Kathrine

Thank you for joining me today. To start, would you mind introducing yourself and what you do?

Dr. Zhang

Absolutely, so my name is Kevin Zhang. I am an ophthalmology resident, finishing up my very first year of residency over at the University of Pennsylvania.

Kathrine

So how would you explain your current role as a resident to a high school student?

Dr. Zhang

Sure, so residency is basically, you know, you kind of finish medical school and you can't quite practice on your own yet, you know, as a doctor seeing patients independently. So residency is kind of this period where you're still learning. You are a doctor, but you're still learning under the supervision of other more experienced physicians.

So you kind of have, you know, you manage patient care, but you're always doing everything with supervision. So in my role, you know, ophthalmology residency is basically a doctor that takes care of patients with eye problems. So if you have trouble seeing, if you need cataract surgery, if you even need, you know, you have problems with the back of your eyes, the retinas, you know, ophthalmologists kind of take care of all of that.

It's a total of a four-year residency. The very first year, which I'm finishing up right now, is actually an internal medicine residency where I see patients in the hospital with all sorts of problems. So generally not eye problems, but things like problems with their lungs, their intestines, you know, their legs, whatever.

Kathrine

So thinking back, was there a specific class, teacher, project camp or other experience that first sparked your interest in STEM?

Dr. Zhang

I think I've been interested in science for a very long time. I think even growing up, you know, I can remember in second grade, I had a science teacher who had us plant seeds, like bean seeds. You know, you probably may have also done that same experiment.

You plant the seed and you see the beans sprout. And so I thought it was so cool. So ever since then, I've really been hooked on science.

Throughout middle school, throughout high school, you know, I took all the science classes. I really enjoyed almost like pretty much all of them. There was an anatomy class that I also took in high school that was really interesting.

It got me thinking a little bit more about medicine, but I really liked chemistry, really liked biology, liked physics. I mean, all the sciences.

Kathrine

I can definitely relate to the plant, the plant experiment that you mentioned. And the difference between you and me is that when I tried that experiment, my plants all died.

Dr. Zhang

It happens. Very common.

Kathrine

I overwatered them. So overcare.

Dr. Zhang

So very common. Mm hmm.

Kathrine

So can you walk me through how your interests developed from high school and college to eventually pursuing medicine?

Dr. Zhang

Sure. So in high school, you know, I had a just very general interest in science. And so, you know, I took all the science classes and I wanted to actually be involved beyond what I was just learning in class.

So I started being involved in research in 10th grade, like the summer after 10th grade. I did a little bit of research over at a local hospital. Basically, it was actually just, you know, learning techniques in a lab, not so much helping, you know, the actual scientists with their projects, but really they were helping me learn techniques in molecular biology, things like PCR, gel electrophoresis, western blotting, kind of basic things like that.

In 11th grade, I applied to a couple of science summer camps, really, really nerdy, but actually it was a ton of fun. So I joined a program called the Simons Program. It's at Stony Brook University on Long Island.

And I did a summer of research there where really, I actually got to manage my own project. I was working with a graduate student. I was looking at carbon nanoparticles and how toxic they were to cells, kind of with the idea that maybe we could actually use these carbon nanoparticles to target cancer.

So it was the very first time that I actually got to work, you know, on a project all by myself, kind of discover new things. And I thought that was, you know, immediately just like so, so interesting. And it was something that I wanted to do for the rest of my life.

So after, you know, that 11th grade summer, I went back to the same lab in 12th grade, summer for 12th grade. And then in college, I continued working in a lab throughout all four years of college. And I continued to like it.

That experience told me that, you know, I not only wanted to do medicine, but also wanted to get a PhD. So then I came to the University of Pennsylvania. I did a dual degree, an MD and a PhD.

And then, you know, even after that, I still wanted to do research. And so I actually moved on to a research track ophthalmology residency, where I spent all of last year, essentially, in what is called a postdoc or postdoctoral position doing more research. And even primarily, you know, I would say 95 to 99% of my time these days is actually, you know, seeing patients and doing medical care.

You know, I still spend a significant amount of time actually doing research thinking of a project supervising students that I have.

Kathrine

So definitely, like the whole being a doctor and being a researcher, like, that's not a common like combination, is it?

Dr. Zhang

It's not super common. But I will say a lot of doctors do actually do research. So particularly, if you look at doctors that work within large universities, academia, a lot of them will still have a hand in research, whether that is, you know, doing clinical trials, that's really common, they enroll patients, and these clinical trials, they test new drugs that are in development.

But also, you know, you have a good number of what we call physician scientists, who are doctors who often see patients, but also will have their own labs, and they're working on basic science projects as well. So even though it's not the majority, I would, you know, it's not the majority of doctors out there, there's a sizable fraction of us, you know, who do both see patients and do research.

Kathrine

Um, so could you describe the most memorable project you worked on or are working on?

Dr. Zhang

Yeah, um, so that really goes kind of two ways. I think the research project that I actually had at the Simons program was really, really influential. Because like I said, you know, it was the first project where I actually got to do research myself.

You know, I was in the lab, I was pipetting, I was growing cells, I was getting the data. And then as the data came back in, I was thinking about how do I modify my experiments, you know, and I was getting really, really excited to actually see the results of my experiments. That project actually ended up in a success as well.

So that data eventually did get published, which was really exciting to see my work, you know, out there for other people to read. So that was really exciting. So of course, you know, that was a really influential project for me.

My PhD thesis was also, you know, of course, you know, I spent four years, you know, of my life on that project. And it was also a really interesting project that, you know, I'm continuing to kind of work on offshoots of that project today, even. I was basically, you know, in medical school, and in my MD PhD, I pivoted to looking at ophthalmology, looking at the biology of various cells in the retina.

And so I ended up studying an interesting metabolic pathway in the retina, where iron, you know, just the iron that you can eat, you know, iron can actually lead to the formation of free radicals that then cause a lot of damage in the cells. And we believe that all this damage that iron causes can actually lead to diseases in the retina, such as age related macular degeneration, which is one of the most common diseases and, you know, the most common cause of blindness actually in the elderly. And so, you know, that project, I did a lot of cell culture, growing cells, you know, and then also did a lot of mouse work as well.

So I actually got to, you know, work with mice for, you know, first time kind of really, in a large way, you know, I was doing a lot of different techniques, I was collaborating with people in my university and other universities learning techniques like mass spectrometry, electron microscopy, it was really cool. And then I got to also publish my work in a couple of different papers. So that was exciting as well.

So I really say, you know, two projects, the first one that actually began in high school, because that was my first taste of research. And it was, you know, a really exciting part. And then of course, you know, my PhD work that I continue to work on today.

Kathrine

So, um, during these projects, was there anything major that went wrong or didn't go as expected?

Dr. Zhang

There is all I think science, part of the frustration, but also the really interesting thing about science is nothing tends to go right. So I would say, you know, you do like 10 experiments, and probably nine of them will fail. But the one experiment that you do, you know, is ends up sending your project, you know, in a totally new way, or just open some exciting areas of discovery.

So, you know, I think it's really like, for example, in my PhD project, I was trying to figure out what these organelles were in a cell. So basically, like, you know, what is the structure inside of a cell, which sounded, you know, like on paper, like a pretty straightforward project. And I was using different techniques, like Western blotting immunofluorescence, which is a way that you can actually tag proteins in a cell with fluorescent markers.

And you can see, you know, where exactly you various proteins are. And so I was using these techniques to try to figure out, you know, what whether these little things in the cells were like endoplasmic reticulum, or were they things like lysosomes, or another organelle called peroxisomes. But you know, when you actually get when I got to the nitty gritty of it, you know, I realized that a lot, there's a lot of variation in experiments.

So you know, you use the wrong antibody, the antibody doesn't work, for instance, or you know, you incubated the slides with the antibody for too short amount of time. Or maybe you know, the reagent that you're dissolving the antibody in and cleaning the slides with is not the appropriate one. And so you know, it sounds ridiculous, but it actually took me three years to figure out that the reagent that I was using was the incorrect reagent.

And so you know, of course, there were other things going on. But kind of the major project was the major question was really to figure out what they were. And it really took me three years to figure that out.

So I think in science, it's so easy to get frustrated. But in reality, you know, this is the case across the board, really, I mean, I talked to all my classmates, and they're all like, yeah, you know, nothing ever works for the first three years. But then somehow, you know, whether it's just, you know, that stroke of like luck or genius or whatever you want to call it, or it's just, you know, you simply you tried everything.

And this is the last thing that's left, you know, eventually, it usually ends up working. But you know, that's the fun, I think, is just discovering, you know, what doesn't work, what doesn't work. And then finally, when it actually does work, it's just so exciting.

Kathrine

That first three year curse that you mentioned is definitely like a universal experience for PhD students, because so many people that I've heard from have like mentioned not being able to figure out anything out.

Dr. Zhang

And yeah, it is super, super, super common. I think it's just everyone, everyone goes through it, you know, we all kind of do the PhD, and we all talk about how, you know, we're gonna have to spend so many years trying to figure out the same problem. You know, a lot of us, you know, end up trying different projects.

But you know, it's all the fun, you know, and we're all as PhD students, at least, you know, we're all there to learn the technique. And at the end of the day, you know, there's a project can go in an infinite number of ways.

Kathrine

Yeah. So instead of describing medicine, generally, could you walk me through a real day in your life as a resident?

Dr. Zhang

Sure. So like I said, you know, I'm in my very first year, it's also called an intern year. And for ophthalmology, it's just a general internal medicine year, which I've actually really, really enjoyed.

So if you've done any shadowing in the hospital, internal medicine, I'm on kind of the inpatient side. So the patients who come into the hospital with pneumonia, or they have a bowel obstruction, or you know, they have cellulitis, an infection of their skin, those are the pages that I would be seeing. So normally, you know, I could get go to the hospital at 7am.

I get what we call a sign out, which basically I hear from the overnight team, was there anything that happened uniquely to my patients overnight that I should be aware of? So then, you know, at the first couple of minutes, I actually look through their chart, I look through the lab results that have come back, you know, are their blood counts okay? Are their electrolytes okay?

Then I usually go see the patients, I talk to them, you know, how was their night? Are they eating okay? Do they have any concerns, any pain, any trouble breathing, things like that.

Then, you know, kind of if patients need consultants, so for example, you know, if someone needs a procedure done to put, you know, like a feeding tube in, maybe I have to talk to interventional radiology, or maybe someone's heart had an abnormal rhythm, I need to talk to cardiology. Usually, I will reach out to those specialists to make sure that they know what's going on and so that they can also see the patient. Usually around 830, or nine o'clock, kind of depends on the service.

That's when the attending physician, so the you know, the big boss basically comes in, we do what's called rounding. And so in my hospital, at least rounding is when we all talk about the patients, we sit around in a table, we discuss all the data that we have, all the imaging, all the labs, and then we talk about the plan for the day, whether that be, you know, should we escalate, like increase the dose of antibiotics? Should we change their pain regimen?

Should we get, you know, other specialists involved? Whatever it is, we talk about all that. And then, you know, we write a lot of notes documenting what we talked about.

Usually at around 1030, that's when we talk to social work. So patients, this is actually a lot of what happens in the hospital, is, you know, patients, we think we treat them, right? Now they're treated, how do they go home?

Well, you know, they've been in the hospital for a month or two months, they've laid in the bed for, you know, so long, right? You know, they've deconditioned, which basically means, you know, they might have been able to walk into the hospital, but after lying in a bed for two months, they can't walk out of it. So now we have to figure out, do we need to send them to a nursing home?

We deal with a lot of the social factors, you know, things like insurance, etc. Usually all that wraps up around 11 o'clock. And then after that, we just do tasks.

So whether it is following up with patients, checking up on imaging results, ordering new things, all that happens usually around noon. There's a conference that we go to for an hour. And then in the evening, you know, it's a lot of documentation, a lot of following up with things.

If patients, you know, want you to talk to their family, that's when that happens and all that stuff. By, we usually finish all our tasks by 5 30. And that's when we sign up to the night team.

So the night team comes in, we tell the night team things that happened to our patients, we let them know, you know, hey, check up on this lab result that's coming in at 10pm. Or, you know, follow up on this result and make sure that you do the recommendations the specialist tells you, and all that stuff. And then we kind of repeat.

Kathrine

So, um, which part of your day is the most meaningful? And which part is the exhausting or repetitive?

Dr. Zhang

That's a really good question. Um, I think the most meaningful, I mean, it has to be really just talking to the patients. Sometimes that can be very frustrating.

But a lot of times, you know, you end up taking care of the problem for the patient, they're so grateful, or even just getting to know them, and know, you know, who the patient is, besides just their medical conditions. I think that is tremendously rewarding. And, you know, it sounds trite.

But, unfortunately, I've had patients in the hospital with me sometimes for, you know, weeks. And then, you know, I leave the service, I come back, and they're still there, or they come back to the hospital, and I see them again. And, you know, while it's unfortunate, they're back in the hospital, it's kind of, you know, it's kind of nice to see them, and you know them, you know, their story, and you get to know a little bit about, you know, who they are.

So that's always been kind of the best part of the day is actually getting to know the patients for who they are. Kind of the thing that I guess the thing that I like the least, and you'll hear this very commonly as well, is we have to do a lot of documentation. And, honestly, it feels like sometimes I would say 80 to 90% of my day is just sitting in front of a computer and, you know, typing things up.

Whether it's, you know, putting in orders, or, you know, writing discharge summaries, basically, you know, like a record of what happened in the hospital. I feel like most of the time we're just sitting behind the computer documenting. That is easily my least favorite part of the day.

But it is, you know, like I said, it's the majority of what I do. And it's important that, you know, whoever comes in and takes care of the patient next knows what we did and why we did it.

Kathrine

I'm not sure if this is true, but I have heard that in some hospitals, they've been using like AI tools to like help with creating summaries of visits. So have you seen like any evidence of AI use in your hospital?

Dr. Zhang

Yeah, so AI use has actually really exploded in the last couple of years. We use what we call an electronic health record, which is basically, you know, you log into the computer, the doctor's like notes are all stored there. And while I don't think it's been implemented yet, I believe the company that makes this electronic health record has developed a way that they can actually read all the notes that have been written and generate an AI based discharge summary kind of of the record.

We don't actively use that yet. But I'm sure within honestly, just like the next year, probably this will be phased in. What we do use AI is a lot of the times, you know, medicine, there's so much research going on right now, there's so many new studies, you know, every day, there's multiple new studies that happen.

And so AI has proven to be a really good way of actually summarizing the research. So you know, you have a question that you want to ask, you know, how you know, for this particular scenario, which antibiotic is the best? And how many days should you treat this patient with this antibiotic?

AI is fantastic for at least pulling up studies that you can then reference to make sure that Oh, yeah, you know, that actually does make sense. Because there's just tremendous amount of knowledge. And you know, AI can a lot of times give you the best answer.

Kathrine

So after entering medicine, what surprised you the most about it?

Dr. Zhang

It really, it really is the amount of documentation, I think, because when you shadow like, you know, if you're interested in healthcare, and you shadow a doctor, a lot of times you shadow, say, a surgeon, or you shadow clinic, and then what you see is, you know, at least in the certain, when you shadow a surgeon, you go to the OR, right? And so you're there, mostly in the OR, you're standing there, you're helping maybe like hold muscle flaps or whatever, but you're actually like directly with the patient. If you're in clinic, you see the doctor talking with the patient, and then generating a plan right there.

What you don't see in the clinic, though, is that after all the patients are gone, the doctor is back in the office, you know, writing notes for two hours. But I think once you actually start when you're in medical school, and you rotate on inpatient services, you realize that the vast majority of what you do actually is just sitting at a computer and documenting. So that is something that surprised me.

It is the unfortunate side of medicine, I think.

Kathrine

So I was wondering, have you like watched any of the medical TV shows?

Dr. Zhang

I love medical TV shows. Yes.

Kathrine

So what is something that they get right, and what is something that they get wrong?

Dr. Zhang

It depends on the TV show. I mean, I really enjoyed watching House. House, I think is, you know, it's part of the process, you know, where Dr. House thinks about what is the patient coming in with, trying to come up with a differential diagnosis, doing the test. That's, I wouldn't say fairly accurate, but in broad strokes, I guess, you know, it kind of depicts the way that we at least think about things and rule out different disorders. But we're obviously not, you know, going to like patients' houses and trying to like find random things in their house. I watched Grey's Anatomy, hilariously funny.

I like it for the drama. I don't think anything in the show is accurate. And then there was another, I think it was like called St. Dennis Medical or something, that ended up being really good, even though it was only a couple of seasons. But it felt like at least the interactions between the doctors and the nurses were a little bit more accurate than what you see in Grey's Anatomy. A lot of times, you know, you can critique the way that these TV shows depict things like CPR. That's always really funny because you see, you know, they're doing CPR and then the hands go down about like, you know, half an inch, if at all, when actually when you're doing CPR, your hands are going down like several inches when you do it.

Of course, they can't do it to a live person. But, you know, just you start noticing some like funny things that they do. You know, monitor is not even hooked up to the patient, but there's lines going on it or they're, you know, they're defibrillating a patient who has no electrical activity whatsoever on the monitor.

So there's a lot of things that you end up noticing. But, you know, I really enjoy medical TV shows.

Kathrine

So what do people often misunderstand about your field, would you say?

Dr. Zhang

About medicine? Like, yeah, like the research side.

Kathrine

I guess, like, what is something you think high school students should know before they decide they want to be doctors?

Dr. Zhang

That's a good question. I think, I think there's many different types of doctors. So, you know, depending on how much you've interacted with the health care system, maybe, you know, you, your interaction with the doctor is just, you know, you go to the office, and then the doctor sees you, and then you leave, right?

And that's generally, I think, you know, outpatient medicine, which is what I described, you go into the office, you get seen, that's the bulk of, I think, how at least young people experience health care. The reality of it is, you know, when you actually go through training, the vast majority of what you see is inpatient medicine, so much so, I would say 90% of what I saw in medical school, and certainly, in intern year residency has been inpatient, where, you know, the patients are just sick, they're always in the, they're in the hospital, right? So you're actually doing what I described, which is, you know, seeing the patients in the morning, rounding on them, following up on the test results as they come out in the hospital.

And that's totally different from, I think, what people expect life to be as a doctor. Of course, you know, when you get, when you finish training, you know, you can choose to be mostly outpatient, but a lot of times, you know, even that can look different. Like, you know, you might come into the idea that, you know, being a doctor is just treating patients, having a sense of, like, everything that's going on with them, but really, you know, most people specialize or even sub-specialize.

So, for instance, in ophthalmology, you might think of, you know, ophthalmologist is just an eye doctor, but we actually can go on after residency to do fellowships. So there's a fellowship, for example, called glaucoma, where all you do after you graduate, or after you finish fellowship, is just take care of patients with one particular disease, which is glaucoma. And so it's, like, so, so, so specific, but that's really the way that modern medicine has become.

Kathrine

And next, what barriers do you think students face when they're trying to enter STEM or medicine?

Dr. Zhang

Also a really good question. I think entering STEM in general, you know, people find, you know, for example, they go in high school, they're in high school and they take, you know, biology, chemistry, physics classes, and they find that, you know, one of those classes might be really hard, they didn't do well at all, and then they think, you know, they can't succeed in STEM. And I would say that's definitely not true.

You know, there's so many different ways of finding a career in STEM that just because, you know, you didn't do well in physics, that doesn't mean that, you know, you can't be a fantastic, you know, chemist or biologist or something like that. So I think that, you know, people, there's a lot of, I guess, notoriety, especially among some of the AP sciences. You know, at least in my high school, people thought that AP physics and AP chemistry were, you know, like terribly, terribly difficult classes.

And so people shy away from them and they don't even try. And I would say, you know, definitely just try them out. And if you don't do well, you know, it's not a, it's not, you know, an indication of failure on your part.

You know, I was not the best physics student, not by a long shot. But, you know, I still consider myself to be very active. I mean, I'm obviously doing a career in STEM.

So just because I don't know, you know, like different equations for electrical field doesn't mean that I can't do science. When it comes to medicine, I think also a lot of people go to college thinking that they have to be pre-med. And I would actually advise you to not necessarily do that.

If you're really interested in learning about biology and, you know, your college offers a pre-med track or a pre-med major, by all means, go for it. But pre-med is not, at least in most of the colleges that I looked at, a true major. It just means you have to take a couple of biology, chemistry, physics, math, and English classes.

And so you can definitely major in something like English or computer science or history, psychology, whatever you want, really. And you can still go to medical school. And as a matter of fact, I actually think that makes you a more interesting person as well as a more interesting applicant.

But I think a lot of people hear, you know, oh, I want to be a doctor. I have to be pre-med. And they hear all these like, you know, horrible things about, you know, it's so hard.

The classes, you know, you're studying all the time. People are like, organic chemistry is so hard. I want to fail organic chemistry.

It's one particular class that I think people are scared of. And they don't try it. But there's really a lot of different ways to being a doctor, a lot of different ways to handle the pre-med courses.

And if I think if you really set your mind to it, you can find a way to do it.

Kathrine

So if you could go back, what advice would you give to your ninth grade self?

Dr. Zhang

To my ninth grade self? So I, like I said, I really liked my science classes. And I think one of the things that I did not enjoy in high school was actually my foreign language class.

It was one of those, you know, requirements that if you wanted to go apply to college, a lot of them wanted to see at least two years of foreign language. And I just really, really, really did not like learning a foreign language. And I didn't do very well in my foreign language classes.

But, you know, I somehow, you know, ended up taking some foreign language classes in college, a different foreign language, and I actually really, really liked it. Ended up actually going to that country to visit. And now, you know, I mean, I'm definitely like far from fluent, but it's so exciting to at least be able to talk to people in their own native language.

And I think it can make a tremendous impact, especially in healthcare. You don't have to be fluent, even just saying, you know, like knowing how to say hello or thank you in their language can go a long, long way. It sounds trite, but I've seen it multiple times already in, you know, taking care of patients.

And so if I could go back, you know, I would say, yeah, you know, definitely, you know, do those science classes, do well in those science classes, but don't neglect the non-STEM classes as well. You know, I love my history classes. I love my literature classes.

And, you know, foreign language, I think, is one of those things that a lot of people dismiss and they think, oh, you know, I live in the US, you know, it's not going to be useful, but actually it can have a huge, huge impact.

Kathrine

So what is one small step a student can take this month to explore your field, like research or medicine?

Dr. Zhang

I think, you know, if you're interested in either of those, reach out to people in the field and see if you can shadow them. There, you know, there are, of course, depending on where you want to do this, age restrictions, but a lot of hospitals will let you just kind of shadow a doctor for a day. A lot of even researchers, science, you know, labs will allow you to just like go into the lab and maybe just observe a graduate student, do a couple of experiments.

People are sometimes afraid to do that because, you know, they don't know someone in science, but I think a lot of doctors and a lot of researchers are actually really open to having people shadow them. So what I'm a big proponent of cold emailing, actually, that's how I got a lot of the positions that I, or a lot of the opportunities that I got. Just look people up online, you know, and if you find what they do interesting, email them.

I mean, the worst they can do is say, no, they don't even know you. Right. And, but that's how I got a lot of my shadowing opportunities.

You know, I just chose people in departments that I liked. I cold emailed them and then, you know, some of them said yes. And then they got to go in for a couple of days and watch some interesting surgeries.

Yeah.

Kathrine

Okay. So that's all my questions. Thank you so much for taking the time to share your experiences.

I really appreciated it.

Dr. Zhang

My pleasure. Thanks for having me.

Kathrine

Thank you.