Beyond the White Coat: Global & Local Health Experiences

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In this UMich Med Mosaic, host Mackenzie Kay talks with medical students Amanda Cassetti, Emily Gitlin and Evelina Hristova about how they’ve engaged in service through initiatives like the U-M Student-Run Free Clinic, Wolverine Street Medicine and Global REACH. They reflect on building trust with patients, navigating care in nontraditional settings and the importance of ethical engagement. The conversation explores how these experiences have shaped their skills and aspirations and reinforced that service can be a critical part of becoming a physician.

More Resources

Global REACH | University of Michigan Medical School

Free Clinic | UM Student-Run Free Clinic | Pinckney

Wolverine Street Medicine - Home

MD Program Year 1 | University of Michigan Medical School

MD Curriculum Health Equity | University of Michigan Medical School

Learn more about the programs at University of Michigan Medical School.

Transcript

Mackenzie Kay:

Hi everyone and welcome to UMich Med Mosaic, a medical student-run podcast we've created to shine a light on the diverse backgrounds and experiences of our students here in Ann Arbor. I'm Mackenzie Kay. I wanted to start this podcast to build community through hearing the stories and experiences of my peers. And as an avid podcast listener, I feel passionately about podcasts as a medium. I'm so happy and grateful to be here at Michigan. Through these conversations, we hope to show that there is a no on size fits all definition of a medical student. Whether you're a current or prospective medical student, we hope that you feel inspired by these narratives.

Welcome back to UMich Med Mosaic, where we explore the story shaping medical training here at Michigan. In today's episode, we're looking locally and globally at the intersection of service and education and the ways that we as medical students can serve our community and beyond. I am joined today by three students whose work spans the Student-Run Free Clinic in Pinckney, Wolverine Street Medicine here in Washtenaw County in Detroit, and Global REACH whose work has taken medical students around the world. Thank you to Amanda Cassetti, Emily Gitlin, and Evelina Hristova for being here. To get started, can each of you introduce yourselves, what year you're in and what you've been involved with outside of medical school?

Evelina Hristova:

Sure. I'm Evelina. I'm a fourth year medical student, a non-traditional medical student. So I did a little bit of international relations work prior to medical school, which really informed what I wanted to do once I got to medical school, especially working with different populations, which is how I found my way to the student run-free clinic. Also briefly was part of Wolverine Street Medicine. I've done some work outside of that with cancer survivors doing the Cancer to 5K the past two years and then just a lot of volunteer work throughout the community.

Emily Gitlin:

I'm Emily. I am in my second year here at Michigan Medical School and most of my activities outside of medicine are around global health and global health equity work, both with populations around the world as well as refugee populations in our local community here in Washington County.

Amanda Casetti:

I'm Amanda. I'm an M3.5 is the common lingo here. So I'm between M3 and M4, doing a research here about street medicine actually. And outside of street medicine, I've been really heavily involved in a lot of community organizing just as a community member who happens to be a medical student. And a lot of that work has been around housing and homelessness and really just human rights in our community.

Mackenzie Kay:

Thank you so much for sharing. So here we have three of you, one who's representing Wolverine Street Medicine, one who's representing the Student-Run Free Clinic, and then one who's representing Global REACH. I'm always curious about origin stories because nobody ends up in these spaces accidentally. I'm very curious about what initially drew you to this work when you came to medical school.

Emily Gitlin:

For me, I came into medical school interested already in global health. I had some formative experiences in my undergraduate degree with mentors in that global space. But what really made me pursue Michigan and pick Michigan as a medical school was the opportunity to continue that work in a way that I felt was very grounded in principles that resonated with me. I think doing global work can be very challenging at times in terms of what is your role? And even with my local partners here, people who've been involved locally, you understand as well the difficulties dealing with vulnerable populations and the desire to work with vulnerable populations, but also in a really ethical and sustainable way. And so I think Michigan, as I chose to come here and as I got deeper into the global community here, I realized that this was something that I could continue to do in a way that resonated with me.

Evelina Hristova:

Yeah. I think in a parallel fashion to Emily, I also chose Michigan primarily for the opportunities through the Student-Run Free Clinic and other organizations in the community. I felt like Michigan's curriculum was set up in such a way that as an M1 and even further down as an M3 and an M4, you had more opportunities to participate and seek out those experiences. And then I think that all comes from a desire and a responsibility I feel to help people in communities. I'm an immigrant, my family are immigrants. We have used free clinics in the past. Those are all things that are very near and dear to me. And I've been given such a fantastic privilege to attend this amazing medical school and have had such a great education up until now and have had all of these experiences and educational abilities and all of that I think just shows a responsibility for me to put that towards the community that has helped me so much in so many different ways, which is how I knew that I wanted to participate in some sort of community or volunteer organizations in medical school.

Amanda Casetti:

What initially drew me to the work of street medicine has been a combination of personal experiences and growing up in a world that led me to believe in harm reduction and that a lot of our work is political. And then having been a part of a lot of organizing groups prior to medical school, doing mutual aid, direct aid on the street as a part of broader projects that are trying to rework the system that we live in and that we see the injustices of every day. Bing a medical provider can be like a radicalizing experience. And so I think the work I did prior to medical school, which really connected the dots on we cannot just be trying to help people, we have to also be trying to dismantle the systems that are creating all of these injustices. So that was what really drew me to street medicine, to be honest, is because it was a combination of seeing this as a lane that I can impact as a medical student and a small part of these injustices that I can put a lot of time toward and meaningfully change the experience of healthcare for some people in my community.

Mackenzie Kay:

Yeah. It seems like all three of you came in knowing very much that this was the type of work that you felt committed to. Were there moments maybe in your first year, second year, third year where you felt reaffirmed in that decision to continue on?

Evelina Hristova:

I think first year is so interesting because so much of it is asynchronous and you go into med school thinking like, "Oh my gosh, this is exactly what I want to do. I want to be around patients. I want to be talking to them. I want to be doing physical exams. I'm going to save the world one patient at a time." And then you get here and you watch 20 hours of videos at home by yourself with your cat and you're thinking, "Okay, I get that this is an important part of the process and I'm learning things, but also I want to talk to patients. That is what I envisioned myself doing in the future." And once I started volunteering at the free clinic and being part of the leadership team, I felt a lot closer to that goal even as I was fumbling through patient encounters and trying to give a clear idea of what was going on to the attendings and still I myself had no idea what was going on with patients. I think being in a room with a patient and being able to have a conversation with them is so affirming to what I want to do in the future in general that it was hard not to want to keep doing that.

Mackenzie Kay:

What you said really resonates with me. M1 year here at Michigan is a lot of flipped classroom and so you're thinking about medicine a lot, but you're not having a lot of opportunity to talk to patients. And so I remember when I was an M1 really looking for opportunities to connect with people through student orgs. And so I did a Wolverine Street Medicine run and I did a couple shifts at the free clinic in order to feel those connections and really remind myself why it matters that I'm here.

Amanda Casetti:

I also want to answer the question you asked before of what affirms you? Because I think that Wolverine Street Medicine is inherently so affirming in this work because it's like sometimes the first time that someone is having a healthcare professional genuinely listen to them and be coming back consistently and being a recognizable figure, recognizable person. I think that by being present in the community so consistently as Wolverine Street Medicine has been doing and as individual members have been prioritizing over the years, I feel like we can really see an inroad of people building community and being in relationship that is getting people more care. And that is just so affirming in this work. And so I wanted to say that because I love that.

Mackenzie Kay:

To that note, I just have a question. In your runs, do you find that the people that you've partnered with have developed close relationships with you and are specifically requesting you and your help and are building trust with you more than they maybe would with the health system?

Amanda Casetti:

Absolutely. Absolutely. And that's a very intentional choice on the part of Wolverine Street Medicine is being consistent both with the individual people that we are serving and trying to build relationships with individuals and then also with partnership organizations that are more present in the community than we could ever be as medical students.

Mackenzie Kay:

That's amazing. I'm wondering if you could, because we're on this topic, walk us through all the different things that Wolverine Street Medicine does for the communities that they serve. I think it'd be really helpful for the audience to hear.

Amanda Casetti:

We do a lot of things which I have to emphasize every single time I talk about this. This work is not possible without the relationships we have built. And so I just have to add that. And yeah, we just provide whatever we can. We have our bags of what we have, lots of wound care, lots of foot care. We've got some over-the-counter meds. We've got some basic prescription meds. And when we have a physician, we can prescribe and refill people's stuff, treat people's hypertension. We also regularly connect people with Packard, the federally qualified health center in the area. We've worked really hard on building out that partnership. There's a group of us with WSM who meet regularly with Packard folks and talk about how we can be better connecting people to primary care and creating those inroads so that we can be calling Packard right from the street and make appointments for people, giving people bus passes so that they can get to those appointments. Really writing in clear paper, like this is when your appointment is, this what we did here today with you and this is why we want you to go see a physician and let's talk through why you're worried about going to the doctor.

Mackenzie Kay:

WSM is amazing because they fill so many important needs. Emily, I actually want to turn it to you. If you don't mind, I have so much curiosity about what it takes to actually prepare to do a global health research project. What goes into getting ready to do that? And when you were abroad this past summer, what was the day like when you were there?

Emily Gitlin:

So one thing that the Global REACH Student Advisory Board has started in the past couple of years is a pre-departure training, more of a discussion really for people who are planning international experiences through University of Michigan Medical School. And through that work, we have really in-depth discussions of possible ethical dilemmas that you might face and challenges that you might experience being in a different cultural setting, being in a place where you very much are a guest and a visitor. And so doing that personal work for me and then also partnering with Global REACH to do that in community with other students who are also going abroad was a big part of my preparation.

And then of course the laundry list of logistics as always. And then also relying on mentors and people who have done this work before me. I was entering into a research project, a research team that has existed and has partnerships in Ghana for many years prior to me coming to medical school here. And so tapping into the knowledge that my mentor and my research advisor has about the area and everything that's going on as well as other students who have traveled internationally. I think the more that you are able to connect with other people who have done similar work and even the local community before you get there is great. We have Zoom, we have all this technology to do that so I was meeting my research team even before I was on the ground, which is really lovely.

Second part of your question of what did I actually do? What's a day in the life? For me personally, my research currently is on testing the efficacy of a new low cost screening tool for neonatal jaundice. And so my day in the life was I would arrive at the hospital, meet with the Ghanaian research assistant that I was working with. And we would go onto the maternity wards and the NICU and the other spaces in the hospital where newborn babies were there for checkups or just general care. And we would consent the mothers and test the babies with our low cost screening tool called a BiliRuler for jaundice. And then depending on what that screening tool showed, progressed care in collaboration with the nurses and the physicians at the health center there to move things along so that the child got proper screening as well as proper treatment depending on what they needed. And then just mostly data collection at that point. We're now on the back end of that now that I'm back in the United States doing more of the data analysis and still continuing to meet with these research teams. But while I was there, it was a lot of one-on-one interaction with mothers and their children to do the screening and data collection needed to test this new tool.

Mackenzie Kay:

Wow. And is the research team that you work with, is it a local Ghanaian team that you partnered with University of Michigan researchers? Are they University of Michigan researchers who are established in Ghana? How is that relationship?

Emily Gitlin:

The setup that we have is University of Michigan researchers who have a longstanding partnership with physicians and researchers in Ghana and have co-created this research project based on needs that the Ghanaian physicians have identified and then just allowing for resources and funding and manpower to stream both ways. And so while I was there as a visiting student, we had a whole Ghanaian staff that I was just joining in this endeavor. And I think that was really special to have that exposure to the inside scoop of what a different health system looks like and be able to connect with those people also outside of the clinic and have people to share their life and their culture with me as well.

Mackenzie Kay:

Yeah, that's amazing. And I appreciate the thought that went into before your departure and then the reflections that you've had afterwards as well. Evelina, same question for you. And I know that things are very much in flux based on what types of patients come to the clinic. And as I understand it with the free clinic, there's also certain days, specialist type days at the free clinic. But if you don't mind just sharing for people who might not know how the free clinic runs, what the general activities look like, I think that would be really helpful.

Evelina Hristova:

I can approach it from a couple of different perspectives as either one of the directors, which I'm one of the M4 directors, what we do during a clinic day versus what a clinical student would do versus what a preclinical student would do. And I think probably what you have most experience doing as a preclinical student, you are joined with a team of a clinical student and the two of you go in a room and talk to a patient and get the physical history and then physical exam and come up with your own differential diagnosis, which is thinking about what could be going on with the patient and then really try to get a good idea of what you'd like to do for the next steps. And then you go present to an attending or sometimes we work with nurse practitioners as well and you present the patient, you talk through what you're thinking, what could be going on. And then all three of you go back, see the patient together and then the attending will talk to the patient. But really it's mostly the clinical student and the preclinical student who are leading the conversation.

And I think as a preclinical student, the unique thing is you are actually doing a lot of that work that you wouldn't be doing until your clinical year, which is why I think the first time you do it's pretty intimidating and you're literally just being told like, okay, go ask a patient all these questions that you've been practicing on standardized patients. And you in your head have an idea of what you want to ask and it all makes total sense and there's logic to it, but then you actually go talk to a person and people have different ways of answering your questions and might not understand what you're trying to get at. And some people just want to be heard and so they'll tell you their entire medical history or what's been going on or what's been bothering them. And so throughout this 20 minute appointment, really it ends up being an hour long where you're talking to them and discovering that, yeah, they might be here for hypertension, but really something else is actually going on and they might need further care either at a specialist or through longitudinal care at the clinic.

Mackenzie Kay:

For people who are interested in participating in the orgs, you can look up the activity of the Student-Run Free Clinic and know what kind of care it provides. But I think until you actually do a shift, you don't quite know what it'll be like so it's really helpful to have that perspective. Just to move on to the human side of training and to the human side of these initiatives. One thing that I've been trying to center over and over again on this podcast is really just the human side of medicine. Without sharing any identifying details of patients, I would love to hear how you guys in each of your contexts have built trust with the populations that you serve, especially when you're working with populations that might be marginalized or vulnerable. And yeah, maybe some of the tensions that you might feel in doing so.

Evelina Hristova:

Yeah. I think Amanda really described this really well earlier, but just showing up consistently makes such a big difference when you're working with people. That is I think 90% of the work to getting someone to trust you and to actually want to talk to you is being there consistently and showing that you are someone who is doing the work. You're not just there transiently. And I think the great thing about the clinic is we do have a set space and so people are very familiar with where we are. And now that I've had the privilege of being at clinic for four years, I recognize a lot of our patients and they recognize me even if they don't know exactly what I'm doing. They know the face. And so I'm able to say hi to them or be like, "Oh, I saw you a couple of weeks ago. How have you been?"

And you also on the back end are familiar with the people who may need a little bit of more paying closer attention to their needs. We have patients who need what we call prescription assistance programs being filled out. And so those are specific documentation you provide to various ... What are they called? Drug companies to get medications at a reduced or free cost. And a lot of that is medication that treats diabetes. So insulin is really expensive and a lot of patients wouldn't be able to afford that without that assistance program. However, those need to be renewed at a very specific interval and sometimes patients needs changed based on what their chronic condition is like. And so a lot of that is making sure that you are also taking responsibility for that and knowing which patients really rely on those programs and making sure that when you're looking at their chart, you're really making sure that those things are being done on time and you have to carry that through various team changes and working with different students.

Emily Gitlin:

Yeah. I want to echo what both of you had said about showing up and being present and showing up consistently. I think that also ... And Amanda, you touched on this as well, goes beyond just the medical setting as well. You need to be consistent in how you show up just in community and showing that you are a member of the community, not just a medical student or not just someone who's providing care. Because I think when you become just another member of the community, that power dynamic shifts and becomes more equalized. And for me in Ghana, that was super important. I was living in a neighborhood essentially on the hospital complex and my neighbors were other doctors who were living there. My neighbors were other people just in the community. And we would go out to the soccer field every Saturday and play together, volleyball or we would go out to dinner. And I think those were the moments that were actually possibly even more impactful than the research itself because it gave me greater context for what I was doing and also allowed me to just be their friend and be there for them in other spaces as well. And I think that's what led to the trust.

Amanda Casetti:

I echo both of what you guys both just said. And I think we're having the same conversation over and over just a little in a way that I think highlights how important the consistency is and that consistency is a key pillar to building trust. And then I also want to name something that you named, which is disrupting the power dynamic. And I think that the reason why I keep talking about community and I keep going back to these relationships that feel somehow separate from healthcare and separate from traditional healthcare, to be in relationship in community is to build that trust with a group of people who have been very, very disregarded by our systems at large and then including our healthcare systems. So many people will delay care until the absolute last moment possible and sometimes not even seek care in those moments because of stigma they've experienced in clinics and in the ER. So I think to disrupt those power dynamics through relationships and then also through specific things in how you provide care.

Part of the reason why I love foot care so much is because I'm sitting on the ground taking care of someone's feet, washing their feet, cutting their nails, taking down their calluses and literally sitting below them and having a human to human connection of like, so how are you? What have you been enjoying lately? And having those moments of connection through care. I think that that has been a really beautiful way that I've personally, and I know lots of my colleagues at WSM have built trust in the community.

Evelina Hristova:

What we're alluding to is literally meeting people at where they are. Quite literally in Amanda's case, just going and meeting the person where they are. And I think in clinic we do that a lot too. Our ultimate goal is we're not judgmental. We're just here to provide whatever care you may need. And so there's patients who have a variety of difficult social situations as well as just they might not be able to afford all the things that we would recommend and we can give them certain things like blood pressure cuffs or even like blood glucose monitors, things like that. We're always happy to provide that for them, but it's also understanding that they might not have the knowledge of how to use that correctly or the time to use that in a way that we would recommend. And so a lot of it is also just thinking on your feet about, okay, I know you can do this this way. I know the right way to do it is this way. Where can I meet you to make those things work for you? Which I really enjoy about being in clinic is just quite literally just problem solving on your feet and trying to do it in a way that benefits the patient and maybe it's a little bit harder for you as a medical provider, but that's okay because the patient understands what's happening and it's working for them.

Amanda Casetti:

Yeah. And it's recognizing that health is not always people's number one priority. In our situation, it's like you're houseless and you're living every day to make it to the next day. And your blood pressure is not your number one problem. And in the clinic, you guys are seeing people a variety of situations and people's healthcare might not be their number one priority. And it's like meeting people where they're at in a really honest way that de-centers your agenda and de-centers your identity as a healthcare professional and brings in the human connection and just like what can we do? How can I support you? How can we with these supplies and all this stuff, the blood pressure cuffs you can give out, the blood glucose, what can we provide in a meaningful way that is going to help in some way?

Evelina Hristova:

When you're a clinical student and you're in the hospital, oftentimes there are so many things that you wish you could do for a patient. And there's so much background things that are going on and there's so many systems level issues that prevent you from doing that. Or even if you do it it takes forever to get done. Meanwhile, the patient is trying to get discharged in like three days. But the beauty of being in a clinic or being at a Wolverine Street run is they are so much less of that structural stuff that gets in the way and you really are free to just think on your feet and use all the things available to you right now to make a difference.

Amanda Casetti:

And I think that the experiences through student run-free clinic and WSM make you a better clinical provider because you're used to figuring it out on your feet like that. I remember in my EM shifts, having patients that I know from the street and stuff and I'm just like, "Oh, I'm intimately familiar with the healthcare system in a way that I know where to pull resources from in a way that makes sense in this context so that you can get better care here in the ED." And I really feel like that muscle of figuring it out is strengthened by the type of work that we do.

Evelina Hristova:

Just thinking outside of the box and not being afraid to do that.

Amanda Casetti:

Not being afraid to do that.

Evelina Hristova:

Yeah. Because I think we're taught very specific algorithms, which is great. When you're starting out, you really don't have the background or the knowledge to do that. But the more you flex that muscle, as Amanda said, in different situations, the easier it gets to use all of your knowledge and all the things even before medical school that you might have come in knowing about and to really just think outside of the box to be there in a way to fix a problem that might not be necessarily the way you would've fixed it otherwise.

Emily Gitlin:

Yeah. I think that something that we're all touching on, sometimes I feel like the best ways to disrupt the system level issues that we're constantly running into in healthcare is just being with our patients and also flexing the muscles of all the interdisciplinary stuff that we've interacted with, but mainly just knowing our community and knowing our patients and giving them that extra time and those extra resources to be able to almost circumvent the system issues that we have structurally.

Amanda Casetti:

Yeah. And I think some of what we're talking about, the things that we do give us confidence to be sand in the gears of a broken system. You know what I mean? It's like we're trying. How do you actually change this? And let's try things. Let's try our research projects in Ghana. Let's try our Student-Run Free Clinic. Let's try Wolverine Street Medicine and have these different experiments of let's try something different and see how it goes. And it's like all of this feeds back into each other. The confidence, the experience, the muscles that you're working, that you're comfortable pushing back and trying to do something different.

Evelina Hristova:

Totally. And just being able to ask why are we doing this the way we're doing it?

Amanda Casetti:

Yes.

Evelina Hristova:

So I'm going into general surgery and it's a huge thing having the hierarchy and sort of respecting the hierarchy and all for very good reasons. Patient safety and all of that. But I think it's so interesting when you're thinking about, we've been training at Michigan Medicine for four years and I don't know if I'll stay here. I might be going in a completely different healthcare setting, completely different healthcare system. And they have different ways of doing things that we were taught as dogma. That is what we do. And you go somewhere else and you interview somewhere else and they're like, "Oh, that's so interesting. We don't do that." And you're like, "Whoa." And it just also shows you, you can ask why and people generally will be very happy to tell you their reason. And sometimes they just don't have a reason. And then you get to be like, "Oh, maybe I can do something different today."

Mackenzie Kay:

I'm loving the conversation that is happening here. It was so nice to just sit back and let it fly. I'm going to take a step back and I just want to remember that we're also students while all of this is happening. You guys are doing amazing, big, expansive work, but this is also happening alongside things like exams and rotations and maybe sleep. So I'm wondering across your years that you've been here, how have you realistically balanced the work that you've done alongside med school or how have you carved out time for this work alongside your studies?

Evelina Hristova:

Yeah. I think it ebbs and flows. There are weeks when you're so busy with exams or quizzes or whatever else is going on And you just cannot volunteer for a Saturday at clinic and that's okay. But there are weeks when you have nothing really or maybe you just have your regular schoolwork and you're like, okay, I have seven hours on Saturday or I have five hours where I can do this one thing that I know will bring me joy. And then there are years like clinical year, I think I was able to volunteer maybe once every six weeks, maybe eight weeks even depending on what rotations I was on. And that's okay too. You have a different priority that you're focusing on.

And then once you have free time again during third year or fourth year, you really get to take advantage of that and decide with all of your experiences now, having done an entire year of clerkships and having done all of these other things and maybe you've gotten to experience what Global REACH is about or you've done some WSM runs, you get to be like, okay, with my seven hours this week, this is what I want to do. And one of those hours is going to be grocery shopping and one of them is going to be maybe going on a run and then five hours of that is going to be being in clinic. And then that changes every week and that's okay too.

Emily Gitlin:

As a first year, you have this flexible curriculum, which I think allows you to get introduced to a lot of these things early on. I volunteered at the Student-Run Free Clinic as a first year as well. Loved it, had great experiences. Also got introduced to Global REACH, got introduced to a ton of other activities as well. So I think that flexibility allows you to explore. And then as Evelina was saying, M2 year, it's a little bit more difficult, but it does just come back to priorities and what's feeding your goal in medicine. I think we're all here wanting to be physicians for different reasons. And you have to carve out the time to keep that vision alive because otherwise the school part is going to be a drag and taking the exams is going to be even harder than they already are.

Evelina Hristova:

Perspective is so important because suddenly you're like six months in and you're on a block neurology for me. Shout out to Dr. Gelb. And you are just slugging through and you're seeing all of your friends who are not doing medicine having fun and going on vacations or spending time with their families or all of these other things that we have put on hold or are balancing differently. And you really have to remind yourself why you're putting yourself through all of this extra stuff. And it's never about the money because all of us can make money doing so many other things. And it's almost never about the power because being a medical provider gives you a certain privilege, but it also comes with a lot of responsibility that you should acknowledge all the time. And so you have to really figure out what you're doing in the grand perspective of things. Especially for me when I turned 30, I was like, wow, I am seeing people getting married and having babies and buying houses and having dogs and things and affording vacations. And I'm literally following an attending around from like 5:00 AM until like 7:00 PM. And they get to say they saved a life because they did this transplant and I like how to retractor for part of that I think. And so you really have to put it in perspective, otherwise you're going to go crazy.

Mackenzie Kay:

So one thing that I've personally felt from being involved with free clinic shifts and then also some WSM runs was just that in my first year I felt that it just gave me a little bit of exposure to patient care, which then when I went on to the wards, just felt that much more comfortable transitioning into clinical year. And I'm imagining extrapolating that times a thousand more hours, that times a thousand more involvement and interest and though and everything and work. What skills have you developed as a result of this work?

Evelina Hristova:

Something that I really wanted out of med school was like, yes, I wanted knowledge and all the things and the skills, but I also just want to keep developing as a person. And I think a lot of that comes down to how you seek to do that. And there's different ways we've talked about. And I think being part of clinic was that way for me, just developing my leadership skills now that as a director, communication skills with patients, providers, people that I've never talked to before, but have to convince to come volunteer at clinic, nursing staff, nursing students, pharmacy students, understanding where they're coming from. And then honestly, just how to talk to a patient. We practice that a lot in different ways during med school, but it just will never be real until you are talking to a patient and you're going to make mistakes and they're going to look at you funny and then you're going to feel horrible for a little bit. And then you'll be like, "Eh, that's okay." And move on. And so it really, I think, allowed me to practice all of those things.

Emily Gitlin:

Yeah. I echo all of that. I think I'll also add or just name adaptability and flexibility. You're never going to really know what's going to happen in a day, whether you're at the clinic or on a street run or in a global space. And so just being really open to whatever happens and trusting yourself and trusting your team members that you'll be able to figure it out.

Mackenzie Kay:

And then I also want to know how you guys will carry these experiences beyond our time here at Michigan, because I'm sure given how significant they've been for you, they will. How do you think your involvement in these initiatives have helped inform your choice in specialty?

Evelina Hristova:

That is so funny you asked me that because as a general surgery applicant, sometimes volunteer work is not the priority when residencies are looking at your application. And sometimes they're asking you like, "Oh, you've put so much time doing this, but I don't see a ton of research on your application." And I think it's because there's this misconception that volunteer work or free clinics, all of these things are not related to surgery. And in reality, surgery is healthcare and people end up getting surgeries probably because they're not getting the healthcare they needed in the first place. And also I'm someone who's incredibly interested in transplant surgery and there are so many healthcare outcomes and healthcare equity and ethics issues and all of those things directly relate to free clinics and access to clinics and access to healthcare in general. And so to me, it's so funny that people separate it in their minds because it's so connected in so many ways. So it's funny that you asked me that because I don't think I would've told you starting M1 year I would've been a surgeon. But now that I have decided and I'm applying to surgery, I cannot imagine doing something else with the things that I've done in medical school.

Mackenzie Kay:

I'm so glad that you brought those two things together because I actually was curious about how they related. So thank you for disentangling that.

Evelina Hristova:

Well, you're not the only one. Trust me.

Amanda Casetti:

I'm going to apply into emergency medicine. Emergency medicine is like the safety net of our entire healthcare system. You don't turn people away. You see everyone. But also through that, it's where some of the most deep injustices of our healthcare system are perpetuated and reinforced. And so I think I see the ED as a place to both do the type of clinical care that I want to do. Of course I love that. But I also see it as so intimately interconnected with street medicine and providing care in non-traditional contexts. And I did choose emergency medicine. It was between EM and FM for me. And it's like both of those are intentionally places I can continue this type of work, street medicine.

Emily Gitlin:

Yeah. For me, my research is currently on neonatal jaundice. I'm interested in going into pediatrics. Those were intentional choices in terms of picking a research team and a research project. But I think for me, looking more broadly at what I hope to do with global health work, I want to continue to have impacts on the implementation of tools or systems that allow people to access care more easily in low-middle income countries and other vulnerable settings. And I think for me, pediatrics is often just that. I think there's a lot of social connections that happen in pediatrics that you don't necessarily get with adult medicine. You have not just the family unit, but you have other support systems and nutrition and school and these other things that are intersecting with child health. And so I think doing work to expand access globally really intersects with the other ideas that are going on clinically with children's health.

Mackenzie Kay:

That makes total sense. And sorry, I didn't want to put you on the spot as an M2 because I know that a lot of us are not quite sure yet.

Emily Gitlin:

We'll see what happens. That might all change.

Mackenzie Kay:

But you answered that so beautifully. Yeah. Just as the last question, do you guys have any advice to incoming UMMS students who want to get involved?

Evelina Hristova:

Go with your heart. You're going to get a lot of advice, what will look good on your application and if you're trying to go in a competitive specialty, everyone has opinions about what you should be doing with your time. And yeah, there's some truth to that, but the reality is you should just go with your heart and do the things that you think are interesting to you and that will naturally lead you to where you're going to go anyway.

Emily Gitlin:

I think rely on your mentors or students that have come before you, I think, as well as trusting your own instincts. There are people who have done this before and you're not alone.

Amanda Casetti:

I think in addition to it, you guys have both said, I feel very strongly that we should be getting outside of the medical school and the University of Michigan bubble a lot more. There is infinite ways to get involved in your community.

Mackenzie Kay:

Yeah. I think it's always helpful to meet the communities that we serve where they are for sure. So just to wrap everything up, thank you all for sharing what you do and how it is shaping who you are becoming as physicians. Whether it's in a free clinic exam room or on the street doing outreach or in a research partnership halfway across the world. The common thread is proximity, choosing to be close to the people and communities that we're learning to serve. Your stories highlight that service in medical school isn't just an extracurricular. It's formative. It shapes how you listen, how you advocate and how you understand what health actually means in people's lives. Thank you for all the work that you're doing and for letting us hear about your experiences. And to our listeners, thank you for listening to UMich Med Mosaic and we'll see you next time.

If you love today's conversation, share it with a friend. If you are a Michigan medical student and are interested in being a future guest, check out the class pages on Slack for open calls for episodes. UMich Med Mosaic is produced by Michigan Medicine Department of Communication in partnership with the University of Michigan Medical School. Find us and subscribe wherever you listen to podcasts. Thanks for listening and we hope to see you soon.