Provider Pulse Ep. 32: Dr. Ayman Youssef, MD (Part 2) - From Texas to Harborview: Information is the Key

Getting into medical school felt like the finish line. It wasn't.

In Part Two of our conversation with Dr. Ayman Youssef, Chief Resident of Quality Improvement in Internal Medicine at Harborview Medical Center, we pick up where we left off in medical school in Galveston, Texas where his sense of belonging had to be earned all over again.

Ayman takes us through the culture shock of medical school, a formative summer in Amman working with Palestinian refugees through UNRWA, and a residency match that didn't go according to plan. He wanted Stanford. He got Seattle. He's grateful.

We get into what Harborview revealed about the kind of doctor he actually wanted to be, the chronic illness he had to reckon with mid-residency, and why he's still on his own timeline — deliberately, and without apology.

And we end where the whole conversation has been pointing: information. Who has it, who doesn't, and the additional work needed to navigate medicine without the hidden curriculum that gets quietly handed to people who already belong. Ayman is honest about what he did and didn't have, what he wishes he'd known earlier, and what he tries to pass on now.

This is Part Two of a two part series. If you haven't listened to Part One (Episode 31), start there.

Visit EthnoMed.org for additional resources. Follow us on YouTube and Instagram @EthnoMedUW

Transcript

25_11_05 Ayman Part 2

Chapter 01 COLD OPEN

[00:00:00] 

Ayman: And if you didn't get your reality and ego checked before, it's gonna get checked now. I was on a high of things are going well and then I came like, and I was like, again, a nobody. And I was definitely not the top of the nobodies. and it felt like, okay, I gotta figure out what I want.

Duncan: Welcome back to the Provider Pulse series of the EthnoMed podcast. I'm your host, Dr. Duncan Reed, a primary care physician at harborview's International Medicine Clinic and Medical Director of EthnoMed. This is part two of a two part series.

If you haven't listened to part one, we suggest you listen to it [00:00:30] first. In part one, we followed Ayman Youssef from a childhood of not fitting in. Too Egyptian for one world, not Egyptian enough for another. Through a chaotic undergraduate career at the University of Houston, to the moment he sat down to write his medical school application and realized for the first time that medicine might actually make sense for him.

He got in. He was on the island, Galveston, Texas, home of the University of Texas Medical Branch, and he arrived with the same approach he'd carried through every new environment, be [00:01:00] authentic and find your people.

But medical school had its own version of the belonging problem and the path from there to here to Harborview to chief residency to the work that we heard him describe in episode one. Took more turns than he expected.

Chapter 02 Medical School

Duncan: How was medical school? So you worked very hard in undergrad in terms of the workload, in terms of academically, how did it compare to what you had been through?

Ayman: I think med school, when you get through the pre-med and the undergrad part, the [00:01:30] fog kind of clears up a little bit. the path is a little bit more clear. Okay, this is the focus.

Duncan: And everyone's taking the same classes, at

Ayman: Everyone's doing the same thing. Different interests there's still different paths along the way. but everyone's doing the same thing, which can kind of strip some of that identity 'cause everyone just all doing the same thing all at the same time.

And you're also surrounded by people that are good at. school, and very intelligent, very sharp, very, talented in a lot of different ways. Now you're surrounded by a high [00:02:00] concentration of them, a high concentration of people.

And if you didn't get your reality and ego checked before, it's gonna get checked. Now, for some people it still doesn't, but your time is gonna come, everyone's time is gonna come at one point or another. And definitely for me, I was on a high of like, things are going well and I'm working hard and then I came like, and I was like, again, a nobody. And definitely like amongst nobodies, I was definitely not the top of the nobodies. and it felt like, again, okay, I gotta figure out what I want. You know? 'cause there's a lot of different ways to approach medical [00:02:30] school.

do I wanna really work super hard where I wanna like, score super well and do everything super well so I can get into a competitive specialty? cause that is the very near future of stress that you have to deal with.

Or, you know, I'm gonna get through, I'm gonna have a good time. I'm gonna learn, Maybe I'll be competitive. Maybe I won't. I think I was more somewhere in the middle of that leaning towards like, wanting to be competitive. 

the only time I think I became kind of obsessive was during step one it was still graded for us. 

And honestly, med school was far more of a [00:03:00] grind in terms of just sheer hours rather than juggling and like this feeling of like, I can't ever, I don't know if this is gonna work out undergrad's. Like, is this gonna work? And you're like, hopeful that you'll get an A in this class. And I hope this freaking, professor doesn't just do something crazy on this exam.

 Med school is less of that in my opinion. It's more of like, investment of sheer amount of time. Some people need less time than others, but everyone's gonna need to put a lot of time. And I think it's getting good at shaving down how much time you need, but [00:03:30] everyone's gonna need to put a lot of time.

 Even the smartest people put hundreds upon hundreds of hours. know, you may do hundreds more depending on where you're at. For me, in my mind, it became more clear like, okay, I just give, x number of investment and I will get outcome. I reminded myself again that I can do this after I had all this like, imposter. I think imposter is a recurring thing. So I did well in step one. I did really well. I was not doing research.

I was not doing all the other things to, be super competitive.

Duncan: What were you thinking about in terms of [00:04:00] doing

specialty at that point?

Ayman: medicine kind of just felt right, you know? It felt like, just like, you know, oh, you know, it's everything, you know? So, you know, part of it was like, I couldn't figure out like, necessarily like, where I felt like the most close to medicine, just kind of felt like all of it.

CHAPTER 03 Shadowing, Access, and the Uneven Playing Field

Duncan: Ayman was doing well. He had good scores, but somewhere in the background of this period, and it had been true all along, was a quiet disadvantage he hadn't been able to fully compensate for. The kind of disadvantage that doesn't show up in a GPA.

one of the things we were talking about, at least [00:04:30] with the minority association of pre-medical students. Yeah. Is just shadowing experiences was a

big barrier. 

Ayman: yeah, yeah. I'm happy to talk about that too.

Duncan: much easier if your parents are doctors or if your friends family's doctors, because I think a lot of these shadowing experiences happen informally.

So if you do come from a background where you don't have connections that is just one of the additional hurdles.

Ayman: I, I'll say for sure,

Shadowing as a weak part of the application

Ayman: that was the weakest part of my application and one of the areas I was most stressed about. I was able to shadow in [00:05:00] a, family medicine clinic it was not substantive.

 I know it's become more competitive and this has become more heavily, something that they're looking for. at least from, my conversations with different people I've mentored over, time.

 really wanting a diversified experience. A lot of hours,not just shadowing, but kind of, you're actually doing something, 

Straight to medical school or extra time

Ayman: So then I guess what's most helpful from your story is that it is a barrier is a barrier. and then, depending on your access or your family connections, that barrier becomes.

Yeah.

Duncan: A bigger one.

Ayman: You have to really try hard and I would say like, there's certain [00:05:30] things you can't get around. So a lot of this stuff, I think part of it is acknowledging, your privileges and lack of privileges. And sometimes, that can be empowering in itself.

 making it part of your story. It's not the story necessarily. You know, you still have to, show you interested in care and like, it should make sense that you wanna do this. 

 it's important to acknowledge this for yourself and it helps set some of the expectation of it is gonna be hard. That's just the reality. Everything in our society is inequitable [00:06:00] and unfair everything. So the sooner that that is apparent and accepted, the more you know what you're signing up for.

And there are alternatives. And I think for me, I, accept there were alternatives to this and that there are people that are far more prepared, to just thrive. I think, knowing early on, okay, I'm gonna have to work harder, I'm gonna have to probably search much earlier. So rather than starting to look for shadowing experiences in my second or third year, I should probably start, first year I might need to take time to [00:06:30] actually find more of that stuff.

So I think just being realistic and forgiving with yourself that like, because you already don't fit the mold, you're not gonna fit the mold. Accepting that and then giving yourself the forgiveness and grace to kind of find how that is actually gonna work out. If it works out and everything's seamless and there's no gaps and whatever, great.

Good for you. But if it's not, feeling like the smoothest way of doing things, allow yourself that. Because what I've seen in other people is, and even myself pushing through and really trying to force something and, really just [00:07:00] trying to go through a process, as if you have no challenges that are different than anyone else, really. I mean, first of all, it's just mentally destabilizing. It sucks. you're gaslighting yourself in a way. 'cause when you don't succeed and you haven't acknowledged that like there's different limitations, different hardships, then you're never gonna feel okay with that failure.

I think contextualizing that for yourself I could have maybe been successful if I did things a little bit differently knowing the challenges.

Duncan: So what you're actually really advocating for is a very realistic [00:07:30] perspective and say the playing field is inequitable. Be honest about where you're coming from and what things you have control over. And give yourself enough grace to say the way that I need to approach things is going to be different than some other people in a different situation.

Ayman: Yeah. And that's completely acceptable. And it might be more difficult, it might be less straightforward, but it's equally reasonable. so going in eyes wide openI think so. For me, absolutely, I balanced things that I, didn't have [00:08:00] access to or privilege to. my privilege is already like I am white appearing, my parents pushed me very hard.

So, that kind of was instilled in me, even when I didn't have it myself. I definitely had the feeling of fire underneath me in terms of I need to do well regardless, because I don't have money and so money's gonna run out. And so even when I didn't have the motivation, that was a motivator.

those things that benefited me. I think I balance things by, where I didn't have access to shadowing or testing [00:08:30] resources or the actual experience of what it means to be a doctor. I compensated with trying to work very hard and then trying to be very authentic.

 I didn't like water down my story, but I shared my story not in an entirely raw way, which may not always be received, a hundred percent, well, 

Really kind of thinking about your identity, thinking about your experiences, and actually, like how does that translate to why that manifests as being a, a doctor, as being meaningful for me, I experienced a lot of suffering, hardship and [00:09:00] that gives me life.

Duncan: That sense of purpose. Something Ayman had found slowly and almost reluctantly was about to get a sharper definition between his first and second years of medical school. He did something that gave the vague idea of becoming a healer a much more specific shape. He went to Jordan.

Chapter 04 Amman - Six Weeks with Palestinian Refugees

Ayman: I was in a focus track, in community engagement. It was called community engagement pathway. and that was a combination of global and rural health. 

I spent time after my first year of medical school as part of the track. I did six weeks [00:09:30] working in a internship at the United Nations relief and works agency for Palestinian refugees. So UNRWA in Amman Jordan,

 I have some Arabic, um, I'm familiar with. I'm not fluent

 you got like. Basically an Airbnb, it's just like a random building with three other people from my, medical school group you Uber 

kind of navigating around, being in a place that you've never been before 

They had us start working on a qualitative project interviewing Palestinian refugees who came from Syria into Jordan after the Syrian, [00:10:00] crisis to assess how their experience was transferring services from UNRWA in Syria to UNRWA in Jordan like.

 Discrimination, poverty, lack of access to resources, et cetera, et cetera. So interviewing staff, what they perceived, the challenges and hardship. So it was interesting, 

 I had this like really interesting, group of folks who had already worked, people that had established themselves in academic medicine, but, would say things that you don't typically hear, in academic medicine, they were talking about capitalism.

They were talking about, inequity. [00:10:30] They were talking about privilege. They were talking about, colonialism. They were talking about United States Empire, all these kind of aspects that you typically don't see infused. A lot of times it's becoming more so accepted and, and part of conversations.

as these things become more accepted in, broader culture. But for me at that time, I was like, this is really cool. These people they care a lot 

Duncan: And that's the first time you're getting exposed to that kind of.

Ayman: uh, you know, I got exposed to that stuff a little bit in college kind of exposure to politics, with Bernie Sanders and all this stuff, and, [00:11:00] kind of these conceptions of things. And I already had my own lived experience, which, for me always felt, not aligned with the, current power structure of the United States both politically and economically.

but you know, these experience in medical school, these kind of formal lectures, these, these professors, these people are like speaking to my experience, things that I care about. So I carried that forward and when I was interviewing,

I really wanted to go somewhere that had a global health program or like global health experience. Like, I really wanted to keep doing the experiences overseas in global health.

CHAPTER 05 Applying for Residency -- The Global Health Dream

Duncan: Global health had become [00:11:30] the organizing principle of a amen's sense of where he was headed. And when it came to apply for residency, he built his entire list around it. He also, for the first time, allowed him to be selective because his scores gave him that option.

Ayman: fortunately I had good scores and I didn't want to just go anywhere, I was selective.

There was places where I felt like I would be okay going to and I could see myself potentially being happy, I applied, I think to like ultimately 26 or 36 total, which was on [00:12:00] the lower end though, than a lot of people I wanted to be by the sea, and I wanted to leave the south. I was tired of hurricanes, I was tired of like highways and roads and lack of public infrastructure I really wanted to go somewhere that had a global health program

Duncan: Stanford, had exactly what Ayman was looking for. A standalone, well-funded global health track built into their internal medicine residency. You could be trained as an internist and have your entire experience shaped around global health work.

They could send you anywhere. It was [00:12:30] on paper, the exact program Ayman had been orienting toward. There was just one problem.

Ayman: I got interviewed at Stanford. I got interviewed at UDub And I got interviewed Vanderbilt. 

And those were my, top three. All of them had, global health, programs. I ended up ranking Stanford first, even though I didn't feel like I related the best, to the people there and the experiences and kind of the nature of the interviews.

but they had a very robust, global health program. It was like its own track very well funded. 

 so I ended up ranking [00:13:00] Stanford, Vanderbilt, and then UDub 

 1, 2, 3.

CHAPTER 06: The Match -- Ken Steinberg Cries

Ayman: And I remember getting the match results. I got ranked to here. Obviously, I remember being sad, initially, disappointed. And I remember getting the phone call from program director Ken Steinberg and I was very surprised that he called me 

He was very genuine. very genuine person, I think is the best way to describe him. I remember,he was letting me know, hope you can join us later today when we all get to meet each other over Zoom and we're gonna do this [00:13:30] later as a kind of like hurrah. I think he cried, you know, he cried in that first initial, like, like, I don't even know this guy.

I don't know anyone on this phone call here. And, he cried and he shared some poetry, cried. I was like, oh wow. You know, like, I love this. and I, remember like, it didn't take long after I got here. And the funny thing is, when I first was looking at residency programs, I liked Seattle and it was like initially on the top of my list, but as I became more focused on like, trying to find the place that met my ambitions and, I felt like, [00:14:00] oh wow, I have these scores, I have these things and I have potential and I really want to ambition match now my career, I start thinking about these things.

 and ultimately looking back, I'm so glad that didn't work out that different way of me doing things where I was really focused on like the future and the career and all this stuff, rather than listening to my gut, because I think I would've been miserable at both those places, you know, great places, but I think this was not like a match for me at the, at the time 

Duncan: and your personality is well suited for here, right?

Ayman: right. I think so. Like, everyone is kind of like very just [00:14:30] authentic in a way, and themselves, and I immediately just kind of felt very, comfortable and I felt like, you know, this, this was right.

Duncan: Ayman arrived at UDub having wanted to be somewhere else. Seattle ended up being the right place for him to discover what he actually wanted.

Ayman: I remember having Harborview as a rotation on the wards, my first year. And I remember it felt very aligned, like the mission and the kind of patients that we're caring for the people and the things that I was hearing espoused, things that people cared [00:15:00] about.

The way that we treated patients, for me really stood out. And as I was having these experiences, I was really just falling in love with, actually working really hard finding out what kind of doctor I wanted to be. Like, what that looked like for me. And I, tell interns that's your goal for a first year.

Like, you're focusing on that. everyone's gonna learn things. You're gonna continue to learn things and you're gonna osmotically improve and get better and know things, you know, know things more over time. Like, don't worry about that. You're supposed to be wrong. It's really weird. If [00:15:30] you were right about a lot of things ' cause why would you know everything perfectly?

Medicine is, hard 'cause there's a lot of seemingly right answers to every kind of thing. But you're really kind of figuring out your identity, what kind of doctor you wanna be and how you wanna practice, how you wanna talk to patients, how you wanna do all these things, how it makes you feel.

And I think it's a very emotional experience. and if it's not an emotional experience, I think there's something missing potentially. it really should be challenging you, it should be pulling at you. It, it is hard. It's [00:16:00] hard seeing people die. It, it's great when you see them get well.

It's harder when you see them get sick again or when people don't improve at all. You kind of really immerse yourself in that. I remember being disappointed that I, didn't match the Stanford or whichever this idea like, wanted to be some global health doctor that I didn't really have a good conception of what that even looked like.

It faded away, you know, I was like, I don't need to go somewhere else. Like, there's a lot of need here. This is where I need to put my focus first. I need to be a good doctor here. Like, I don't need to be running around and, and no, disrespect on [00:16:30] people who are like doing that and, where that makes sense in their journey.

I think this is my journey. but for me it didn't make a lot of sense anymore. My interest in what felt meaningful to me. And I'm still figuring that out.

Chapter 08: Chief Year, Chronic Illness, and the Limits of Willpower

Duncan: Residency, then chief year and with it had different kind of tests, not the academic kind. The kind that involves your body and what happens when you have been working flat out for 20 years. And when just working harder is no longer the solution.

Ayman: Part of being a chief was 

 exploring more of the reality of working as a [00:17:00] doctor, but working from a very particular lens of professional development, having different types of responsibilities and roles, and then knowing how a system works. I really was curious about how the hospital operates, being on a different end of things in terms of actually delivering care.

I'm glad I got this position being in quality and safety. 'cause there's so much in it that I think is helping me grow as a human being and as a doctor professionally. I'm getting to talk and meet so many people

 it's really humbling to reach out to an attending and talk to 'em about a potential mistake thatwas made. I'm just someone that graduated, they've been [00:17:30] practicing for, a decade plus or whatever number of years more than me is, that's a humbling, dynamic.

I'm still figuring out my process. Like I'm interested in pulmonary and critical care. I like being challenged by the patients who are very sick and where things feel bleak, but also there's interesting pathophysiology like diseases. Also we're sharing that space with people who are really trying to cope and understand what is happening to someone they love or themselves.

 I'm figuring out, I'm balancing it. I have, things that have happened to me over residency [00:18:00] that I've had to balance I've, come to understand I have some chronic diseases. I have autoimmune disease and I have a sleep disorder, And those have been real things that I've had to reckon with,I can't do everything. And part of me, like going through this whole process, like as hard as I work, I can make things happen. And that's not true always. And I think coming back to, it's okay, you know, I, I really love this thing and I'm giving myself some time right now, I don't fit the timeline of going from residency into fellowship. I'm doing this chief [00:18:30] year, which is already another year, 

my plan was then to do a year of hospitalist after chief year to, then apply, end of chief year.

 I now have changed that to two years of hospitalist because I want a full year of, being a hospitalist without having to think at all about something different and making sure, if I really want this or not, to go into the specialization and do the whole interviewing and application process, which can be really hard and frustrating.

 I'm bringing up that point. 'cause, I don't have everything figured out still as glittery and maybe from the [00:19:00] outside, like, oh, look at this super successful guy. I think there's been so many missteps and real big failures along the way.

but you can still get to something that feels like it's right for you at the end of the day.

Duncan: If there's a through line across everything Ayman has described the bullying, the engineering wrong turns, the medical school culture shock.

The match that didn't go as planned. The body that set its own limits, it's this. He did most of it without a map and a lot of the extra difficulty came not from the obstacles [00:19:30] themselves, but from not knowing they were coming.

This brings us to the part of the conversation Ayman returns to information and who has access to it.

So my question is now if you look back on your younger self who's even in undergrad, what advice would you have in terms of finding someone that could make life a little bit easier? 'cause you did things a little bit the hard way. Are there specific things that you could think about? 'cause there's kids [00:20:00] at home right now that are, undergrads at University of Washington, a lot of places similar to you.

They grew up in circumstances that were not ideal. They're working really hard and then they just feel like things are stacked against them and they don't know the path forward.

Ayman: yeah. You know, part of me, part of me feels like this is exactly what I had to do. To get here is, I had to struggle like this. And part of this, there is a reality where it is gonna be struggle. It is gonna be hard because, things are stacked against you. It doesn't mean it's not possible, it just [00:20:30] means that, there are a lot of things that are in the way.

And there are many more people that have far more disadvantages or hardships that I don't. 

 one thing I'm learning now, and I, and now that I have the ability to talk with people more.

It's something I haven't done well in my life. And I think that's part of this, experience of growing up, with having people in your life talking to you. And this idea of mentorship is such, actually, I think a huge thing. it is like a very unique thing.

And, the concept of mentorship and like being very open to that. I had a mentality [00:21:00] that I, think other people who come from similar backgrounds of having to work really hard and struggle through things and push and, you know, effort, effort, effort, effort.

You don't let people help you. I definitely have a hard time receiving help.I think accepting that you need help and then how to get help. You know, many times I didn't realize I needed help.

There were times that I, knew I needed it, but I didn't know how to get it and then acting on it, you know, so there's, there's so many aspects to that. How do I be successful in undergrad?

How do I [00:21:30] get this experience? How do I get into med school, I think what actually will serve you well is really being honest about. What are the hardships, what are the things that you don't necessarily have access to easily?

I think once you recognize what your hardships, limitations, whatever you wanna call it, is, then, you know, okay, this is where I need to be strategic. If this is really what Your goal early on is, I want to be a doctor, whatever. It's pharmacist, nurse.

It honestly doesn't matter. [00:22:00] I think one thing I, I wish early on, and which I tried to help with my brothers is seeking a real mentor, which is someone who agrees in this partnership to continue helping.

And, it's not equal. They're giving you a lot, to mentor you But a true mentor who is like willing to give the time and energy and invest and, keep dropping ladders for you to climb up on, that's hard to find, may not be present for a while, but I think really pushing yourself to ask questions [00:22:30] early on.

Like it doesn't matter. Don't be shy. Like ask people like. Hey, I, I'm really curious. I'm so and so. I'd like to kind of at least hear what it's like for you to be a doctor or what it's like being a nurse. there's, formal ways to do that. You know, a lot of people, they have a family or a friend or someone make that connection and do that for them.

But, you know, I don't think there's anything wrong with trying to reach out, I think there's lots of ways where like people show interest and they email 

 Let's say you're someone in high school or undergrad and [00:23:00] you email one of the people's whose emails are, available online as like a reach out and you say Hi, you know, 

I'm, I'm very interested and you show like this genuine interest. I find it hard to believe that people would not actually connect you with the right person. And you may not get access, but you actually will get information. Potentially, you might get to meet someone and at least you've made a connection in someone's mind.

 I think I really would've benefited early on from just information. I think what we're talking about a lot is information. [00:23:30] There's a lot of people that get handed information, but the sooner you understand that, okay, what I really need to do, yes, the grades and all these things, what I really need to do is look who could be people that gimme information, and that might be a little bit of a protracted process.

 You might start with someone that you think could help you and then they like maybe give you some things and they be like, actually, you need to talk to this person. And eventually, you know, after a few iterations, you might find the right person

Duncan: Um, no, [00:24:00] I think that's exactly

Ayman: you might find me, you might find Duncan.

Duncan: Yeah. And I think I'm notoriously bad at responding to email, but I think the, and when I was a young person, I was crestfallen when someone wouldn't respond to my email. But what I'm realizing is that there's such a low barrier and it's fine to re-say and say, Hey, just bringing this to the top of your inbox.

And I'm like, I'm so sorry. and what I now realize being in this role is there's nothing personal. Yeah. That person's just [00:24:30] very busy. Yeah. And if you're persistent enough, I don't think I ever view it as being annoying. I'm just like, oh, thanks for giving me the opportunity to respond.

And I really do have the best intentions and I really do want to connect. And then maybe I'm not always the best doing that, but I think a lot of, yeah, doctors feel that way. And if, if there's an opportunity to connect with someone that's put in their lap, they would, they would love it.

Ayman: Yeah. what I would say to the other situations where like, trying to connect with someone and they're not very nice [00:25:00] about it or whatever kind of negative interaction, then, that clearly was not gonna be constructive anyway, so saved you, you know, okay, next.

You know, like that's not gonna be the experience every time, so you might as well shoot your shot, like literally cannot harm you

 The information Ayman is describing isn't the kind you find in the catalog or a guidebook. It's the stuff that gets passed quietly from one person to the next if you happen to know the right person.

Chapter 10 The Hidden Curriculum - What Isn't Written Down

Duncan: And that hints at too, at the hidden curriculum? Yeah. Because there's the syllabus. [00:25:30] I mean, all these med school syllabi I think are on paper. But then the real experience of being on the wards of understanding how the power dynamics work, that's a completely different thing, right?

That there's very few things that are written out that explain that.

Ayman: I mean, just think about like any of the times where you're about to start something new and if you have, you know, a friend or someone, you reach out before the rotation starts or before anything starts and you say, Hey, you mind if we chat on the phone quick or like, you know, walk me through like what this's like, and that's real life.

[00:26:00] You know, when you start a new position, hopefully the person that you're taking over from will sit down with you and give you a real, you know, it's not on the computer, it's not on the document, it's not on the email, but it's like a, you know, we're gonna have coffee and we're gonna like talk about, this is the reality of like

Duncan: And maybe that's what mentorship really is, is giving you the low down information that's not written down.

Ayman: still have to do all the work and you still have to figure it out. But you know, it, it is helpful to be like, okay, I'm just letting you know right now that, although it is how it looks online, but you really need to actually have your stuff ready, like [00:26:30] three, four months actually ahead of this, et cetera, et cetera,  Someone who doesn't know all these things, you're gonna come to find like, it's not gonna work out because I didn't know this

Duncan: Yeah. And I think framing it in terms of how can you get information because there's certain types of information that is not readily accessible in formal avenues.

And what you need to know is what do you really need to do to get to the next step? 

Right. And that's the question. And then certain people have access to that information and certain people don't. information is the key [00:27:00] to forming your path.

Yeah. And then there's a hard way of doing it like you did, you did the blood, sweat, and tears. Yeah. You point out that maybe that was the only way that it was gonna work out for you anyways, but then there's even small ways, to be a little bit more strategic,

Ayman: Yeah. And, there's always gonna be some blood, there's always gonna be some sweat and there's gonna be tears, you know, and I think part of that is just human development. You know, it's the experience. And like, those aren't bad things when those are happening.

And there are opportunities to, be growing and improving and, [00:27:30] reflecting. But, probably, you don't have to go through all of it, you know? And I'm still putting myself through some things. I'm learning finally how to, advocate for myself more.

part of that process like that when you grow up, I don't know what it is, but yeah. I, I know what 

Duncan: it

is. You're kind of not entitled. You don't

Ayman: not entitled. You don't, not entitled. Yeah. You know, I think you, you don't really have that, that, that ability to really advocate for yourself.

It doesn't feel, you know, natural.

Duncan: 'cause you don't feel like you belong. It's the same thing that 

Ayman: don't [00:28:00] feel like belong. 

Duncan: You feel like, you know, you're this chief now and you still feel you're not entitled Yeah. To all the privileges of this position that someone else from a different background would say, of course I'm entitled to these even if I'm not a chief.

Yeah. Even if I'm just an intern.

Ayman: Yeah. And I think that's just, part of the, longitudinal process of when you enter these spaces, um

Duncan: part of it's cultural too, though. Mm-hmm. Right. That part of it is the humility of different cultures for sure. Which don't allow that. And you see it at play all the [00:28:30] time in medical education.

Ayman: Oh yeah, there's a lot of interfacing dynamics behind these things.

Duncan: Yeah. And becoming aware of them and like what you were saying is the hard stuff is like understanding what you need. Mm-hmm. And where you are. And those are not painless things to go through. Yeah. But they're going to pay off the biggest dividends because wherever you go, you're gonna be there.

Right. So the sooner you figure out what makes yourself tick, yes. The better off you're gonna be because you have quirks. I guarantee it. But as long as you can be [00:29:00] aware of them and anticipate them, that can help you a lot.

 That exchange about entitlement, cultural humility, and what it costs to spend years not quite believing you belong in the rooms you've worked to enter, might be the most honest part of our conversation.

Ayman: And finding, you know, who are your advocates? there's those connections that like, yeah, this person has power, this person has the ability to help me. But then, you know, you might find people, you know, you, you were one of those people to me, like, you know, it wasn't necessarily like you were going to elevate [00:29:30] me in terms of like status or like, you know, privilege But. You as an individual, you know, you Duncan, you know, showed me like someone who was themselves, like yours authentic, and showed me that that was like a real thing that was possible. Like that you exist, you exist 

Duncan: and

in medicine,

Ayman: medicine and your act of being yourself was important. , So I think like finding those people and just reminding your yourself of them.

Duncan: which was not tolerated in medical school when I went to medical school, [00:30:00] they did not appreciate that. They still don't appreciate it.

Ayman: Yeah. And I, and I think, you know, it's still harder to make that space for yourself, but you just have to be aware, like, what you need. I'm glad I'm here and, I would be having a little bit different time than at another place.

And

Duncan: But you would still make it work though, knowing you, you would still make it

Ayman: still would find that nook or cranny.

Duncan: and if you didn't get into med school, you'd still make it work too.

Ayman: Yeah.

 Dr. Ayman Youssef is a chief resident in internal medicine at Harborview Medical Center, where [00:30:30] he runs the department's morbidity and mortality conference and works in quality and safety. He's planning to pursue a fellowship and pulmonary and critical care on his own timeline, on his own terms. If you're somewhere on the road, he described in these two episodes, pre-med, medical school, residency, or just trying to find your footing in a system that wasn't built with you in mind. A few things from Ayman worth carrying with you. Information is a real currency. The playing field is uneven, and [00:31:00] acknowledging that isn't an excuse, it's a map. And being yourself consistently in rooms that weren't designed for you helps everyone who comes after you. Thank you to Dr. Ayman Youssef for giving us his time and sharing his story.

This has been The EthnoMed Podcast. I'm Duncan Reid. To learn more about the communities and clinicians doing cross-cultural care in the Pacific Northwest and beyond, visit ethnomed.org. . If you enjoyed this episode, please [00:31:30] share it with a friend.