Path to Medicine: Navigating the MD-PhD Journey

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In this episode of the UMich Med Mosaic podcast, M3 host Mohika Nagpal leads a discussion with three University of Michigan Medical Scientist Training Program (MSTP) fellows as they share insights on balancing MD training and PhD research. Hannah Carter, Caleb Cheng and Philip Barrison talk about finding mentors, the structure of their weeks, and navigating the transition from classrooms and clinics to labs and research. They also share how they get involved in the MSTP community and other med school creative outlets—like the annual Smoker musical—that keep them grounded. Whether you're considering an MD-PhD or just curious about life as a physician scientist, this conversation offers helpful insights into the MSTP path.

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, a first-year student at the University of Michigan Medical School. 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 one-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.

Hi everyone. Welcome to episode five of UMich Med Mosaic, Choosing the long road. In this episode, we are diving into the unique experiences of students in the Medical Science Training Program, otherwise known as MSTP, an annual cohort of students here at UMMS who are simultaneously pursuing both an MD and a PhD. These are students who are training not only to care for patients, but also to shape the future of medicine through the production of knowledge. It is a pleasure to have Philip Barrison, Hannah Carter and Caleb Chang on the episode today, three MSTP students who are going to share their experiences. So welcome everybody. Why don't we start with introductions? Let's do name, where you're from and what year of the MSTP you are in.

Philip Barrison:

My name's Philip Barrison. I am originally from Tampa, Florida and I am a rising sixth year student in the MSTP program, meaning completed two years of medical school and then I am now just finishing my third year of my PhD, hopefully with just one more year after a PhD but we'll find that.

Hannah Carter:

My name is Hannah Carter. I am a rising seventh year, so technically one year above Phil, but he's got an interesting track, so I am also hoping to finish my PhD during this year and then go back to medical school and I am from Middletown, Maryland.

Caleb Chang:

I'm Caleb Chang. I'm from Ann Arbor, Michigan. I'm in the same cohort as Hannah Carter, which means I'm a rising seventh year almost finishing my PhD as well.

Mackenzie Kay:

Awesome. Thank you all so much for being here. So we're going to just go way back to the beginning when you were all applying to medical school six and seven years ago, what initially drew you to pursue the MD-PhD rather than an MD alone or a PhD alone?

Hannah Carter:

I had research experience in undergrad that I really, really loved. Frankly, I wanted to do research because I thought you kind of needed it for your MD application and I had a high school experience in research that made me not want to do it even. But I had such a good experience with my undergrad research and my mentor was an MD-PhD student who was doing his research that I maybe started lying a little bit saying that I wanted to do an MD-PhD because I really just wanted to do an MD, but then by the time it was done, I was fully sold.

Caleb Chang:

I feel like I had kind of similar experiences. I've always wanted to do medical school, but I also joined research lab because I think you have to, I kind of hated it for three years, but I think near my junior year when I was thinking about applying for medical school, I really felt like I didn't want to stop doing the bench research and I felt like for while you can do research as an MD, you don't really get that time to do that bench research that I got to do in undergrad because I didn't want to stop. I just felt like I wanted to do another four years at least by doing the PhD.

Mackenzie Kay:

Four more years, four more years.

Caleb Chang:

Part emphasis on the at least.

Philip Barrison:

At least. I didn't realize I wanted to do MD-PhD until pretty late in the game. It was probably a few months before applying. I originally, probably a year or two in college was starting to think about going down the route to medical school but didn't have a clear path forward for what I was looking for and I started to get involved in various research groups at my undergraduate institution working on projects in health communications, research, implementation science and public health.

As I got closer to graduation, I worked numerous internships and jobs including a policy fellowship in Washington, DC and then I started working as a study coordinator at Tampa General Hospital after I graduated and around that time I found that I was really being drawn to questions and health services research as a researcher more than as a physician, but I also knew that I wanted to be involved in patient care and my advisor at the time who was a nursing PhD kept trying to convince me out of applying to medical school actually.

She kept saying, "Phil, you're not going to be happy as a physician. You think like a researcher, you should go get a PhD." I didn't agree with her entirely, so I decided why not both and decided to shoot my shot and see what happened when I applied and now I'm here.

Mackenzie Kay:

Amazing. Well, I'm so touched by at least a couple of you have talked about the power of the mentorship and how mentors have been instrumental along the way. Now, could you talk us through the process of actually applying to MSTP programs and what you were looking for in a program and how Michigan really fit into that picture?

Hannah Carter:

Sure. There's an important distinction to make, which is that MSTP stands for the Medical Scientist Training Program, which means that we have an accreditation from the NIH for our MD-PhD program. You can apply to MD-PhD programs that are not MSTP and I, as far as I understand, it's the same process. It's just that there's a list from the NIH that is the specifically MSTP accredited MD-PhD organizations, but this should apply for any MD-PhD. Really, it's going through your AMCAS just the same as the MD application, with the exception that you add a research statement and they want to see more research in your application, so you need to have that as a backbone.

Philip Barrison:

Someone pursuing a PhD in social sciences, MSTP programs are not always clear on what type of PhDs they're going to entertain and others are much more clear. University of Michigan is pretty open to a lot of different PhD routes, whether it's social sciences, humanities or engineering fields.

That application process though turned into both a trying to discover which programs might entertain the research I'm interested in, but then also some programs as well required me to take a GRE and apply separately to PhD programs outside of the traditional MSTP application. There's a lot more navigating less formally written rules.

Caleb Chang:

The only other difference I guess I would highlight is the interview is two days long, I think. Right? So one of the days is purely the research stuff, purely MSTP, and the other one is with the rest of the MD cohort.

Hannah Carter:

And research stuff means interviewing with potential researchers that you might work with, trying to ask them good questions and then trying to suss you out if you're a serious candidate.

Philip Barrison:

And oftentimes the MD-PhD or MSTP program assistant director usually interviews candidates.

Caleb Chang:

We also have a student interviewer I think for everyone as well. There's a student representative on the admissions committee and everyone has a student interviewer.

Mackenzie Kay:

So I think is a nice touch. Yeah. So Caleb, you only applied to one MSTP program, and so why Michigan? Why was this the only one?

Caleb Chang:

I initially applied to all MD programs, including Michigan, but actually late into the game I kind of decided to do MSTP at least for here.

Mackenzie Kay:

And then for the other two of you, what drew you to Michigan specifically?

Hannah Carter:

Michigan was actually a bit of a reach school for me, but it fit within a school that I thought I could potentially get into. I then realized that my then boyfriend, now husband's family is from Michigan, so that was very convenient and the interview weekend when I came here really sold me on coming to Michigan.

Caleb Chang:

Because I was there, right?

Hannah Carter:

You were there for a second look, I remember.

Caleb Chang:

But no, we interviewed together.

Hannah Carter:

I definitely remember second look clearly. Maybe you were still only MD.

Philip Barrison:

Clearly you weren't memorable enough.

Caleb Chang:

I guess I wasn't.

Hannah Carter:

You were only MD for the interview, so I couldn't possibly remember you then, but they do a really good job of selling you on feeling like you're a member of the family when you come in here. And also I got in, which is one of the main criteria for going to any school.

Philip Barrison:

I originally put in about 10 to 13 applications, and then when it came down to picking out a school, deciding on Michigan, my decision was partially driven by my perspective towards faculty mentorship and this feeling that I was going to be able to access the mentorship, I thought I needed to develop as a scientist here. And I think anywhere that I was looking at could have offered that, but it was a matter of feeling that personal fit with faculty I was working with as well as this sense that the program I'd be supported in, it's a long and MSTP programs, it's a long time, it's almost a decade of your time.

You're committing to something and I want to feel that I had security along a training pathway. I was considering some other programs that had similar resources, but some that it felt very much like I would have to be on my own in a lot of regards and I didn't want to be that person. So for me, I got a sense, especially during my interview day here at Michigan, that I would have that type of support here and talking to other students who are further into the program while I was an applicant really helped solidify my decision by the time I was admitted to Michigan that this was the place I was going to go to.

Mackenzie Kay:

Thank you so much for sharing. Now I'm just dying to know about your research projects. Are you guys willing to give the elevator pitch for what you're doing?

Hannah Carter:

Sure. I'm working in Beth Moore's lab. She works in the Immunology and Microbiology department. She does some of the med school classes in immunology, so some of the M1s know her, but she looks at the lungs and lung immunology. Specifically, I'm looking at this particular transcription factor that we think is leading to more fibrosis. Originally we thought that was because immune system cells were leading to more inflammation and being activated, and now we think it's totally different cells, so it's actually not very immunology related, but it has to do with lung fibrosis and what's driving it.

Mackenzie Kay:

Awesome.

Philip Barrison:

Yeah, my work's been studying how various AI tools have been implemented, adopted, and used in primary care practices across the United States. I've been working with my advisor, Dr. Alexandra Vinson, to study one specific application of AI for automating the generation of patient portal responses and trying to study how people from different backgrounds, both inside and outside of technology come together to make meaning around technology and how our different interpretations of technologies often influence institutional and individual logics behind how we come to make meaning of them in practice, what types of labor is valued, what type of labor is devalued in the context of emerging technology in healthcare?

Mackenzie Kay:

Fabulous.

Caleb Chang:

I studied pancreatic cancer in Arul Chinnaiyan and Costas Lyssiotis lab. We found a gene that might be a good target for therapeutics and pancreatic cancer for the metastatic version. Thankfully, it's worked pretty well in our cell line models and mouse models, and so we're now kind of applying for clinical trials here at Michigan.

Hannah Carter:

He has a recent big paper out that has to be mentioned.

Caleb Chang:

I wasn't going to-

Philip Barrison:

Mr. Nature.

Caleb Chang:

Okay. Okay, guys,

Hannah Carter:

You're allowed to say it if I prompt you.

Caleb Chang:

Yes. The paper just came out in Nature a couple months ago, which is really exciting.

Mackenzie Kay:

Congratulations. That's amazing. How was the process of choosing your lab and your mentor?

Hannah Carter:

So the MSTP program here has you do your first rotation right after your first year, and then you do at least one more rotation, maybe more after your second year with the option to do what they call four one-week experiences after your first year. So rather than doing a more substantive rotation, you just spend four weeks in four different labs to just get a feel of the lab and then you can follow up with a longer rotation. So my early experiences were based largely around people who I had either interviewed with and got a good vibe from when I initially interviewed or asking around older MSTP students or some faculty members for people who really had a strong emphasis in mentorship, I was very open in the area that I wanted to study.

Turned out that none of the people I was originally rotating with were able to take me on for a lot of various reasons, so I kind of shuffled around for a little while and then I kept hearing Beth Moore come up as a really solid mentor that was really well-liked that was going to stay at the institution for a long time and had funding, and fortunately when I came to her lab, I loved it, so it all worked out, but it was a bit of a trial finding my way there. I kept finding mentors who then couldn't take me at the last minute and so on and so forth.

Caleb Chang:

For me, I worked with Arul Chinnaiyan in my undergrad, so he's actually the mentor who kind of inspired me to do research, and he's the one who kind of pulled me pretty hard to do an MSTP even though I had applied for med school before, so I knew I wanted to work with him, but actually, I guess one thing I'll highlight about Michigan is that we do our clinical rotations before doing our PhD, and that actually helped me really want to do pancreatic cancer research, which Arul didn't do that much at that time, and so that's why I pulled in Costas who does pancreatic cancer research. He was really cool. I saw him at a talk during my undergrad. He had long hair, had a mustache and was really, really charismatic, and so I wanted to work with him and he happened to do pancreatic cancer. Yes, those are very important characteristics of a PI, but it's been really great to have both of those people on board.

Hannah Carter:

Take notes anyone who's looking to recruit MSTP students, got to grow out the hair, got to do the mustache.

Caleb Chang:

I'm looking at it guys.

Hannah Carter:

It's on the way.

Caleb Chang:

That's right.

Philip Barrison:

Yeah. I started working with Alexandra officially in my second year of my PhD. I originally was working with a different PhD advisor during my first year of my PhD, which I'd got to know them on and off during my first few years in the program and after about a year working with them and trying to figure out what direction I was heading with my research, I came to a conclusion that it just wasn't the best fit for my own interests and where I was trying to develop as a researcher.

So I ended up chatting with my department chair and brainstorming some ideas. I'd previously known Alexandra, my current advisor from, I had interviewed with her back in 2019, and her and I had worked on some side projects together, and so it became kind of a natural fit that I was already used to working with her. I was already very comfortable with her mentorship style and moved from there, and then we've been working together now for about two going on three years.

Mackenzie Kay:

That's awesome. Thank you so much for sharing. I am so curious as to... This might be like a chicken or the egg question. Are you finding that your research interests or did you find that your research interests were motivated by your clinical interests or that your research interests are maybe influencing your future at clinical specialty?

Caleb Chang:

I guess I alluded to this before, but I think the medical side definitely influenced my clinical or my research side, but I think it's definitely both. Even now I'm choosing to do GI because I liked the GI service when I did med school, but I'm also doing pancreatic cancer research and I've really liked the field. I like the aspects of pancreatic cancer that got to research. I've loved the people that got to meet, and so both of them are enforcing the idea that I should probably do GI.

Philip Barrison:

I suppose it is a chicken or the egg because I think things have been self-reinforcing for quite a while. For me, I know before starting here at Michigan, most of my research was generally in the palliative care hospice and then primary care spaces and trying to figure out which actually originated first if there's a clinical interest or a research interest. I can't disentangle at this point that's too far back, but I think my interest particularly around health services and primary care access and resources have continuously reinforced each other. When I went through my clerkships, that reinforced both the clinical interest as well as driving forward to my research questions and as I continue to be in this research space now that continues to reinforce. So I think to me, separating them isn't really something I choose to do, rather I think of them as a complete package rather than one thing in another.

Hannah Carter:

That's interesting. So you had your clinical interests informing your research interests, you're not able to disentangle. Mine is definitely that my research interests are informing my clinical interests. My undergraduate research was in HIV, which kind of introduced me more to the deep depths of immunology, which is what I've been studying and is probably going to inform my future career goals to be able to continue to research immunology.

Mackenzie Kay:

Yeah, thank you all. It's actually so cool to have three different perspectives here.

Hannah Carter:

No right answer.

Mackenzie Kay:

No, no right answer at all. That's awesome. Okay, so do you think you guys could walk me through a typical week in the PhD phase since you guys are... this is where you are right now?

Hannah Carter:

Yeah, I mean every week is different, but I, for example, meet every Monday with my mentor and a senior or a junior faculty member who works in my lab and we have kind of a group meeting every week on Monday, which theoretically means that on Friday I got together a presentation, but usually it means that Monday at 09:00 AM I'm frantically trying to put one together for a 10:00 AM meeting.

But then I spend the week doing experiments and those can look very different for the rest of the week. We've got regular required seminars on Thursday and Friday. Those are on sabbatical now that the summer's here, but usually that's every Thursday and Friday and the rest of the week is pretty flexible. It's kind of different all the time. I guess we have lab meeting Thursday mornings too, but stuff like that.

Caleb Chang:

The Cellular and Molecular Biology program, which is the PhD program I'm in, we have seminars on Mondays, but again, they're off for now for the summer. Other than that, I hardly know what I'm doing in the next 30 minutes, so it's been very chaotic my entire PhD. There's really nothing typical about it.

Philip Barrison:

Yeah, I can resonate. Every week is something different. During the first two years in my program, which isn't healthcare infrastructures and learning systems, we have required coursework for the first two years of that PhD, and so my weeks were generally structured around the coursework, but still doing research in the hours outside of that.

Now that I've been done with that coursework for over a year, my weeks can look anything from, I have a couple of meetings scheduled to, I'm doing field work in another state and I'm collecting ethnographic data, so it's really a week by week. Right now I've been in the process of finishing some interviews for some interview data I've been collecting as well as analyzing some interview data, so I'm in a data analysis and writing mode right now.

Mackenzie Kay:

Very different pace of life than probably your first two years of medical school where year one we're doing classroom time, year two we're doing clerkship time. How was that transition?

Caleb Chang:

For me, it was actually kind of hard at first. I think two years of being told exactly what to do all the time to going into, I think my third year, I don't think anyone knew where I was 24/7 and I didn't know if I was doing the right thing, if I was doing the wrong thing, if I was supposed to be doing something. It was kind of hard actually at first, but I would say yesterday we just got a bunch of emails from the MSTP being like, we have a meeting on August 20th, you got to start doing these clerkship things and all that stuff, and I'm like, "I like this freedom. I don't really want to be forced to go anywhere anymore."

Philip Barrison:

Yeah, I think the transfer from very structured time to unstructured time was an adjustment and I've been happy with how the adjustments gone, but I think med school is very regimented. You very much know it's built into short-term goals. Often of M1 year you have a quiz in two weeks, you have a block exam in six weeks, and so you can chunk your time in spaces like that. Once you get to clerkships, I'm in this clinic for two weeks. I'm on this service for a month, so it's very easy to know this is what is expected of me to some regard and be able to consolidate your energies.

For me when I transitioned to the PhD, I think this transition to both self-accountability of I am responsible for setting my own deadlines and setting my own goals, and oftentimes working on projects that are so ambiguous to know where they actually end, that you're having to nebulously work in this space, that this self-motivation becomes really important because I'm sure you guys can come for this experience when you meet with your advisor on a weekly or every other week or whenever it is and you sit down with them, you sit there awkwardly for a minute in silence and they're like, "So what's going on?"

And you have to go forward with what you want to talk about your own agenda in that conversation and think especially from early on in medical school where there's so much that's focused on being a learner and focused on what skills do you need to develop into a training physician? As a PhD student, there's this push for how do you become an independent investigator? And there's that challenge of there's no written rule book of how to do that.

I mean, just like there isn't a full written rule book for physicians, but it looks very different and I think that transition, the first few months of starting the PhD for me was definitely a struggle of trying to figure out how am I going to schedule my time? How am I going to prioritize what I want to do, let alone how do I ask a good question? That was hard, but I think now that I'm in that place, I agree with Caleb. I much prefer the space than the medical school space at times.

Hannah Carter:

I spent two years in undergrad working way too much in a lab, and then I did a post-bacc for two years. So I feel like I've had four years of nearly full-time lab experience before I started the PhD, so I kind of felt like I was sinking back into a pretty familiar routine. It is super nice to have the flexibility. It can be really tricky when you show up and you're like, "I don't actually know what to do today."

And you either have to come up with something for yourself or talk to someone or realize maybe you can just take the day off and figuring out where the lines are is definitely different in the PhD than in med school. But I also did really miss being able to go into the clinic and talk to patients and have that sort of social interaction too.

So it's definitely different, but both are temporary and like Caleb said, we're going to be going back into the clinic and this is only a really prescribed four years, so I did not find it as hard as I think some people worried the transition is going to be.

Caleb Chang:

I feel like even the difficulty for me was drawing boundaries about how much to work, not even just how much I can work, but how much I should work because I think in PhD you can work as much as you want, you can work 24/7 if you really want to. Whereas for med school, for me, I felt like I just show up and then I leave at whatever time the residents let me leave if I ask nicely and then I go home and maybe study a little bit. But I felt like for a PhD, it's been a lot more vague about should I get this experiment done at midnight today or should I just leave it till tomorrow kind of thing. And that's been another adjustment as well.

Philip Barrison:

I think sometimes this conversation gets brought up of why do an MD-PhD versus just an MD or a PhD? I think for me personally, I feel like the opportunities I've had over the last few years to develop as a researcher specifically in the way I choose to think about the world and merge theory into practice, I don't think personally I would've been able to develop that as early in my career as I have with this dedicated time and space.

Let alone, I think that's not for everyone. There are plenty of people who do develop that through other pathways, but for me, that opportunity and a PhD to really be able to immerse in this work and be able to have the headspace around it has been really important. And I think that's something for anyone who's considering an MD-PhD thing about what is it that you're trying to get out of doing the combined program because there's both the career trajectory, but also what type of training do you want with that?

Because plenty of people do lots of research beforehand or excellent researchers or post-graduate research training as well and can develop the same exact skills. It's just a matter of where you are and what you want to develop.

Mackenzie Kay:

That's such a good point. So we've talked a little bit, at least in terms of putting the clinical space and the research space in opposition, except for you, Philip, you view it as one and the same. How do you envision in your future career combining clinical care and research as a physician scientist?

Caleb Chang:

Well, at least on a day-to-day basis, I think most people have this kind of structured for, or sorry, 80/20 kind of schedule where you do maybe four days of research and then one day or two half days in the clinic or whatever. The person I'm doing the preceptorship with Dr. Eileen Carpenter, she kind of has a setup where two days out of the month she's doing scopes because she's a GI internal medicine doctor, and then two days she's doing a general GI clinic, and then about a half day a month she does pancreatic cancer-specific clinic.

And I think what she is able to do is do endoscopic ultrasounds on patients with pancreatic cancer and then harvest some samples from that biopsy. Obviously doing whatever you need to do with a biopsy first, but then developing organoid systems from them and then that contributing to her research. That seems pretty good. We'll see if that works out, but that's kind of the idea right now.

Mackenzie Kay:

Got it. Yeah.

Hannah Carter:

I am hoping to go on and be a rheumatologist, which will also deal with the immune system, but I think for the most part I'll probably end up studying something that's as many researchers do, it's so specific that it's not like my patients are all going to have this one disease or this one problem. So I hear inspiring stories of how a certain patient inspired researcher to go down this course, and I'm hopeful that that interaction will still happen.

I've also seen a lot of times when someone's researching something and they're presenting it to a group of people that includes some physicians and the physicians say, "Yeah, this is interesting, but actually what we see more in the clinic is this. So if you just take this slightly different spin on it, you're going to find a lot more clinical relevance to it," which I'm hoping to also be able to apply to my own research, but there is a lot of separation.

I think one thing I really want to get out of having both degrees is the flexibility to not get burnt out. As a clinician who sees patients for 50, 60 hours a week versus a researcher who is constantly under pressure for deadlines and doesn't see patients, I really want to be able to incorporate both of those motivations together into one career.

Mackenzie Kay:

Yeah, it's hard to strike that balance.

Hannah Carter:

Yeah, I'm hoping it'll be good for me. Hopefully it's also good for the research and the patients, but it's really a selfish endeavor.

Mackenzie Kay:

No, I think Caleb's explanation of having the research... protected days for your research and then going into the clinic, doing your scopes, getting your samples, and then having them contribute back to the-

Caleb Chang:

So perfect.

Mackenzie Kay:

It's so perfect. Yeah, it's amazing.

Caleb Chang:

I think it seems pretty rare though. A lot of people have said that it doesn't work that well all the time. We'll see. We'll see how it works.

Philip Barrison:

I think it's so hard to be looking at a question that is in our 10 years in the future, and for me, this is something I've consistently struggled with from when I was asking, "Why do I want to do an MD-PhD?" When I was applying to, even throughout my time as a medical student, as a doctoral student, trying to figure out, "Well, what does this path look like?" And I think it's managing expectations of trying to figure out, "Well, what does the actual logistics of getting a job in medicine look like and getting a job in academia or industry look like and how do you balance that?"

And for me, I think a lot of this interest of mine has come back to training as a general internist and particularly because my research is not disease specific. I'm not organ systems specific. I'm interested in larger infrastructures and how health systems go about delivering care and integrating technology. And I think that the thing that I keep coming back to is I'm interested in practice, whether it's outpatient general primary care or general hospitalist work.

And finding a place to merge my experiences as a general internist with my experiences as a researcher in informatics and sociology particularly, I find myself continuing to be motivated. You often have, when you look at health systems, you have clinical informaticians and computer scientists and people who are experts in these technologies who are trying to design technologies that are for clinicians and patients without necessarily understanding the experiences of those clinicians. You also have many clinicians who are in this space who are trying to make decisions about technology but are not experts in that technology.

And driving motivation for me continues to be this idea of being a boundary spanner, being able to be someone within a healthcare organization who is able to speak both languages and be able to both engage with the IT and technical folks while engaging with clinicians and patients, and particularly being able to translate those experiences, whether that's through research or if I end up taking a more operational role in the future.

What that looks like right now is still a black box that I'm slowly trying to open. But I think a thing with MD-PhD training is everyone's forging their own path of what this career looks like. No matter what your training is in research-wise, there's not many people who have done exactly what each of us have done before.

So it's saying what a career path looks like is still kind of this giant... I like these concepts, I like the idea of doing these things, but I probably won't know until I'm in my post-graduate training where the career opportunities lie in front of me or if I'm going to have to build something on my own. So to answer the question of how I see combined to, to be decided is the general response.

Mackenzie Kay:

Got it. Now taking a step back to life outside of research, life outside of school, what kind of support systems or hobbies or activities feed you during this very long road that you've been on?

Hannah Carter:

I've got a bunch. I have a lovely, wonderful husband, Joe who cooks a lot, so that's great. I am very involved in the Smoker, which is a musical that the students write based off of some other existing intellectual property, but it's just an extremely silly, stupid way that med students don't have the time to spend our creative energy, but we do it anyway every February and it's just a great, fun, silly time.

Mackenzie Kay:

And it's a roast of all our faculty.

Hannah Carter:

Yes, excellent point. Yeah, we're making fun of the faculty, which also shows that they've got a pretty good sense of humor about themselves. It's been really great for a program that we're in for so long to be able to continue to be in these communities while we're in research to connect back to the medical school and to just be able to engage with this sort of creative endeavor every year for six, seven, someday eight years of someone in the program who graduated a couple years ago had a long PhD and also a curriculum change, so he ended up being there for 10 years. So in some clubs, the MSTPs are kind of the institutional knowledge and a big part of the community, and so that's been a really lovely thing to get to be a part of.

Mackenzie Kay:

Yeah, and we're so grateful for you.

Hannah Carter:

Thank you for saying that.

Mackenzie Kay:

Yeah, we are.

Caleb Chang:

Well, I love my cohort.

Hannah Carter:

Yeah, we're good too.

Caleb Chang:

No, our cohort's been really nice. We're kind of locked into being friends for eight years. Well, I guess-

Mackenzie Kay:

You have to get along.

Caleb Chang:

We have to get along. It's been really nice to have them, a smaller group to kind go through life with and all these experiences. I have my church group, which has been really good for me. I'm also really lucky from here, so my parents are still here. My brother's here, my sister just left, but she was here for most of my training time as well. And then I spend a lot of time with my lab people because we kind of lock in and work a lot every day, but it's been really nice to have them do that with me too.

Philip Barrison:

For me, my PhD cohort has been where a lot of my supports come from, especially in the past few years. I think just building a group of people local who can understand the experiences you're going through and you can share discussions with as well. My involvement in the music and art scene in the area, both through things like the Smoker as well as outside groups in the Southeast Michigan area has provided an outlet for myself creatively as well as an opportunity to build community with other people throughout Southeast Michigan.

I think finding ways to engage my other passions and interests outside of medicine and research has been how I've been able to really develop support and community. And even with my PhD cohort, we all do such different work that we often aren't actually even talking about work. We're often drinking in Detroit or I'm dragging one of them out in the woods somewhere, something of that nature.

Mackenzie Kay:

What kind of creative endeavors do you get up to?

Philip Barrison:

So my bachelor's degree is in music and I play bassoon in various groups.

Hannah Carter:

Every instrument, Phil plays every instrument.

Mackenzie Kay:

Wow.

Philip Barrison:

Yeah, so I play with... In the Smoker and I play in Michigan Medicine's Life Sciences Orchestra, and then I freelance with couple local symphonies and chamber groups as well.

Mackenzie Kay:

Oh, fabulous.

Philip Barrison:

Yeah.

Mackenzie Kay:

So I just want to ask, what has been the most unexpectedly joyful or challenging part of your journey so far?

Hannah Carter:

I kind of already answered myself. I think that the community, when you show up, you hope you get along for eight years, obviously. But I don't know that I appreciated how much fun it was going to be to get to be in the sort of collegiate community where you have extracurriculars and you're able to participate in your creative pursuits in a way that I think if we had not been in sort of this college training setting for so long that we'd be able to do and make the friends and build the long-term relationships that we've been able to do from being here for so long.

Philip Barrison:

Yeah, Smoker band... For me, it's been Smoker band. I think every year, no matter what happens, it's the one thing I have every year where I know there's a group of people who I can really just enjoy myself around the Smoker band... the pit orchestra for the Smoker. We've historically been rather usually about 10 to 15 people and tends to be pretty close-knit and its own separate cult within the Smoker doing our own thing. And it builds a nice sense of community across people through various years in the program. And it's something I look forward to every year.

Caleb Chang:

Man, I got to join the Smoker, I guess. I would say for me, it's also people, but I think the people I got to mentor in my lab, I've mentored quite a number of students who've been super helpful for my project, but also just been really fun to get to know people who've been born 2004, 2003, some babies. But it's just so cool to see them grow over the last couple years and being trained in science and being able to think critically about things now.

And obviously I think I've gotten pretty lucky and been really fortunate with my project working out pretty well, and then seeing the reception from the community as well as how far it's progressed in terms of clinical trials and stuff like that. And I guess the other thing that's been really cool is just even the statistics of pancreatic cancer has been changing pretty fast in the last few years.

We've had drugs that come out that we've wanted for 40 years that has just come out in the last couple, and it's just really cool to see kind of behind the scenes of what's coming up in the next hopefully 10 years for pancreatic cancer treatment. And that's been really exciting for me.

Mackenzie Kay:

That's so exciting. And just to wrap it up, if you could go back and give your pre-med self a piece of advice, what would it be?

Hannah Carter:

Stop skipping meals. To work... No, I mean, because I was working in labs so much, I kept just being like, "Oh, it's four o'clock," and I realized I'd never eaten. I'd be like, "Man, I would've had so much more energy if I had just eaten during normal times." But that's just a little bit of chaos, gremlin energy that probably carries through today, which is a weird thing to think about research. I think a lot of people think that it's very boring, but when you're in it's very exciting to get it all done.

Caleb Chang:

I think same, just go have more fun in college. I think I was also pretty much in the lab 24/7 when I was in... back then, and it was super fun to do research, but I think I was just indexing so hard into that that I didn't do that much outside of it. And I really wish-

Hannah Carter:

This might not be relatable for a wide audience.

Caleb Chang:

Really?

Hannah Carter:

Two people who were so into their research that they just weren't having fun.

Caleb Chang:

It's so much fun.

Hannah Carter:

No, nobody's ever been like that, ever.

Philip Barrison:

I think it's so easy along every part of this pathway to compare yourself to people. And I think the longer I've been following this pathway, the more and more I realize how different everyone's journeys and experiences are and how little value that comparison often yields. I think if I could go back and tell myself, I think just continue committing to the things that you're passionate about and interested in, and it's not worth the headspace to constantly be in a comparative mindset because imposter syndrome is real and it's very easy to develop these mindsets and doing something for so long, you just need to find a way to bench that. And I know I still struggle with this. It's not me saying, "I don't do this anymore," but it's something I wish someone would've sat down with me earlier and helped me be cognizant of that and be reflective towards that.

Mackenzie Kay:

Yeah, that's great advice for everybody, I think irrespective of if you're on the MSTP journey or not. And with that, I want to sincerely thank all three of our guests for taking the time out of their busy lives, balancing research studies, life, and everything in between to be here today. Caleb, Hannah, and Philip, it was truly a pleasure having you join me for this conversation on Transitions in Medicine. And to our listeners, thank you for tuning in and we'll see you next time.

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