Vital Signs S1E2 - Dr Josh Webb, Surviving the Rigors of Medical School

In Episode #2, we hear from Western Atlantic University School of Medicine's own Dr. Josh Webb about what students needs to do to survive medical school.  Its a tough journey and Dr. Webb gives you a lot of good advice on how to deal with stress, free time and the medical school grind. Vital Signs is a podcast for anyone who is at any point in their MD Journey, just starting out investigating becoming an MD or already in practice.  We can all learn a thing or two from each other.  Join us as we explore this tough but very rewarding journey together as we speak with students at Western Atlantic University School of Medicine, faculty and those in the industry.

Transcript

00;00;00;01 - 00;00;50;07
Anthony Licausi
So hello and welcome to Vital Signs. Thank you so much for joining us today. My name is Anthony Licausi, the associate director of recruitment here for the Southern Region for Western Atlantic University School of Medicine. And our guest today is doctor Josh Webb with two decades in medical education. Doctor Webb is a passionate rural and remote general practitioner and assistant professor of clinical medicine. He is a father, husband and an authority on integrative health and longevity. His collaborations with Unicef and the World Health Organization, along with practice on four different continents, highlight his commitment to a holistic well-being. Doctor Webb seamlessly integrates traditional and modern medicine, focusing on resilience and a healthy lifestyle, offering comprehensive care and profound educational experience. So welcome, Doctor Webb.

00;00;50;07 - 00;00;54;04
Dr. Josh Webb
Thank you for joining us. Thanks very much. Thanks for having me.

00;00;54;04 - 00;01;10;25
Anthony Licausi
What I wanted to do is, first of all, get a sense of your experience so far at, Western Atlantic University School of Medicine, or WAUSM, as we call it. And how is your experience been with both the faculty, the students teaching on the island? Tell us a little bit about that.

00;01;10;28 - 00;02;12;27
Dr. Josh Webb
Well, Anthony. So I've been here. I'm a considered founding faculty, so I've been here, since the school opened, and I've worked at previous medical institutions, in Canada and what really drew me to WAUSM is that they the, the founders, the founding faculty, we had seen what was going on with medical education, in North America as well as in, the Caribbean. And we wanted to fix the problems that we would see. There's a lot of things that are being done, and they're just being done, because that's the way that we've always done them. And we were like, oh, well, what if we try this one? If we try that and there's often a lot of pushback saying, well, you know, well, this is how things are done. This is how we teach this. And having a diverse group of physicians and PhDs, we said, well, there's better ways to do this. We can we can adapt, you can change, and we can do something that's newer, that serves our students better or provides better education, better and ultimately better health care for patients. When our students graduate.

00;02;12;29 - 00;02;54;15
Anthony Licausi
And those are all great ways to, you know, as the importance of medical education and the innovative, innovative ways. That WAUSM. Is is, challenging that which is which is fantastic. So on the island, you, you, teach the first semester group and you talk about the rigors of medical school, the that first comparison between leaving undergrad and coming to medical school. What are the things that you see? What are the challenges that you see most from those students, let's say in the first week? What are the what are the stark differences that you see between, let's say, a student that's coming out of undergrad and then going into medical school for the first time?

00;02;54;17 - 00;04;44;00
Dr. Josh Webb
It's funny, I reflect back to my first week in medical school and how drastically different it was from undergrad, and I think what the way to to look at it is when you're when you're in an undergrad, you you go to school, you, you know, I'm going to University of California or wherever I'm going, I'm going there, I'm studying this. And when you when you start a medical school, you're not really going or studying. You're on the journey of becoming. You're becoming a doctor. You're becoming a physician. And it's, you know, you don't just come attend your classes, do your homework. Everything is all about becoming a physician. And that's the big transition. It's not just doing your classwork and studying. It's about making sure that every step of every day is in that process of of becoming. And you really have to fundamentally change the way that you think you change the way that you study. You have to change the way that you interact with your students, your colleagues and professors, because you are now becoming a physician. And that's a that's a real specific distinction that I think a lot of students really have to kind of, accept that when you're accepting your path or your journey into becoming a physician, it's not about getting your class schedule and completing these prerequisites and all that stuff. It's about a whole entire lifestyle. Because, of course, as you know, the training doesn't stop at the four years and medical school will continue on into residency fellowship. And then obviously when they go and practice, you know, as a licensed physician, you know, they're still going to be learning. As you know, it's constantly it's a constant state of education.

00;04;44;00 - 00;04;56;19
Anthony Licausi
So you mentioned studying, which is a, a there's a stark difference in studying in medical school. Tell us about those style words that the students need to kind of embrace in order to, to be successful.

00;04;56;21 - 00;06;38;11
Dr. Josh Webb
Well, I remember in undergrad raising your hand and asking your prof, is this going to be on the test? Is this going to be on the exam? And they say, oh, well, don't worry about that because they wrote the textbook, they wrote the exam. But for a medical student, you know, it might not be on the quiz or the exam that we have coming up, but you don't know what's going to walk through the door of your office or your clinic or on a clerkship rotation or in residency. You don't know what you're going to see. So, you know, preparing for your exams is one thing. But becoming a physician and being able to recognize something that you haven't seen before. And then we may come, you know, in your first clerkship rotation or may come 20 years in the practice, but yet, you know, the answer is it's very likely that that you will be tested on this. It just depends on where and where and not really that really follows that model of becoming a physician. So, you know, you have to integrate, understand and be able to, connect all of that knowledge, connect all of that information versus just being able to regurgitate a fact on the test, which is, you know, a lot of our undergraduate, you know, I remember memorizing structures for organic chemistry, you know, do I have a huge understanding of organic chemistry? No, but was able to memorize the structures that connect them together and then regurgitate them on a test? Absolutely. But for medicine, you've got to be able to really understand it at a, at a molecular level and then work all the way up through and apply it to the patient, and then take what you see on the patient and work all the way back down to the molecular, cellular level. And that's the difference.

00;06;38;13 - 00;07;07;25
Anthony Licausi
So you mentioned the unexpected. So how do you teach the unexpected? How do you teach the students that whatever will happen that day is going to walk through the door? And let's say, for example, in an E.R. situation or somebody comes into your, to your, to your practice and there's something that is urgent, how do you how do you go about teaching that to the students when they're. So at that point, you still textbook PowerPoint slides? How do you do that?

00;07;07;27 - 00;08;07;14
Dr. Josh Webb
We we do a lot spend a lot of time helping them map things out, really working from, you know, the chief complaint, what the patient walks through and says, you know, I've got a sore throat and working from that down to, to this, the structure of the anatomy and then the function and then the immune system and how that all works and how that is all integrated and connected. So that way, as we we move through our career, we can just plug in new information and new ideas and new details. You know, the and this has been been true in medicine forever that they say that, you'll learn by 50% of what you learn in medicine is wrong. The problem is we just don't know which 50% and you. But if you have a really strong understanding of how the structure of the function pathology, the parts of physiology, how that works, it's not hard for you to go in and modify and change and learn new things.

00;08;07;17 - 00;08;23;05
Anthony Licausi
So what do you think are the biggest mistakes that the students make when they, they're in this they're in this new environment and they come to you and they're they're going through the class. What do you think? It's the things that the students, you know, just they don't get right in that first in that first setting,

00;08;23;07 - 00;09;57;03
Dr. Josh Webb
they're trying to use rote memorization. I would say that would be the first one, you know, things like flashcards or just memorizing facts without building an understanding. You know, that's a that's what you do in undergrad is you you put together your crib notes and study for your exam, but they really have to work on on that understanding and really try to integrate, that knowledge and really have a good, strong hold on it. And then I think the other, difficulty that students have with is the amount of time that it's going to be required to study, you know, it's deep. You know, we say it's the equivalent of two full time jobs, students here. We use a flipped classroom model, which is fantastic because the students come in and they're in class, you know, between 2 and 4 hours every day. And it's not lecture based. It's problem solving. It's really working through and integrating the knowledge. But when they leave, they've got to go home and spend another 10 to 12 hours really working through. And it's not just doing the pre-work, it's making sure they integrate and understand what they're learning. And for some students, some things are going to be really easy because they came from a nursing background or they came from a biochemistry background, but other areas are going to be challenging because they didn't come from, an anatomical background. So you've got to really identify where your strengths and weaknesses are, and you've got to put in like a lot of time. It's a lot of time. And the students so, you know, I don't know many people that spent 16 hours a day learning in their undergrad

00;09;57;05 - 00;10;46;17
Anthony Licausi
that I was just going to say, that is going to be something that if they did tell you that in the in their undergrad, then that's going to be a surprising, factor, because I don't think any student would spend that much time studying for their major, for example, as they would in becoming a physician. So take me through kind of a day in the life, like the schedule. What do you think is a it's a good schedule as far as studying as far as academic work. And then also, you know, there's sort of there has to be time for non-school related activities. For example, you know, de-stressing exercise is what. So take me through what you think is a great or what you've seen as a great schedule for a student, let's say, from, you know, from morning to, to night.

00;10;46;19 - 00;14;04;14
Dr. Josh Webb
So let's, let's these are semester one students, for example, their their typical day starts at about 8 a.m. in the classroom some days 9 a.m., and they're usually in class between, you know, eight and 11, eight and eight to work for hours. And that's not necessarily every day because they have they have breaks and they have certain periods of time as they have other activities. But, you know, they're in the classroom, let's just say 12 hour or 4 hours, a day in the morning. And that works out to be 20 hours a week at noon. You know, I remember I was pretty exhausted after four hours of, of, of learning at noon, finding some, you know, taking an hour off, you know, whether it's going to the gym, catching up on groceries, you know, FaceTiming with mom and dad or your girlfriend or your wife or your partner back home, you know, having a little bit of social time and then kind of when 1:00 rolls around right back into it. And, you know, we know that your ability to focus is kind of 45 minutes to about an hour. So studying for 45 minutes to an hour, writing things out, mapping things out, reviewing and then taking a little breaks, through the day. And that first, first semester for myself, I would do a little 15 minutes of exercise here and there, just to one to help wake me up, because it's it's you're studying on a level that you've never studied before. Maybe I have a snack. Go for a walk. We see students walking around campus all the time just to get some sunshine and some exercise. Move your body and then back into it. Evening comes around. Maybe you take an hour and head to the gym, and then you're kind of right, right back into it, reviewing, studying, you know, using the multitude of resources we have, everything from from videos. We also have phenomenal faculty. So going and having faculty explain something to help you work through it, help you problem solve. And that's really nice thing about small classroom size and good faculty ratio is the students can come and pick your brain for an hour, and we can really help them understand where the potential knowledge gaps are. And then from there, go back home and try to address those knowledge gaps. I think it's also important for students to make sure that they're testing themselves. So using question banks, you've got a variety of question bank resources, that the school provides. And there's also, private ones, things like, you world embossed osmosis, a variety of different kind of Q banks is what we call them. And the students can go and do blocks of questions because, you know, it's important that because they're examined on those multiple choice questions, they have 90s on average to answer a question. And when it comes to their Mes and then their Usmle, which they're going to need to pass to move into clerkship and, attain a residency, that there's a whole skill set in that alone, just the test taking ability. And I think it's important that, right from day one, your putting yourself there and putting yourself into that testing ability, which for a lot of students was brand new with very minimal medical knowledge. You're not getting many questions, right. So it can feel very humbling, but you're developing that those test taking skills in those tests, taking abilities and you we just continue to improve and further improve until you're you now performing at a much, much higher level.

00;14;04;16 - 00;15;26;29
Anthony Licausi
And those are our key, tenants to the fact that WAUSM uses the NBME exams and they use questions from Usmle to help students on day one, which is, beneficial and not another. Not a lot of schools do that because they want to make sure that, you know, the students have an understanding of how the tests are, what kind of questions they that come from the tests, and how they can kind of navigate and maneuver through the testing. Because, as you know, those tests don't just start with you being in semester one two. They continue all the way into post residency with, of course, with Usmle step three exam. So there's a lot of that that, is it's all great information that you share about about the testing environment that we, set up. So you mentioned earlier about the schedule and the day of the student. And I love from your presentation, you laid out a lot a great schedule, but there's all these distractions. There's there's drama, there's, TikTok. There's, social media. There's all these things. So what what advice do you give to students? Because as you know, people's attention spans may not necessarily be the best when there's all these distractions. So how do you what do you tell students to how they can navigate through that?

00;15;27;02 - 00;17;09;23
Dr. Josh Webb
You know, especially now, things like TikTok and social media are really distracting. They're designed to be distracting. They're designed to make you want to pick up your phone and, oh, I gotta check, I gotta check, and, you know, it's it's all linked into dopamine athletes. And we talk about this in our, in our, neurology, brain behavior unit, how it's designed, how it's wired. And, you know, this is Harvard harvesting your attention in your energy. So my big recommendation for students is to, you know, get rid of all, all of their social media, you know, sure have WhatsApp, because it's not only social media, it's actually messaging. You can message parents, friends, family or iMessage or whatever your messaging platform is, but really trying to, get rid of those energy vampires that are just sucking your attention and not not delivering much in return. And I remember seeing students coming in to see me, you know, later on and not performing as well as they watched. And I said, well, pull your phone and let's look to see how much time you're spending on like TikTok. And, oh, they're spending three hours a day on TikTok. And it's not three hours consecutively. It's 15 minutes here, 20 minutes. There are a half hour. There. And they're like, wow, I didn't realize I was spending that much time. And also sit talk is designed to have, you know, 15 seconds, 32nd video clips. So it it requires our brain to rewire the way that we perceive and process information. And unfortunately, in medicine, 15, 16 seconds are not really how things work, especially if you're going to be teaching yourself Madison. You need to have much greater ability to focus. So getting rid of your social media, which is challenging for a lot of students. But when the students do, then all of a sudden the grades start to go up. They start to perform better.

00;17;09;25 - 00;17;19;14
Anthony Licausi
And to a lot of these students recognize that that was the problem. Do they? Do they honestly then admit that they did have an issue in that area?

00;17;19;16 - 00;17;39;00
Dr. Josh Webb
Absolutely. And that's the nice thing about especially, you know, students coming into Madison are generally, very bright. They're they're mature, and they've got a lot of responsibility and to have a high, high drive and high expectations. So once they make a correction and they see the results of that correction, they be like, oh, wow.

00;17;40;16 - 00;17;45;00
Anthony Licausi
I was going to say self-realization is probably the key because they have to realize that for themselves.

00;17;45;02 - 00;17;47;05
Dr. Josh Webb
Exactly.

00;17;47;07 - 00;18;25;13
Anthony Licausi
So you talk about, some pillars of success that we, want to definitely share with our audience. And, you know, people think, oh, pillars, it's going to be very complicated. It's going to be a lot of, you know, concepts that and it's actually it's very simple things that students need to, to do in order to be successful. And you have here, you know, four which are great. You have sleep, you have eating, you have exercise, and you have de-stress. So tell me a little bit about those pillars and how you incorporate that into the, into the, into the teaching of the students and the curriculum?

00;18;25;15 - 00;20;04;18
Dr. Josh Webb
you know, and those, those, those come from, a long, career of teaching a lot of integrative, health behaviors and helping, patients improve their health without medications and those surgeries really taking charge of their health. So, you know, sleep is really important. We need sleep to, integrate knowledge, integrate information. And, you know, as a med student, you don't have it. We don't have a ton of sleep. So you need to make sure that you're you capitalize on what? Sleep you can. You know, I was pretty sleep, you know, six hours was about average through medical school. You know, some nights, not none at all. If you're really working hard. And as we know, residents and doctors often are up for 24, 30, 48 hours, you know, being quite, quite sleep deprived because it's the nature of the job. But I think it's important when we have the opportunity to really focus on sleep because it's it's nourishing, helps, our bodies, our mind and our soul is, being able to cope with the stress in medical school. Nutrition is also really important. I think it's important that students are putting in, adequate nutrition and making sure that it's, you know, full and nutrient dense foods, avoiding processed foods. We we we know that, processed foods affects cognition. They affect overall, physical and cognitive performance. So really trying to move away from, you know, having chips and, and the soda and instead trying to have, you know, have water, have tea, have coffee, really trying to to model the healthy behaviors that you're gonna want to have your patients model moving on. And the students generally perform at a much higher level versus living off of, you know, energy drinks and chocolate bars.

00;20;04;21 - 00;20;35;00
Anthony Licausi
And do you think that the students, when they hear this from you, because a lot of students are habitual and people are habitual, they do these these practices. They they have their coffee, they have their energy drinks, they have their power bars. They do all these things. And it's just, you know, it's like it's like breathing for them. But when you point this out to them that they have to make a change. What is the reception? What what is that? What are the things that surprised you the most when what you do tell the students that and they they look at you with these wide eyes.

00;20;35;02 - 00;21;34;14
Dr. Josh Webb
What's what's I think what's what's amazing is, you know, we've had some students here lose, you know, 100 pounds in the in the two years that they're on by making small changes, you know, during their break time between, you know, our study sessions, they get up and they go for a ten minute walk and they do that ten times a day. All of a sudden they're walking 3 to 5 miles a day, which they weren't doing before, and then making the nutrition changes and they come back and see me and they say, hey, Doctor Webb, since I made these changes, I find I can study longer, I can focus better, my sleep is better, I'm doing better on all my tests. And I always joke is like, well, it's almost like I know what I'm talking about. I was joking, but when when they make those changes, the performance improves. You know, I used to work with with athletes and it would be the same thing. You take a phenomenal athlete who's eating junk food and you put them on, you know, an appropriate diet and you make sure that they're they're getting sleep and not partying. And all of a sudden their performance continues to improve and improve. Improve.

00;21;34;16 - 00;21;56;00
Anthony Licausi
And those are things that I think people know. But then once they apply them, they're so surprised by the fact that they actually work as opposed to just talking about it rather than doing it, because a lot of people, they love to say those things. But then when you put that into practice, it definitely makes, a great, a great improvement.

00;21;56;04 - 00;22;17;24
Anthony Licausi
I always say that you can have the worst workout plan, but the best diet and you're going to get better results if it that way than if it was the other way around. So I'm glad that the students are taking advantage of that and that you're promoting that because, you know, having a healthy lifestyle is so important to for their for their education as well.

00;22;17;27 - 00;22;19;04
Anthony Licausi
So go ahead.

00;22;19;06 - 00;24;14;17
Dr. Josh Webb
If and if they do have a healthy lifestyle as students, they'll carry on with that in residence and in practice. And we know that physicians that practice a healthy lifestyle are more likely to make impactful changes in the patient populations. They're less likely just to be like, here's a prescription, here's a bill. Yep. They'll get patients moving. They'll get patients improving their diet. And then we see things like reduction of diabetes, reduction of cardiovascular disease, arthritis, joint pain, anxiety, depression. You know, if I could take nutrition and exercise and put it into a pill, you'd have the most profitable pharmaceutical in the history of, of of of mankind. But unfortunately we can't. So you've got to, you know, start putting the work in. Exercise is another important one. We an exercise really for a student is whatever you can do and what to do. You know, like I said, for some students it's walking doing the lap around the school. I think it's a little bit oh, it's about a half a mile a lap around around the school property. And they, you just see them off between classes and on breaks going for a walk. And you'll see them, groups of students, and maybe they're chatting about medical school or maybe they're just dancing and de-stressing. And that takes you to the final thing, is your stress management and really figuring out what your version of stress management is. Maybe it's music, maybe it's dance, maybe it's meditation, yoga, you know, FaceTiming with with family back home, finding some way to kind of reconnect with, with yourself and the world around you. Because when you're here but you then 16 hour days, you can kind of forget, you get the blinders on and you forget about everything outside. They're kind of why you're doing this and saving time with yourself and the outside world. So it's important to have that kind of reconnection to be like, oh yeah, you know, and and that helps promote resilience and wellness. And those are big issues now with, with still with it in, you know, in any line of work and especially in health care.

00;24;14;19 - 00;25;08;14
Anthony Licausi
Yeah, sure. And what do you, what they're talking about all these pillars which is it's it's great stuff. I mean anybody even if you don't go to medical school, you should put that into practice, into your daily life because it's a, it's a, it's a fantastic way of, of life management. So let me ask this question. What is the being that you've been on the island? You're you're one of the founding faculty. I'm sure you have many stories. What is the biggest surprise that you've seen, let's say, from a student that came in on day one and was in a certain mode, they were in a certain funk, whatever you call it. And then by the time that they've gone and then obviously they're going to, continue on to their clinical education. What is the biggest surprise or maybe some, some example that you can give us that you saw that is is a motivator for, for our listeners.

00;25;08;17 - 00;26;50;29
Dr. Josh Webb
You know, I can think of kind of one example for each color. Like I mentioned, we've had, you know, a couple of students who lose a significant amount of weight, you know, upwards of 100 pounds in some, 20 or 30 pounds and others and really improve their health. And they see the physical and the cognitive benefits of that, and all of a sudden their grades go from, you know, barely passing to all of a sudden they're up into the 80s and they're still studying the same way that it's still doing the same work. But just the lifestyle changes helped. We've seen with with sleep students coming in and there's, you know, they sleep 2 or 3 hours a night and they're not sleeping well. They've got the TV on in the background. So they're not really having true restorative deep sleep. They're they're groggy and they're having trouble focusing. And then we get them on on a good sleep patterns of program. And all of a sudden, once again, the grades jumped 10 or 15 points. We see the same thing with nutrition cutting out processed foods. You know, energy drinks is definitely a big problem, because the students want to focus. But next thing you know, if you're if you if you're essentially chain smoking Red Bulls, it's not going to help you, over in the long term. And then with, with that stress management, you know, being at medical school, being away, you know, this is grandma's home is a beautiful island. We have incredible beaches. It's really, really safe. So there's not a lot of stress there. But we do have a lot of students that, you know, it's the first time being away from home, being away from friends and family. So there's a there's a stress there. So just reconnecting with themselves, reconnecting with the islands, connecting with their peers and college, creating some some social space to manage stress. And all of a sudden, their ability to handle stress improves because their baseline stress is lower. So when an exam comes, you're here, not here. Right?

00;26;51;01 - 00;27;46;02
Anthony Licausi
Right. And and those rates go up and up and up. Well that's the I mean that's the most important thing in the student's mind. But sometimes they can't figure out how to do that. And then the of course the answers right in front of them by making all those, life changes, which is such a, which is such a, it's very simple. It doesn't have to be complex. So and the fact that you, you're able to, to help the students do that is fantastic. One last question for you before we wrap up, I wanted to just kind of get your sense of what advice would you give yourself in the first week? So let's say you're the student. You're you're you're coming in to, week one at, at Watson. And you, you know, you've never been exposed to medical school. You're, you're bright eyed and bushy tailed and you want to. What advice would you give to, you know, to Josh Webb coming in as a semester, one student in that first week?

00;27;46;05 - 00;30;18;21
Dr. Josh Webb
I it's interesting that you ask that questions because my my research project as a resident was based on that. What what practicing physicians would give advice to residents newly graduating in the practice. So I really always like, looking forward to help you address your situation. And I see that successfully leaves clues. And I think the big advice would be success leaves clues. So look at your upper classmates. Look at your faculty. Look at the people that are that are in a place or situation that you want to be. And then go talk to them and find out what they found for their success. So if you're struggling with test seeking skills, find someone who's really good at it and how to work hard at it and go learn from them. If you're struggling with, you know, connecting the molecules to the medicine, you go find someone who's really modeling that knowledge and that integration. If you're struggling with doing patient interviews and histories and physical exams, find someone who's really good at that and and go find the clues from them to their success. And and another I guess what I got out of that was that you're not alone. There's others and there's resources and there's people out there that can assist you when you're, you know, going through this experience because a lot of people have gone through it themselves and they know what, what what to do, what not to do. And that the advice that you've given today, I if anybody can take anything away from this, podcast, I think that's that's probably the most important thing is that you're not alone. And there's a lot of people out there to help you. Doctor Webb, thank you so much for your, for coming on to the to the to vital signs today. We appreciate you. We appreciate all that you do for our students. And, hope to, have a great conversation with you in the future. Thank you so much. Awesome. Thank you so much. And for prospective students, you know, all of our faculty have open door policies. So the doors are always open. You can always come by and say, hey, you know, I'm struggling with biochem, I'm struggling with family. I'm struggling with finances. I'm struggling with my landlord. Whatever you need, we're we're here as a fantastic community and we're here to help support and help you move forward. And we're really big on that. Success leaves clues and we're really helped. Interested in helping you get to the point that you can leave the clues for the next generation to come up and solve.

00;30;18;24 - 00;30;27;17
Anthony Licausi
A 100% agree. That's fantastic. Thank you so much, Doctor Webb. Have a great rest of the day and thank everybody for joining us. And we'll see you next time. Bye bye.