Cheryl Martin (Host): Want to know what it's really like to be an internal medicine resident here at Community Memorial Health Care? Well, we get the inside scoop with Dr. Hannah Robinson, Program Director of the Internal Medicine Residency Program, and Dr. Rahul Jalota, a third year Internal Medicine Resident and future Chief Resident. This is Wise and Well, presented by Community Memorial Health Care. I'm Cheryl Martin. So glad to have both of you on. Please introduce yourselves and tell us where you went to medical school. Dr. Robinson, let's begin with you.

Hannah Robinson, DO (Guest): Hi, thanks for having us. So, I'm Dr. Robinson I am the Program Director, and I went to medical school at Touro University California, in the Bay Area, and then I actually did my internal medicine residency here at Community Memorial Healthcare. I was part of the second inaugural class, so I've been in every position in the residency program from intern to Program Director.

Host: Great. Dr. Jalota.

Rahul Jalota, MD (Guest): Hi there. My name is Rahul Jalota, I'm one of the PGY3 internal medicine residents and next year's future chief. I went to medical school in Kansas City University in Kansas City, Missouri. Thank you for having us.

Host: Great. So, what is the process of choosing a residency program like for a medical student?

Rahul Jalota, MD (Guest): So, as a medical student, your third and fourth years are traditionally where you get to explore your interests, find your potential career. Students will traditionally rotate through a couple of different rotations, including internal medicine, surgery, family medicine. And in their fourth year, these students get to do audition rotations at different programs, where they spend two to four weeks working as if they are the resident of that program.

Those two to four weeks are similar to a prolonged interview, and it shows the students whether the program is a good match for them, and for the program, whether the student is a good match for that program. In late September, the applications are submitted and the interview season will typically last between October through January.

At the end of it, both of the, both the program and the students will rank one another and submit rankings based on personal preferences, personal goals, and by March, each program and each individual student will find out which individuals they've matched.

Host: So, what are the most important factors to consider when evaluating programs?

Rahul Jalota, MD (Guest): So, when evaluating programs things like location, board score passage rates, fellowships after residencies, those are all important; meaning like the quality of the education that you'll receive, but even the smaller nuances such as the call schedules, the parking situation, the 24 hour shifts if they're applicable; those are some of the smaller things that should be taken into consideration as well.

Host: So, what ultimately led you to choose Community Memorial Health Care's Graduate Medical Education Program?

Rahul Jalota, MD (Guest): So, personally for me, I went to school in Kansas City, Missouri this was during the pandemic, and I knew that when the pandemic hit, that I definitely wanted to come back to California, be with my family, and my wife's family, because we're all from this area. In terms of CMH in particular, a lot of times I joke and say that the reason I chose CMH is because the location next to the beach and the food.

Um, and by them feeding us, it shows that the hospital and GME, they care for us. Because throughout my medical school, most of the time I was forced to fend for myself, bring my own food. And in reality though, now that I've been here for about a little bit over two years now. That's absolutely what I found to be true. Our program, they support us and they do everything that they can to help us succeed. And I have absolutely zero regrets about choosing a program as supportive as this.

Host: That's great. Now, Dr. Robinson, share your story.

Hannah Robinson, DO (Guest): Yeah, just to add to that, I think, you know, the most important non negotiable factor when any student is choosing a residency program is, that program going to teach them to be a confident, compassionate well trained physician who's going to take good care of their patients. So when I visited CMH, interviewed here, it was apparent that I would receive an excellent education here.

And, there are a lot of programs around the country where you can receive great training including ours. So it often does, come down to other factors. For me, when I visited this program, I truly felt like the people that I met would care about me, they would be invested in my education, and they would do everything that they could to help me become an excellent physician and reach my career goals. So I think that extra like human element factor was really important for me when I came here, the people that I met here were people that I thought I could spend three years with and be happy. And that's what it ended up being.

So I'm, very happy here as well.

Host: And now you're the Program Director of the residency program. Dr. Robinson, describe for us the philosophy of the residential program.

Hannah Robinson, DO (Guest): So, for us, we want to train really competent and well rounded, kind physicians. We do follow the apprenticeship model in medicine. So our residents work very closely and alongside, attendings and subspecialists. The best way to learn medicine is actually to practice medicine in a safe environment where you have people to back you up, teach you, warn you of the pitfalls, and, you know, let you make some safe mistakes on your own.

So we do follow that apprenticeship model, and we also focus on very strong didactic training. So we have protected didactic time with lectures from some really great teachers in our community. So between the two of those, our residents get a lot of didactic training and also practical on the job training so that when they graduate, they'll be confident that they can practice independently and effectively.

Host: In your opinion, what sets your program apart from others across the country?

Hannah Robinson, DO (Guest): So I think in this community hospital, we're really well situated to provide exceptional training. One of the things that I think is important about a community program is that all of the attendings who teach, do so, because they are passionate about it and they want to teach. One of the downsides to a big tertiary academic program is that, you know, sometimes professors have jobs that require them to do certain things they might not necessarily be passionate about.

Here, all of the attendings teach because they want to. It's not because they're required to. I also think that the size of our program really helps us provide the best medical education possible. You know, we have a medium sized program. It's a pretty good sized program, so it's not a small program necessarily, but it's also not so big that you're gonna get lost in the mix.

We know all of the residents personally, individually. We can tailor their education to exactly what it is that they need. So no one here is going to fall through the cracks. Our program is at a size that it has enough flexibility that we can really tailor each resident's education to exactly what it is they need.

We know the residents well enough to know that everyone learns differently and we can accommodate that for each resident. And just practically, you know, we can adjust people's schedules to accomodate what they looking for in their future career. And I think that really allows a lot of flexibility, a lot of individualized training that really benefits our residents when they graduate. And helps them be successful in the future. And then I also think that our focus on well being as well as our support for research is really exceptional, particularly for a community program. We do have a dedicated member of our faculty that helps the residents with their research.

And we have a lot of support as far as statisticians, people who understand how to write papers that will get published in medical articles, that sort of thing. I think that's really unique for a community program. So we're really proud of that.

Host: Now, talk about primary care pathway for internal medicine residents and its structure.

Hannah Robinson, DO (Guest): Sure. So, you know, as much as many of us internists love hospital medicine, we do recognize that primary care is very important. Preventative medicine is essential for the population health. So we have a primary care pathway that the residents can take if they like. We ask that the residents kind of decide early on in their education that this is probably what they would like to do.

So, when a resident elects to take the primary care pathway, we really just try to focus on getting them more experience in multiple outpatient settings. And multiple primary care settings, so the residents can use their elective rotations And also, substitute an outpatient rotation or a primary care rotation for one of their inpatient medicine rotations later on in their training.

During those rotations, we really are very flexible in exactly what the experience will be like. So the resident kind of tells us, this is why I want to do primary care pathway. These are what my career goals are, and these are the experiences I think would really help, would help me achieve that, and then we create that schedule and rotation for them.

So, you know, we've had residents who are more interested in sports medicine, for example. Those residents would spend time with our sports medicine physician, they spend time in the orthopedic surgery clinic, learning how to do injections, take care of musculoskeletal problems, other things.

Other residents have focused more on doing extra urgent care shifts, spending time with subspecialists, such as our cardiologists, GI doctors, nephrologists, endocrinologists even our, like, urologists and urogynecologists and then we also have our residents, if it fits for them, spend time with, uh, general surgeon who teaches them how to do a lot of outpatient procedures and clinic procedures that they would want to include in their practice in the future.

So it is flexible and tailored to what the specific resident needs. And then, of course, there are a lot of practical issues. You know, we want to focus on chronic disease management, making sure they understand how to do the billing and coding. And to support this, we have you know, like macros, like outlines in their outpatient EMR that tells them exactly what each diagnosis may need.

So, for example, a patient with diabetes, they need to be on certain medications, they need certain screening to make sure they don't have sequela of their diabetes, on a regular basis, those sorts of things. So, it's just a way of organizing the rotation and being flexible so that the resident can be set up for success in their future career.

Host: So, this is quite different than from the traditional internal medicine residency track? It looks a lot different?

Hannah Robinson, DO (Guest): I mean, I'd say there are definitely a lot of overlaps and similarities. Our goal in this program ultimately is to graduate people who are capable of being internists in any setting. So these residents most likely want to be in the outpatient setting. They most likely want to focus on primary care.

But you know, for example, right now we have someone in the primary care pathway who is applying to a sports medicine fellowship. So, even if you take the primary care pathway at CMH, you will graduate being able to be a hospitalist, being able to work in a skilled nursing facility, being able to cover urgent cares, but they do spend more time focusing on primary care and preventative medicine.

Host: Overall, how does your program then prepare residents for the complexities of primary care and hospital medicine?

Hannah Robinson, DO (Guest): Yeah, so I think, you know, at CMH, we are lucky to have very complex interesting patients in both the inpatient and outpatient settings. This is a very diverse community. We have a lot of different types of patients that come through our hospital. We have everyone from migrant workers to Hollywood types that come through our hospital.

So, you really get to see a very broad range of pathologies and I think one of the important things about our hospital is that, even though we're a community hospital, we're a fairly large size community hospital, and we offer a lot of services that most community hospitals don't. So for example we have a very robust interventional radiology program.

We have a very robust structural heart program where we do TAVRs and MitraClips and other procedures. We also have some inpatient capabilities such as continuous EEG, continuous renal replacement therapy, ECMO capabilities, just a lot of services that we can offer to our patients that keeps them in our community that other community hospitals might not necessarily have.

In a lot of community hospitals, those more complex patients get transferred to a tertiary center. But there are actually very few diagnoses and issues for which we would ever transfer a patient to a tertiary center. We find that most patients want to stay in our community and we do have a high enough level of services here that we're able to keep those really ill, complex patients in our hospital. You know, it makes for a really, really great education.

Host: That's great. That's great to hear. So, Dr. Jalota, what advice would you give to medical students interested in applying to your program?

Rahul Jalota, MD (Guest): I think one of the biggest advices I would give is when applying to our program, think about what would make them feel well supported, what would make them feel happy, and whether these qualities are things that they could see aligning with our program. Most programs will give a phenomenal education, and it's these smaller nuances that help make one program stand out from another.

And I think our program excels in doing the aforementioned. For example, in our program, we don't have to do any 24-hour calls, we don't have to have a jeopardy system where one resident, if they call out, no other resident necessarily needs to take their spot. It's very easy to reach out to attendings, you can text them, you can call them even in the middle of the night, and for the most part, they're all very receptive and welcoming to these questions that we may have.

So I think these are some of the traits that need to be evaluated when applying to our program.

Hannah Robinson, DO (Guest): The other thing that I would add as far as a piece of advice to the medical students is be honest with yourself and be honest in your interviews. You know, it's very tempting to give the answer that you think the person asking the question wants to hear to, you know, increase your chances of matching to that program.

But I think honesty is important so that you don't match into a program where you're not going to fit in. Three years, up to 80 hours a week is a lot of time spent in an environment and you really want to make sure that you pick an environment that you will be able to thrive in, that matches your personality and you know, a place that really is going to provide the type of training that you need. Everybody needs something different. So be honest with yourself and be honest with the people interviewing you, and you will probably match at a program that is appropriately suited for you.

Host: That's some great advice. Now, I'm certain that for some of the medical students, one question may be, how does this program support work life balance for residents? What do you say to that?

Hannah Robinson, DO (Guest): So here at CMH, we take that very seriously. We do a lot of things to support wellness and to make sure that our residents are happy in life and have a good work life balance. I can uh, name a few of them. So have quarterly wellness half days. That's where if a resident needs a half day off, they can request it, no questions asked. Maybe they need a doctor's appointment, go to the dentist, get their car fixed, or maybe they just need a day off to rest up and catch up on other things. So they can take that half day off. It does not count as part of their paid time off. They just get that day if they need it.

We also have uh, once a quarter kind of like bonding, fun, wellness events in place of our protected didactic time. So, in the past, residents have done a lot of different things. They've gone to escape rooms, hikes, beach picnics all sorts of things. We also have a resident retreat day each year so the residents have gone up to Ojai and gone to the spa. They have taken a charter out to the Channel Islands and kayaked and hung out at the beach for a day, just so they have some time to hang out and bond and get to know each other and have some fun. We also have a dedicated licensed marriage and family therapist who is the Director of Resident Wellbeing. She is available to the residents if they ever need her, and she also meets with the residents I think twice a year just to check in, see how they're doing and just make sure everyone's okay.

We also have a lot of lectures on wellness regarding, you know, like sleep hygiene, fatigue mitigation strategies, that sort of thing. And I think most importantly, we just truly care about the well being of the residents. We tend to match very kind residents who look out for each other.

If someone's fellow resident is struggling, I know that they would let us know and that we would check on that resident and make sure they're doing okay. And finally, wellness is considered at all levels of decision making. So the therapist, the Director of Wellbeing, she's present at GME committee meetings so, we're considering the residents wellbeing at all levels, including their schedule making, their access to food on night shifts, all that sort of thing. So, that's another good thing about the size of our program. We're able to keep an eye on people and make sure everyone's doing okay.

Rahul Jalota, MD (Guest): I think the one thing that I would just like to add to this is that every month we also have a meeting with our Program Director, Dr. Robinson, and with our Chief Resident where the residents come as a group. And are able to voice their concerns about certain things, whether it's related to academic learning, quality of life, and try to implement changes, and these changes have been instrumental to our wellbeing as well.

Host: Well, you have covered a lot of ground in this discussion, very comprehensive, in depth. So Dr. Hannah Robinson and Dr. Rahul Jalota, thanks for coming on and talking about the Internal Medicine Residency Program here at Community Memorial Health Care. Thanks so much.

Hannah Robinson, DO (Guest): Thanks for having us, Cheryl.

Rahul Jalota, MD (Guest): Thank you.

Host: To learn more, visit mycmh.org/internal-medicine.

And if you found this information helpful, please share it with others, especially on your social media. This is Wise and Well presented by Community Memorial Health Care. Thanks for listening.