trip to Haiti, I was curious to know and ask you, do you still have an interest in global medicine? And would you recommend pharmacy students participate in a similar experience, if given the opportunity, because I definitely would, because of how influential it was in my decision making, just in my clinical exposure and perspective of healthcare?

Tess Calcagno

Yeah, you know, when I was in pharmacy school, and when we went on the trip to Haiti together, it was, it was really cool, because that was like, my first time seeing the patient in, in the entirety of the clinic visit, you know, kind of shadowing and getting that exposure. And in that setting, I feel like it's, it's very good exposure, because you're able to see a wide variety of patients quickly, you know, you're working with the physician closely. And as far as global medicine, I think that I am very interested in it still. It's part of the reason I chose University of Miami, we have a population of people from around the world actually living here. In our hospital, a lot of people are from South America, Central America, we have people from Haiti, so in the Caribbean, as well. And then you know, it's very multi national here in our in our hospital. So that's been like kind of my way to pursue global medicine locally, which has been really cool.

Nathan Gartland

Fantastic. Well, we'll transition into our next section of the interview, and that's talking about the medical school application. So I know it's been a little while. Since you knew you applied at this point. The processes are already changed dramatically, just within the last four years. Do you mind just sharing a little bit of what that process was like for you, especially while doing it in pharmacy school?

Tess Calcagno

Yeah, so the process was I remember it being very early, you know, it's a year and some change before you're actually matriculating into medical school. And I remember that I had to be very organized, you know, am Cass opens at a certain time and you want to be able to submit it the very first day since applications are rolling, at least they were back when I was applying. And as far as balancing that with pharmacy school, I was on you know, my fourth year of pharmacy school and like, as you guys know, if you're in pharmacy school now, or if you're practicing pharmacist, the fourth year is primarily like clinical rotations. So you can be flexible in terms of interviewing and taking electives at different times and kind of like molding your schedule to how you want to spend your time.

Nathan Gartland

Yeah, that was great. I think 100% It was much easier once the rotations that started because I could make my own schedule. I wasn't really dependent on exams. And I think that was a major feature that I appreciated. Like you mentioned off blocks as well for interview season. So you You could fine tune your applicate or fine tune your experiences to match your interview cycle leading up to happy rotations, I would argue that it's pretty a pretty stressful time period, when you have to plan for the MCAT and everything like that.

Tess Calcagno

I would agree. Like once you have all your guess once you have all your ducks in a row per se, like you have your letters of recommendation, you have, you know, your MCAT scores done, you've written your personal statement, maybe, and you're gearing up to apply the actual year of application was not stressful, but I think the preparation component, you know, it, it can be stressful, but just taking it one step at a time and realizing the things that you need to kind of have in place for that that year to be a smooth transition into into medical school.

Nathan Gartland

One of the nice features too, is that a lot of pharmacy students who are interested in pharmacy residencies have already been working on building their application up. So transitioning over into medicine wasn't anything you know, too far fetched, we had already put the, you know, the work in to have good grades, we would have had already been involved in research experiences. So we didn't really have too much more legwork. It was more self organizing everything and making sure we checked all the boxes.

Tess Calcagno

Yeah, I think I think the major, you know, key to success during the final year before you apply is just organization. You know, at that point, you've, you've put in all of the grunt work throughout your time in pharmacy, school and undergrad, you know, now it's just time to kind of make sure everything is like 100%, where you know, it needs to be.

Nathan Gartland

And if my memory serves me, you had a very successful application cycle with many high tier interviews. When it came down to it. i You kind of preface this already, but I know you had to choose between Georgetown and Miami and Georgetown is a very, you know, well recognized and prestigious program. How did you come to that decision? Was it as obvious as the interest in international medicine? Like you mentioned? or were there other features that you had to consider? Because I know you were really struggling between the two at the time period?

Tess Calcagno

Yes, yeah, that's a great question. It's, it's, it's one of those decisions in life where it's kind of like, you know, a hinge point, and you often look back on it. But I feel that I made the right decision. And at the time, the reason I made the choice was I, you know, I grew up in central Pennsylvania, I went to school in Pittsburgh. And I hadn't really lived outside of Pennsylvania, and I kind of wanted to force myself to get out of my comfort zone a little bit. And when I went to interview at the University of Miami, and then when I went back for a second look, it felt like a whole new world down here. You know, it's, you have a different language, you know, 50% of the time, different culture, you know, the weather is different. It's, it's a different vibe. So yeah, it was a lot of it was a factors outside of the the program itself, because I think at the end of the day, like, they were pretty, pretty comparable in terms of academics.

Nathan Gartland

Fantastic. Alrighty, so kind of moving into the specifics of your medical experience. Let's discuss your life in medical school. So as you approach the last year of medical school, can you tell us a little bit about your journey starting at first year? What was it like? How did you adjust?

Tess Calcagno

Yeah, so my journey starting first year, was, it was nice. I had a couple years or a couple of months living in Miami before classes began. During those months, I was actually studying to take the Netflix. So then I, you know, I took that exam. And then medical school began in August. And it was, it was an amazing experience. I met, you know, hundreds of people within the first week, I was introduced into medicine, I had it, you know, I got a white coat. And then, and then the kind of the work began. We did basic sciences during our first year. And we began with anatomy, and I just remember working very, very hard. And trying to balance all the classes. You know, it felt very, very similar to pharmacy school, and I know we'll get we'll get into that. But um, yeah,

Nathan Gartland

yeah, I love that. And anatomy is such a beast of a class that it's something especially as pharmacy students that a lot of us have never seen before. We were never trained in the intricacy of anatomy. So I think it can be a frustrating class to transition into because it's something that we don't have a little bit of a baseline knowledge on. And then we're sitting next to one of our classmates who might have had a PhD in anatomy or did yeah, extensive work in other classes. So staying in your own lane and recognizing that, you know, you have to just work as hard as you can, I think is also an important facet to carry forward.

Tess Calcagno

For sure, I think medicine and being in medical school has been a very humbling experience, to say the least. And I think that, you know, if you do choose to go this route know that, like, there's still a lot to learn, you know, it's a whole different field. It's a whole different profession. But yeah, it's good.

Nathan Gartland

So what's something you like about medical school? That's, I guess, a little different from pharmacy school? And then to kind of throw this in there? You know, what do you like? What do you remember you liked more in pharmacy school compared to medical school? Is there anything in particular?

Tess Calcagno

Yeah, for sure. So the thing that I'll say about medical school that I really, really like, like is there's a couple things. But the the first one, I'll just I'll relate to academics, in the sense that in medical school, we spend the large majority of our time in clinic. So it's a lot of hands on experience. And the lectures that we do have first year and a little bit of second year, they were all recorded. So it felt like a very adaptable curriculum where I could like be home in my pajamas and listen to a lecture on 2.5 speed. And then, you know, go do some some some practice questions. And I kind of felt like I was learning more more rapidly and more efficiently. And then the second thing I'll say that I like more about medical school is the it felt to me that the support system between myself and my colleagues was a little bit stronger. Maybe it maybe it's trauma, bonding, I don't know, but just, you know, I felt I felt the support was a little bit more there as opposed to pharmacy school where I felt that everybody maybe would go home at the end of the day, like go back to their, their own lives, it was less like immersive of an experience. And then for pharmacy school, um, what I liked about that was I would say that the information was a little bit, the resources to which like you acquire the information were a little bit more organized. You know, for example, in medical school, we use a bunch of different question banks to try to do well on our board exams. For pharmacy school, it was just like, you know, the lectures, you know, you like really know those lectures in and out, you'll do well on the exam.

Nathan Gartland

Yeah, absolutely. And having just that one comprehensive, like a Plex style book, that's all you needed, you didn't need any other outside resources, versus I'm gearing up for my step one exam right now. And I have like, 15 different tabs open for different like programs and practice questions of the day. And it's definitely a little less organized. So I 100%. Appreciate that. That point right there. But um, all right. So you mentioned a little bit of clinical rotations just a moment ago. And so for our listeners, you know, clinical rotations are a major component of the medical school education process, in the sense that we spend 50% of our time of our years in medical school, just in clinic. So our third and fourth year are spent basically on the wards or in clinic or in a doctor's office. So tests, can you walk us through some rotation basics, some information on shelf exams, how the scoring and honor system works, and just kind of your day to day experience? That's, I know, that's a lot right there.

Tess Calcagno

Yeah, of course I can, I can do my best. So I've done all of the basic core clerkships while I'm finishing up my last one here in family medicine. So what kind of is it it's similar to a day at work? You know, you go in at a certain time and you leave at a certain time and you're expected to do whatever the team really needs you to do. It was the first opportunity that I truly felt and said to myself, like oh, wow, like you are gonna be a doctor like you're doing it, you know, so I felt like they kind of took the training wheels off pretty quickly and kind of kind of threw you in and expected you to know how to how to take care of patients how to, you know, pre round on patients in the morning if you're on a hospital rotation, kind of follow those patients throughout the day. And then you know, you go home and you study for your shelf exams, primarily through questions is what you know, most of us do you world questions. And then you know, you go you go in and do it the next day. So it's very much like a clinic and then you you study for your shelves. and you get graded through clinical evaluations as well as your shelf exam score.

Nathan Gartland

Awesome. Yeah, to end to clarify some of those points. Like you mentioned, with shelf exams for our listeners, those are essentially miniature board style checkups to make sure you're learning what you should be learning to standardize the education process for across all medical schools. Correct me if I'm wrong on that. Tesco sounds great. And then also with honors and scoring. It's basically an evaluation of how well you are doing on the wards are you professional? are you handling Are you basically operating in the sense that you are going to be a doctor someday, even if you're not perfect with how you handled things, or if your clinical knowledge is in perfect? Showing that interest to learn, I've seen or heard, that is so important, just taking an interest in a particular field are volunteering to take on a challenging patient can go a long way, similar to how you treat it just with your happy rotations. And that kind of transitions to into my next question of, you know, how different our medical rotations from your pharmacy appy rotations?

Tess Calcagno

Yeah, so that's a great point. I don't want to give a cop out answer but I truly feel that it depends on the rotation, I, I've had rotations where I've been responsible for four or five patients on the service, and I would see them in the morning, I'd present them on rounds. I, they'd be my patient, and I'd write their note, I'd do all the follow up. And I'd feel like you know, I'm really at the level of, you know, a resident. But there have been some rotations where you're kind of expected to take more of a role of like shadowing the the residents and the other physicians. So it really can depend and vary based on you know, the team, you're with the specialty you're in, etc. For pharmacy rotations, I felt that they were similar. They were all similar to one another, right? Like, you kind of had your your role as a student, and they would involve you to kind of a standard degree across all rotations.

Nathan Gartland

Yeah, absolutely. That's definitely a good way to compare the two. And it's a little different in the sense that, you know, with pharmacy rotations, you do an acute care rotation that can be in anything per se, you know, or you do a community based rotation versus with you know, medical rotation, some of them are related to you're in the O R for doing this particular surgery or assisting on that surgery or you're working with anesthesia, or you're, you know, an OB GYN. So there's, there's a lot of different, I guess, more sub specialties that you can get involved in, versus, you know, you're only limited to one or two acute care appy rotations, and you'll make it see a couple tiny things, you know, so I think with the medical rotation system, the fact that you also have two years to do, it also adds to the the breadth of exposure that you get.

Tess Calcagno

Yeah, I agree. 100%

Nathan Gartland

already. Um, so my next question is, and I'm sure I know your answer already. But do you believe your pharmacy training has helped you in your medical school? And on the wards? Yes.

Tess Calcagno

Yeah, for sure. Hands down. So it didn't help. As much as I would have liked it to like the first few years honestly, because it's a lot of of like, knowing the disease pathway and like anatomy, as we were talking about earlier, and like memorizing, like genetic conditions, and like biochemistry behind diseases, it was really important for step one, clinical years for sure, like, you know, every patient you see, is going to be on a medication, well, usually every patient, you know, so that helps a lot to understand and know, like, just in clinic today, like, this guy was hypertensive, he had a, he had a coronary artery bypass graft in the past and like, he was on Metoprolol for his, his blood pressure. You know, and I'm just like, that's, that's not he needs to be on better, better drugs. So that's just an example. But

Nathan Gartland

yeah, I love that because especially I'm glad to hear that too. Because in my first two years, I would agree with you that there isn't as much pharmacy focus, especially in the first two years of the medical education process. When we cover beta blockers. We cover the first agent and that's about it, you know, there's no other beta blockers exist, you know, in the curriculum. Yeah, having that pharmacy background makes me sit there and I'm just like, you know, getting a heated thinking about oh my gosh, how are we going through this super important Topic, why aren't we talking about the heart failure guidelines? Why aren't we talking about all these other clinical, you know, facets, you know, PK pharmacokinetics, all this, like, you know, important material that is so heavily focused in pharmacy, and is somewhat overlooked. I think, in the first two years of the medical education system, obviously, the focus has shifted. So you know, there's not as much time to, to, you know, dedicate to that particular information. But um, that is reassuring to hear that I will get to use a little bit more of that that knowledge base on rotations.

Tess Calcagno

Oh, yeah, you will. There's never like a formal, you know, education. It's kind of what we get in the first few years, but you're going to be well above your, your peers and your colleagues with your pharmacy background.

Nathan Gartland

Alrighty, so lastly, I'd like to introduce the USMLE Step Two exam. For our listeners, this is the second national board examination that is used to quantify your merits in medical school. Many residency programs look at a student's step two score when comparing applications for positions. Now, that's step one, the exam that I mentioned, as well as in episode two with Dr. Price grow Hall, mentioned as well is now transitioning to pass fail, I believe there'll be an even greater focus on the performance of this particular exam. Not necessarily for for tests here, but for, you know, coming physicians in the future. So I'm wondering, you know, do you agree with this assessment, and, you know, how are you personally planning for these boards? I'm not sure you might have even taken them already. But I'm curious to know.

Tess Calcagno

Yeah. So I, I took step one scored. So that that was a thing, and that is done. And, you know, I think that the shift to making step one, you know, pass fail, make step two, the only, like the only objective indicator, you know, so I think that step two will be extremely important for medical students and future residents in the in the future IRS, and even during my year, because I know that it's like 5050, on on those people that took step one pass, fail versus scored. And step two is it's very similar to step one, but it's it's a little bit more practical knowledge, I would say it's more of like, management questions. Questions about like, what would you do next? And this is very near and dear to my heart right now. Because I'm studying for step two, and I plan to take it in June.

Nathan Gartland

Yeah, that's actually when I'm taking my step one as well. May 27. So unless I have to push it back, but hopefully that's not the case. But um, no, that's a good like synopsis on step two. And I agree with you that while I'm, you know, happy at the moment that I don't have to put as much effort into step one, because of the Pass Fail transition, it does worry me a little bit in the sense that all this pressure has now been shifted to the back end of our education process. And a lot of residency programs aren't really sure what to do with with this new with a lack of this what was once a purely objective and deciding critical component to how to classify, you know, residents for positions or I guess, applicants for residency positions. So it's going to be a very interesting time for medicine.

Tess Calcagno

Yeah, I think I think it's very interesting. And, you know, we'd like to say, Oh, well, this shift is going to be focused to research experiences and letters of recommendation, etc. But those things are, while important are not, you know, objective, if you're a program director, like I imagined that it would be nice to just look at the paper and say, Okay, this number sounds good. This number not so good, you know, and just kind of flipped through things. But I think it's, it's gonna become a lot more complex. And I think that, you know, residency program directors have a big task ahead of them.

Nathan Gartland

Yeah, I agree entirely. And one final point to that is, you know, is this going to turn into which, you know, medical school is more prestigious? Is that going to be a factor? Because we no longer have one of our, you know, objective tests? How can maybe a potentially lower tier medical school applicant compete versus, you know, a Harvard applicant if we've taken away that measure? So there's a lot of pros and cons to the decision, and it's something that I think like you said, it's going to be unfolding as the years progress. So I'm excited to see we're the guinea pigs for this. I guess, technically, you know, some of your classmates might also be if they didn't take a score to step one, but it is an interesting phenomenon, nonetheless.

Tess Calcagno

And I've also just one more thing I've noticed that a lot of people in my class have have an are going for more competitive specialties, you know, with with that pass Step one score hoping to, you know, achieve a good step two score, which, you know is interesting because that might have not been the case, if they were to take step one scored.

Nathan Gartland

percent. That's definitely an interesting point as well, already. So transitioning then. So now for the big topic, I guess that every medical student dreads is residency applications. In contrast to pharmacy school, where growing minority apply for residency position, every medical student must obtain a residency to practice and use their degree. To further complicate the matter, there's an overabundance of medical students compared to ACGME accredited residency positions, leading to a rise in unmatched graduates. And essentially not matching is, you know, for our listeners is that pretty much the worst possible outcome, because you're sitting there, you have to either take a research year or some other kind of filler, or pick up a job, that's not in medicine. So the goal is to 100% match the first time around, or you're going to be in for a rough ride. And that's not to say that you won't match in the future, you know, especially for applicants who are very competitive who are going for very competitive specialties. You know, they have a better chance than, let's say, a less competitive field. But I'm curious to know, what are you planning on applying for? And what have you done to make yourself a competitive applicant?

Tess Calcagno

Yeah, so that's, that's a great point. Unlike pharmacy school, we have to do residencies most of the time. And for me, I'm going to imply apply to internal medicine, with the ultimate goal of applying to cardiology, for fellowship, and practice as a cardiologist. So, for me, internal medicine was a great decision, and I really enjoyed my rotation on it. And what have I done to make myself stick out? Honestly, like, do do what you enjoy in medical school, you know, make a podcast, like, like humans doing, or, you know, do do what interests you, and kind of you'll you'll start sticking out. For me, I like to tutor a lot. I've had a lot of research experience in pulmonology. And just study hard, do well on your clerkships, you know, get good step two scores, hopefully, and good letters of recommendation, but just be very happy about medicine, and, you know, good things will kind of come to you.

Nathan Gartland

Yeah, and I think what I've seen from and heard from, you know, reports from other classmates ahead of us, is that a lot of once you kind of get that interview, scheduled, and everything, it's more so just being a good person being charismatic, you know, answering questions in a pragmatic way. And just kind of being a resident that a lot of people want to work with in the future, I think that's what, you know, everyone in medical school is all applying for the same positions. And if you haven't noticed, everyone in medical school is already, you know, very qualified. So it gets even harder to kind of stratify or differentiate between a lot of these applicants. So sometimes it just comes down to having that personality that one or two features that makes you stand out from the crowd. And, and adding to that, you know, I want to ask you, do you think your pharmacy background will be of interest to program directors and make you you know, more competitive per se? doesn't add that wow, factor, I suppose.

Tess Calcagno

I would say so. Especially in the setting of like, as we discussed earlier, the the limiting objective factors that these programs can use, you know, if they're sifting through 1000s of applications, or hundreds or whatever, you know, and they see oh, okay, farm D, well, she gets a little interesting. And then, you know, I think if somebody knows what a farm D is, and knows, like, everything we had to study and knows our skill set very well. Maybe they've worked with a pharmacist before, they will be very impressed.

Nathan Gartland

That's definitely reassuring to hear as well. What Um, all right. So transitioning to, we're kind of working our way through your your process, because you have step two on the way residency planning has to go, you know, into your next couple of months after you take step two. I'm curious to know. Let's talk a little bit about sub i's sub internships. How important are these and can you just, you know, tell us a little bit more of what they are exactly, and why most of them are done in your fourth year of medical school?

Tess Calcagno

Yes, so a sub internship, known as a sub i is basically an acting Um, internship for a medical student. So the best way that it's been explained to me is that it's like a four week long interview where you essentially act as an intern, people applying to different specialties do their sub internship within the specialty that they're interested in applying. And it's done in the fourth year of medical school, because at this time, you've had, you know, a baseline and a background of all of the other specialties. And you know, you're gearing up to apply to residency. So you kind of want to have like letters of recommendation that represent the closest thing to what these programs will be receiving, in a way. So I'm doing myself I in internal medicine in July for four weeks, and presumably I'll be working like 12 to 14 hours a day and you know, getting a letter of recommendation and then submitting it for residency applications.

Nathan Gartland

And I think that translates a little bit to to how happy rotations go when it comes to students interested in, you know, pharmacy residencies is a lot of the recommendation is to do competitive, difficult rotations that would prepare you for potential residency interviews or interviews or residency spots at different programs. So I think that's a good way to parallel the two. Yeah, and so I guess another question about residency applications is, how many programs do students generally apply to? And I'm very keen on expenses, because that's a major feature of what I do when I talk about students applying to medical school, you know, how expensive is the residency process?

Tess Calcagno

Yeah, so it's a great question. Two things. One, how many is very, very, very dependent on specialty, I would say, for the most, you know, middle of the road specialties in terms of competitiveness, such as like, internal medicine, emergency medicine, anesthesia, we want to apply to like 30 programs, or maybe less, maybe, maybe 20 to 30. However, I have some friends applying to dermatology and orthopedics. And they they apply to much more. So it really depends there on on what specialty you're applying to. In terms of cost, I heard that this can be parallel to the cost of applying to medical school, in terms of the application itself. However, interviews may be virtual still, they may keep that with or without COVID. It's kind of like something that hasn't really been been declared yet. So I think that could reduce the cost, you know, significantly in terms of travel expenses.

Nathan Gartland

Yeah, especially if you're applying to so many programs, and for most applications, depending on how competitive it is, I find that there tends to be way more interviews for residency positions than, you know, a traditional medical school applicant, just because there are substantially fewer, you know, residency applications being submitted versus 53,000 applications for for medical school. So that's that's an interesting point. So can you walk us through then I guess, when do you have to submit your your information when you rank? I know you will use arrows. But can you tell us a little bit about that real quick, nothing too in depth. And then you know what follows after you submit?

Tess Calcagno

Of course, so I will submit the E RAS application with the letters of recommendation and my step two score and all the stuff in the end of September 2022. And then I will wait. And I will get interviews, hopefully in November, December and January. So I actually scheduled time off during those three months, similar to what I did before medical school. And then after interviews, you kind of wait and then you can start ranking your programs. You submit your rank list to E RAS no later than the end of February 2023. And then Match Day is in mid March 2023. And then I and then you know where you're going.

Nathan Gartland

Wow, it's a scary process once you kind of lay it all out there like

Tess Calcagno

yeah, Yeah, I know. It's it's it is scary.

Nathan Gartland

So you mentioned everything, you know, the process the application. And you mentioned you took some time off for interviews. So what is fourth? You're like that. And after? Because I know some students might actually have rotations like on Match Day or, or after that, what does that really look like? Is it usually pretty lacks or it? Does it turn into a giant vacation? Or are you still expected to kind of hang around and check all your boxes.

Tess Calcagno

So for my school, specifically, you have to have at least six credits in the fall and in the spring, which translates into at least four weeks in the fall, and in the spring, which is not a lot. Fourth year is very lacks in terms of time off, like I think I have off like three months in the fall and three months in the spring. I don't even know how much time that leaves me. But yeah, there's a lot of time off. I'm planning to get a puppy.

Tess Calcagno

It's a lot of work, we just got one as well. So really

Tess Calcagno

nice. Congratulations. Oh,

Nathan Gartland

thank you. Um, and so leading into that, too, you know, obviously, you haven't had fourth year, but you're expecting it to be a little bit easier. Besides the interview process out of all the years, which year do you think was the most challenging for you?

Tess Calcagno

Ah, first year, for sure. I think the transition into it and just the sheer amount of information that you're learning in the beginning, is the hardest, and it was the most challenging for me. Once I kind of got a good handle on it, and we transitioned more into clinical curriculum, and I, you know, I had a better support system for things things got easier. And I would say, third year, best year so far.

Nathan Gartland

That's reassuring that because I'm looking forward to I just have to survive this step exam. So I guess last question, you know, are there other specialties that are highly dependent on pharmacy knowledge, you know, some come to mind would include, like anesthesia, or oncology, but are there others that are less obvious?

Tess Calcagno

Yeah, um, first, like, probably most of them except for surgery. But some, like surprising ones. For me, definitely. Like Family Medicine, you know, internal medicine, like general, very, like, a lot of it is medication management, you know, the large majority of of the day is spent on medication management for these these physicians. Other things that I can think of Obstetrics and Gynecology, pediatrics. Just anything in internal medicine, really? Anesthesia for sure. Yeah, I think that's, that's probably,

Nathan Gartland

yeah, that's, I mean, that's a good list, especially like with family medicine. There's, there's so much polypharmacy that you're working on a managing and optimizing medications, which is just a unique skill set that a lot of the medical education system, at least in the first two years doesn't really focus on. So I think that's, you know, I think it is reassuring to know that, like pharmacy is much more extensively utilized, you know, in the clinical realm, versus, you know, what we've seen in our textbooks.

Tess Calcagno

Oh, yeah, much more.

Nathan Gartland

All right. So we're coming to the final few minutes of our show today. And I want to ask a few closing questions. So how do you think your pharmacy degree will help with your ability to practice medicine or communicate with patients in the future? I know you've somewhat answered this a little bit, but we're thinking long term per se.

Tess Calcagno

Long term, I think it will give me a leg up in quickly identifying, you know, issues with medications and formulating good medication therapy management plans. And I guess on a deeper level, it allows me to really understand what what I'm prescribing and doing for my, my patients as a cardiologist. You know, medication is one of our biggest tools. So I think having that background and that understanding can give both me the confidence and maybe the patient even a little reassurance that you know, I know what, what's going on. And how, yeah, yeah,

Nathan Gartland

and I guess for individuals considering medical school after pharmacy school. Do you have any recommendations you'd like to share with them based on your experiences thus far? Any tips?

Tess Calcagno

Yeah, I would say if you really want to do it, try try to tune out people that are telling you not to do it because it was the best decision of my life. And I think that if you have an organized plan, and you're willing to put in a little extra work on The front end, the dividends are are plentiful in the end. So, you know, I'd say go for it and, you know, keep your head up and keep working. Yeah, I think

Nathan Gartland

that's such a positive message too to kind of reiterate that is, you know, for individuals who are considering this particular pathway, you might come across some resistance, which, you know, not, especially, like, for instance, one of my examples is from my parents are thinking, oh my gosh, you're gonna add four more years of your education, you're foregoing a six figure salary, you know, and you're at, you're doubling your loan burden, you know, what are you doing, like, just don't do it. And obviously, they're very supportive. And that's not something they they would, you know, took to heart. But um, you know, it's just another feature that you might come across in your clinical setting on your appy rotations when you tell, you know, a preceptor or something that you're going into that are considering medicine. So I love that that comment. Yeah. Alrighty. So one or two more questions. So I want to say I think there's a general frustration in the pharmacy profession that physicians can sometimes be unaccepting of recommendations or pharmacy input. What are some ways that we can help break down some of these walls, per se, between the professions and open up better lines of communication?

Tess Calcagno

Yeah, I think that's very true. And I've seen really good examples of how we can break down these layers, or these walls. Actually, in practice, I think it's really a good idea to have the pharmacist not only on rounds, you know, in the hospital, but have them be present, like before rounds also and have them, have them go and see the patients and really just increase the communication that they have with the team. I was on a team in internal medicine, and we had a had a pharmacist, and she would just be there during the whole process. And anytime any question about medication needed to be answered she was there, she was ready to, you know, answer the question and be a really valuable resource. So I would say just open lines of communication and trust between team members.

Nathan Gartland

Wonderful. Alrighty, so we have come to the end of our interview, and I'd like to thank all of our listeners for their attention and interest in medicine. If you have additional questions about the medical school journey, check out my personal website at WWW dot physician pharmacist.com. Before we let you go test, how can our listeners get in touch with you?

Tess Calcagno

Yeah, of course, they can email me first and last name@gmail.com. Also on Twitter, first and last name, so feel free to reach out.

Nathan Gartland

Wonderful, and that information will also be included in the show notes. So feel free to check that out at the end. So thank you so much for being on the podcast tests. I look forward to seeing what medicine and pharmacy take you best of luck with your rotations and residency applications. And step two as well.

Tess Calcagno

Best of luck to you too. Thank you so much for having me. It was a pleasure.

Tess Calcagno

All righty. Have a wonderful week and take care.

Tess Calcagno

All right. Bye

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