Advice for IMGs, Fresh Residents, and How to Thrive with Dr. Matthew Szaro

This week, Dr. Tanner Schrank and Sophie Neale sat down with attending physician and international medical graduate, Dr. Matthew Szaro. Juggling roles as a Canadian, Polish alumnus, and anesthesiologist in America, Dr. Szaro's personal and professional journey is nothing short of fascinating. From the classrooms of Jagiellonian University Medical College to the medical facilities in Boston, his experiences span diverse healthcare cultures and landscapes. Listen in as he delivers insightful advice for students and residents and discusses what he found rewarding and challenging during his medical journey.

Read more:
Dr. Matthew Szaro: https://www.linkedin.com/in/matthew-szaro-13306a34/
Ace Exams with AMBOSS: https://www.amboss.com/us/students/exams
AMBOSS for Clinicians: https://www.amboss.com/us/clinicians

AMBOSS Qbank Q: https://next.amboss.com/us/shared/questions/ocx-0WvzV/1
Book rec: "Mindset" by Carol Dweck from 2006: https://www.randomhousebooks.com/books/44330/
Fun fact: https://www.aad.org/public/diseases/hair-loss/insider/shedding 

Sign up for a free 5-day trial at https://go.amboss.com/pod-5day-trial. 
Read more at the AMBOSS blog: https://go.amboss.com/blog-ambosspod. 
Find out more about the AMBOSS podcast: https://go.amboss.com/int_podcast-23.  

Transcript

Tanner 0:22

Hello and welcome to the Ambos podcast, beyond the textbook. We're your hosts today, Dr. Tanner Shrank and Sophie Neil, bringing you experiences and advice from healthcare professionals and medical students from around the world. Today We're delighted to be joined by a very special guest, Dr. Matthew Charo. Dr. Charo is now an attending physician, After completing his anesthesiology residency in Boston, Massachusetts, he's also a former classmate of mine from Yian University Medical College in Raku, Poland. From college to Medical school to residency, he has found success in diverse situations and even made time to, have a social life outside of studying. We'll find out all about his experiences, his strategies for success, and advice for international medical students and graduates. But before we jump into the interview, let's try out our ambos question, bank question of the day stick around until after the interview to find out the answer along with our book recommendation and a medical fun fact. Alright. Here's your ambos qbank question of the day. A 16 year old boy comes to the physician for a routine health maintenance exam. He feels well. He has no history of serious illness. He's at the 60th percentile for height and weight. Vital signs are within normal limits. The lungs are clear to auscultation. A grade three out of six systolic ejection crescendo decrescendo. Murmur is heard along the lower left sternal border. The murmur decreases in intensity on rapid squatting and increases in intensity when he performs the Valsalva maneuver. This patient is at increased risk for which of the following complications? A angiodysplasia. B, infective endocarditis, C, sudden cardiac death, D, paradoxical embolism, e, pulmonary apoplexy, or F cerebral aneurysm. Stay tuned until after our interview to find out the answer to that question,

Sophie 2:35

Well, Matt, so nice to meet you. Thank you very much for joining and being on the show. Can you maybe take us on your journey through medical school to where you are today?

Matt 2:44

yeah. Thanks to you guys for having me on. I've always wanted to be on a podcast, so this is a dream come true, really for me. So my name's Matt. I was born and raised in Canada. My parents were from Poland originally and they immigrated to Canada right before I was born. Growing up I always kind of knew that I wanted to live in the US when I grew older. I think I got absorbed in the American propaganda and, you know, cultural exports. But I always had that strong inclination to go to the US So, For my undergraduate I applied to Johns Hopkins University and completed my four year undergraduate degree there in Baltimore. And I stuck around for two years after that working in the emergency department at a community Hospital Union Memorial. During that time I was applying to US medical schools. I was, Very sure that I wanted to complete medical school in the us. And after a couple cycles, I wasn't having a lot of success pursuing that route. I had only had one interview during that time at New York Medical College, and I. Was speaking with my advisor and she was saying, one of the marks against my application was that I was, A Canadian and half of US medical schools don't accept foreign students. and. Though I was a good student during my undergraduate years and I scored well on the MCAT exam I just was not able to get a foothold. So eventually I started looking overseas and I actually got accepted to medical schools in the UK and Ireland. Which I turned down actually because I was anxious, that I was giving up on the US Medical School dream. But after still not getting any footholds, I ended up applying to Yon University in Poland based on the recommendation kind of of my parents growing up in Poland. And I accepted the position there and pursued my medical career there at YA University along with you, Tanner?

Tanner 4:48

and then you were applying for residency in the us So this is a very common pathway for international medical graduates around the world. So what were the biggest challenges for you to get to the us?

Matt 5:01

I remember that period was filled with a lot of anxiety for not just me, but like all our classmates. You know, first and foremost, we were doing this in the area where step one was still scored. So that was a very important test for us. Everybody really hunkered down. Did a lot of studying for that, and, me and a lot of my colleagues, we ended up doing very well on, the exam, which automatically, took a lot of stress. Because that's kind of the, benchmark, especially for international medical graduates. And then afterwards we did have the opportunity to do rotations in the us. At the start of our fourth year of medical school, I did one month of. General surgery sub internship at Johns Hopkins University and I did two months at uc, San Diego one month on the orthopedic service, and one month on the surgical I c u team. So kind of getting those connections, Getting letters of recommendation from US programs showing that I could actually, complete The tasks of a us? medical student successfully I think was very helpful to my application. And then quite honestly, a little bit is still luck. You know, when you're applying as an international medical graduate, you'll always have a little bit of a stigma attached to you to some degree. Especially as more and more American students are applying for residencies from American medical schools. It's a challenging environment but if you really want, something, it is possible to achieve it. If you really want to do something like dermatology, plastic surgery, you're gonna have to work really hard, but it is possible.

Tanner 6:41

Mm-hmm. And so doing well on that step one, and then doing those US electives was kind of your way of standing out.

Matt 6:48

Yeah, it's tough, again, coming from, An international medical school and then also being a Canadian citizen you know, there were just small flags on my application that I thought I needed to prove myself in other ways so that people could easily look past those,

Tanner 7:04

yeah.

Sophie 7:05

So you mentioned Matt, something that helped you to stand out was your, step one three digit score. And I know of course with that change from the scoring into pass fail, it's given a lot of international students quite a lot of anxiety as to how they are gonna stand out. So is there something else that you, did you feel in your path that helped your applications stand out?

Matt 7:23

Yeah. That, change I know is, Causing a lot of anxiety for current international medical graduates. That was a very easy way to Make yourself stand out, having an eye-catching number. The step two exam, I think is unfortunately gonna become the replacement for the step one exam. It's still scored on the Three digit, system. So a lot of. Medical students are turning their attention to that exam, really hunkering down to, do well on that exam. But otherwise, I think, you do need to have some kind of basis in the US where you show that you can, work with the best medical students in the us. You have to have. People know your name and someone vouch for you. I was at uc, San Diego, I was privileged enough to have the chance to communicate with the anesthesiology residency program director at uc, San Diego. And he gave me some advice. He told me places to look out for how to kind of frame my application and. Kind of helped guide me along,

Tanner 8:29

Wow. That's awesome.

Sophie 8:30

yeah. That's really nice to have somebody to help you to do that. I think in any field, to have someone as a bit of a mentor and to give you that guidance, it really goes a long way. And would you say that mentorship is actually what led you into the field of anesthesiology? Or was it something that you just generally found very interesting and,, how has your journey been in that field so far?

Matt 8:49

My journey to anesthesiology, I think it really started when I was an undergraduate. They gave us this catalog of doctors that we could shadow. this one doctor in anesthesiology, I ended up. Shadowing him over the course of a year. And I remember he was a prickly personality. But that was kind of my first exposure. And then when I went to medical school, I did the stereotypical medical student thing of, oh, I wanna do cardiology. Oh, I want to do, you know, electrophysiology. Oh, I want to do dermatology. Oh, I wanna do this and that. And so when it came time to finally submitting my applications, I thought about what I wanted and I liked the hands-on nature of anesthesiology. I liked that when you are working with a patient, you're Actively working hands-on to help the patient. I found internal medicine sometimes you were absorbed a little bit more in your computer work than you were on, hands-on work. So I knew, I wanted to be hands-on involved and I chose anesthesiology and it's, I gotta say it's a great field to be in. That's really cool.

Tanner 9:59

And you said you really like the hands-on aspect what is the most rewarding part of being in this field?

Matt 10:06

I think one of the most rewarding things is when you know, you're kind of doing, a elective like hip or, or knee replacement, or, just kind of something super elective. The patient's not, you know, critically ill, they don't necessarily need the surgery per se, and you get them out to the recovery room and they wake up. No pain. You know, happy, smiling, Sometimes they are in that anesthesia, you know, saying random, funny things. Uh, That's always a blast. I also really enjoy OB anesthesia. It's very stressful. Can be very taxing at times. You know, the clock never stops in ob up in the middle of the night doing emergency C-sections. But when moms get to see their new babies, it's always, Yeah.

Sophie 10:52

special to be part

Matt 10:53

of that.

Tanner 10:54

yeah, it's firsthand work with the miracle of life, how could that not be rewarding? Right.

Sophie 10:58

pretty special.

Matt 10:59

I prefer 10:00 AM instead of 4:00 AM but you know,

Tanner 11:03

Definitely. Yeah.

Sophie 11:04

We need to have a word with these babies. Yeah. Time to sort out their schedules.

Tanner 11:09

Yeah.

Sophie 11:10

Can you tell us a bit more about your time as a resident and what was a typical workday like for you at St. Elizabeth's?

Matt 11:16

Yeah, so the anesthesiology residency consists of one intern year and three clinical anesthesia years. We call'em ca years. The intern year can be surgical or medicine. For me, it was a mix of both. Three, months on general surgery, some I C U rotations, some cardiology rotations and. One of the benefits of my anesthesia residency program in particular was that I had two months of transition to anesthesia during my intern year. So towards April and May of my intern year, I was already gaining, experience in the field of anesthesia. Then once July 1st, Hits on your first year of anesthesia, it's, Kind of go, go, go for the next three years. For the first two months you were paired with a senior resident. You know, you can't be trusted to, to be alone in a room at that point. But you got to shadow them. Kind of take the lead with just someone there as constant backup, and then progressively you get more and more autonomy depending on, how you're progressing. Over the course of the three years of anesthesia, you know, you do a bunch of specialized rotations, ob anesthesia, pediatric cardiothoracic, anesthesia. You also have rotations in um, regional nerve block acute pain service, pre-op clinic, all that, type of stuff. So you, are constantly moving month to month. What you're doing. In my final year, my ca three year, I served as chief resident for our cast characters. That was, a rewarding experience, taking a leadership role uh, within the department. knowing that my co-residents put their faith in May to help guide them through at least one year of residency. So that was a, a great experience as well.

Tanner 13:08

That's pretty cool.

Matt 13:09

It was amazing.

Tanner 13:10

That's really nice too, that you get to sort of ease into it you get to keep a teacher there the whole time, right? Like you're still learning on the job.

Matt 13:18

As you get more and more autonomy like the attendings are always with you when you go to off to sleep with the patient. And most of the time they're there when you wake up with the patient.'cause those are obviously the two most dangerous times over the course of anesthesia. But one of the benefits of my program was that it was relatively small. And so the anesthesia attendings, they got to know you pretty quickly and kind of they learned what you needed to. Improve on, What you were strong at already. So they were able to tailor their supervision to your needs. And, pretty quickly they were able to gimme a lot of autonomy in the operating room. Make my own decisions push medications for anesthesia induction,

Tanner 14:01

wow. that's cool. I really also like the fact that you got to see so much of medicine, so many different kinds of patients. You mentioned obstetrics, pediatrics. Even like the knee and hip replacements, like all of these are different disciplines, whereas a different specialty would be just that, right? Like A cardiac surgeon just operates on hearts all day right? If you're a pediatrician, you just see kids and their families. Like, It's cool that you got to see all these different kinds of patients in the same specialty.

Matt 14:30

Yeah. I think that's definitely something I really appreciate about the field of anesthesia. You know, like on a Monday you're doing a ruptured aortic aneurysm. And you're stressed and you're panicking, sweating, But then, the very next day you'll be doing, a knee replacement and you'll be so much, calmer, and then the next day you're working with a couple pediatric patients. It's all over the place. You always need to know your physiology of. every single age group need to know how different patients with different diseases react to different medications. It's, It's a lot of information and the joke is anesthesia is kind of like being a bartender. You have to, make cocktails all day. You have to tailor to everybody. And that's kind of the fun part of it is it's a very diverse. Patient population

Tanner 15:19

So, What would you say has been the most valuable lesson you've learned in your medical career?

Matt 15:25

One example that really stands out to me. St. Elizabeth's doesn't have like a pediatric service. So we went to Boston Children's Hospital to do, Rotations there for two months to get our pediatric experience. And Boston Children's Hospital is one of the preeminent children's hospitals in the entire world. You know, a lot of people fly from many different countries that we have patients with very rare disorders walking through those doors every day. And I remember my first day I had two extremely challenging patients and. I didn't even know where the bathrooms were in this hospital. You know, let alone I'm doing my first case was an eight year old with Down Syndrome who was going for a takedown, colostomy. My second patient was a six week old, Who had pyloric stenosis, but the twist was he also had hypertrophic obstructive cardiomyopathy. With a mean gradient of over 80 millimeters, mercury. And for those of you who don't know what that means, It's just a bad heart condition. Very challenging to deal with. And on a six week old, no less, you know, that was, it was horrifying. And so I call up my attending the night before to discuss the plan it was Dr. Susan Eklund. I still remember. I tell her I am kind of outta my depth here, and she says, just remember anesthesia's the same everywhere. The drugs are the exact same. We're not doing anything. That's completely foreign. You know you're still gonna treat blood pressure with the same medications. You're still gonna go off to sleep with the same medications. We're gonna be there to support you, you know,'cause obviously there's challenging patients, but, Don't let them intimidate you. And I think that kind of stuck with me a lot. This idea that The fundamentals, you've learned how to do them properly. You've, been through four years of medical school and however many years of residency you can do

Tanner 17:33

Mm-hmm.

Matt 17:34

Take a breath. Remember the lessons you've been taught and keep going through it. The only way through these surgeries is forward, really. Sometimes you just gotta get a little bit out of your comfort zone and rely on what you know to guide you through it.

Sophie 17:50

That is really excellent advice because that sounds terrifying, and I think it's really easy, as you said, to be overwhelmed by the situation of a patient, but to bring yourself back to a, what have I learned?

Matt 18:02

Yeah. At the end of the day, you know, these patients need help, whether it's from you or someone else, and don't be afraid to ask for help when you need help. Yeah. There's no shame,

Sophie 18:12

Yeah, No, definitely not. Well, along the lines of, of giving advice medical students and graduates are always asking for tips and strategies to prepare for the us. Emily, as we've spoken a little bit about already, and as you already mentioned, you did quite well on your step one, and I think you're step two. So what was your strategy in doing so well in those exams?

Matt 18:34

Yeah. For me, my biggest resource that I've used through medical school, through residency has been the, an flashcards. I still use them every day. In fact, I just had my anesthesia board exam just four days ago, and my preparation was based on four years of doing flashcards of anesthesia. And there are some pre-made decks out there on the internet. I know I use some for the U S M L E step one. I didn't like those pre-made decks personally. I created my own flashcards and I really challenged myself to know topics inside and out. My flashcards they weren't questions. They were just like one word, you know, cisatracurium. Des Fluorine and I just have to talk about everything involved that I know about those medications, you know, dosing, Properties, whether they're histamine, releasers or not. Doing those flashcards every single day was really helpful to me. I don't think you necessarily need to do an anky style approach. The key is not the flashcards themselves, the key is the repetition. Mm-hmm. You don't learn medicine in one sitting. You learn it day after day after day. Seeing, similar patients come through similar clinical scenarios. Doing, the same questions on those question banks reading the same textbook paragraph again and again. It's the repetition

Tanner 20:04

Right. Yeah. that makes a lot of sense. I think that, ties in with the other answers too, like going back to basics, preparing yourself for being in these situations, because when you. Have like just a word on your flashcard and then it's up to you to connect it to all these other scenarios, that's exactly what it's gonna be like. When you're in that situation, oh, they have high blood pressure. What was that thing I'm supposed to do? And then you make that connection isn't ever gonna be like, in this situation you do blink. Like that's a bad flashcard.

Matt 20:33

exactly. Yeah, I know a lot of those pre-made decks. I found that I was learning the visual of the card itself and just what should fit in that, blank spot rather than actually learning the material of it. So if you didn't actually get that exact flashcard. on the exam, You didn't learn the material and you need to know contingency strategies as well. You know, what happens if Plan A doesn't work? Yeah, I have my anesthesia oral boards coming up, and that's kind of what the exam is, is they'll give you a challenging scenario where there's no correct option, and then you choose an option, you. commit to it, and then they tell you it isn't working, and what are you gonna do now? That's really what the exam is.

Tanner 21:16

Mm-hmm. You gotta be ready for those curve balls.'cause they're gonna come in real life too.

Matt 21:20

Exactly.

Tanner 21:21

I think that's a very winning strategy and it makes sense why you did so well on those tests. So now that you're starting your new position, congratulations by the

Matt 21:29

Thank you.

Tanner 21:30

Are there any changes that you would've made along the way through this journey from Johns Hopkins to med school to residency to where you are?

Matt 21:38

One thing I've thought about and I don't know if I would necessarily change it, but I mentioned earlier that I actually got accepted to schools in the UK and Ireland and turned them down before going to Poland. I enjoyed my time in Poland, in Krakow specifically. You know, I got to to travel a lot and see a lot of the world. I don't know if maybe I would've seen things differently, if my education would've been different, if I would've been a better prepped medical student coming out of the UK and Ireland. I don't know, but that's something that I think about is. What would've happened if I had gone there instead of Poland? Maybe I would be in a different residency program. I don't know. Maybe it would be better, maybe it would be worse, but that's something that always sticks with me. I was very stubborn to kind of give up on the dream of being a US medical student, and so I quickly threw out the opportunity of being a medical student in in the United Kingdom. So,

Tanner 22:43

Right. Yeah, I mean, that makes sense. And let's not like mince words here, like when you study in Poland, it's good education, but they're not preparing you for the US M L e, like they would prefer you to stay like in Poland. So it's kind of up to you to do your own studying for that, right?

Matt 22:59

Absolutely. You know, the education was great at Yon University. They're a very strong medical university. But they are not interested in teaching you how to excel on the U S M L E or the N B M E exams. They want you to learn their material, which, you know, the European guidelines are slightly different than the American guidelines. medications that are approved are different. Even the format of exams is, is very different. it was a lot more, Rote memorization rather than it was applying the knowledge you knew, you know, the US m l e I think it does succeed well in being like a good exam at truly testing that you understand the concepts and you can apply those concepts to medical scenarios. For me, I hate exams that are written that are just rote memorization. it's important to know, but like anyone can learn that. It's how you apply those lessons to the real world. Yeah,

Sophie 24:01

Yeah, I think that's really good advice. And I do wanna ask you for one last bit of advice to throw out there. If you can give our listeners any advice beyond the textbook, what would you say?

Matt 24:13

make room for, for your social life don't put that on the back burner. One of the benefits of going to school in Poland was that it gave me a lot more free time than US medical students and I got to travel around Europe a lot and that was one of the things I was incredibly grateful for. You know, seeing so much of the world during four years of medical school is truly like one of the things that really stands out to me and. I highly encourage people to not put all that stuff on the back burner. You know, the clock keeps going forward. You don't get that time back and there's always gonna be an excuse for why you can't travel or why you can't do this or that, or the other thing. If you prioritize it, you can make the time for it. And I highly recommend people to kind of reevaluate what is important to them in their life, whether it's travel, whether it's, spending time with friends and family. Don't let that go because you're a medical student or a resident.

Tanner 25:16

I, I really like that advice. I, might be a little biased because I was part of the, some of that travel, but I really, really like that advice. Yeah.

Sophie 25:24

Yeah, no, I, I agree. I think whether you're in medical school or wherever you're doing life can pass you by really, really easily. And as you said, Matt, you don't get that time back. I think that's really, really important to remember, you know, do the things that you love as well as the things that you might also love studying, but do the things that you, you want to do as well as, working and studying.'cause those are the things that are gonna, you're gonna, remember.

Matt 25:48

Exactly. You know, I love my job, but I try to take none of it home with me. When I come home to, to my fiance, I give her like a five minute recap of my day and like, I cut myself off. I don't like talking about medicine outside of work. That's not who I am. I'm so much more than that, traveler Reader, a, a. podcast listener, you know, all these things, That's way more important than all those notes that you're behind on.

Tanner 26:16

Right.

Matt 26:17

sometimes you kind of have to step back and remember, You know, I wear pajamas to work. You know,

Tanner 26:23

You're putting people to sleep.

Sophie 26:25

I, in your pajamas,

Matt 26:27

I'm responsible for, for nap time for adults, you know, that's, that's what I'm doing, you know? and it's important That you do, you do your best in the moment, but at the end of the day it's, there's so much more than than that to life. Exactly.

Sophie 26:42

so that concludes today's episode, and a really big thanks to Dr. Matthew Charo for sharing his enlightening experiences and insights with us and all of that great advice. I think your journey provides a lot of guidance for medical students, especially those that are looking to practice internationally. So thank you so much for taking the time to chat today and all of the best of luck in the future.

Matt 27:03

Thanks so much for having me, Hopefully, Somebody can gain something useful from what I've said today.

Sophie 27:08

definitely. It was really, I think, really great advice

Tanner 27:11

Yeah. thanks for taking the time and sitting down with us.

Matt 27:14

Absolutely. Thank you so much.

Tanner 27:16

and now let's get back to that ambos qbank question of the day. Your key info from the question was the systolic ejection crescendo de decrescendo murmur, the lower left sternal border, and the murmur increasing in intensity when the patient performs the Val Salva maneuver. Your attending tip for the question says, echocardiography would most likely show asymmetric interventricular septal hypertrophy, and or systolic anterior motion of the mitral valve, which are consistent with hypertrophic obstructive cardiomyopathy. So with this knowledge, you should have chosen answer C, sudden cardiac death. To find out more about hypertrophic cardiomyopathy and questions like this, head over to the links in the description to try out ambos for free for five days. And now your book recommendation is, Mindset by Carol Dweck from 2006. This book is an insightful, thought provoking read that drastically shifts the perception about success and potential. Critically examining the contrasting fixed and growth mindsets, making it a must read for anyone, striving for personal and professional growth. And finally, your medical fun fact is, That The average human sheds between 50 and a hundred hairs from the top of their head every day. so if you find that you're pulling your hair out more often than that, definitely check out ambos to alleviate some of that stress and better prepare yourself for your medical studies.

Sophie 28:54

To our listeners, thank you for tuning in. We hope this episode offered valuable insights and fueled your passion for medicine. Join us on our next episode of the Ambos Podcast, beyond the textbook where we continue to bring you engaging discussions with healthcare professionals and medical students around the world. If you enjoyed this episode, please consider subscribing and leaving us a review

Tanner 29:15

I'm Dr. Tanner Schrank.

Sophie 29:16

And I'm Sophie Neil, and this has been Ambos Beyond the textbook.