Dr. Kaylee Spano, MD: 2nd-Year Pediatrics Resident

Join me and Dr. Kaylee Spano, who just finished her intern (1st) year of General Pediatrics Residency! Congratulations! Kaylee and I talk about some of the logistics around residency years and schedules, and we dive into what drove her to pediatrics and what she's hoping to sub-specialize in after residency. We also talk about medical education, research, and other ways we explore what the right niche is for us!

Transcript

SPEAKER_00 0:02

Okay, welcome back to another episode of In Practice. And I'm super excited today because we have our first, well, not our first resident, but our first early resident. So I have Kaylee here, who just finished, if I'm right, Kaylee, you just finished your intern year and you're gonna start like regular residency soon, or maybe you you just did because July 1st just passed.

SPEAKER_01 0:23

Yeah, exactly. Yeah. Um just why don't you just share?

SPEAKER_00 0:27

Why don't you just share um you know what you just finished, what you're starting, what you're studying, whatever you want to share about yourself.

SPEAKER_01 0:36

Yeah. Um, so I just finished my first year of pediatrics residency, um, which we call our intern year. And then after that we start residency, although intern year is kind of a part of residency as well. Um, so now I'm a second year pediatrics resident, um, which looks similar to intern year in like the clinical settings that we're in, um, but you have a little bit more autonomy and a little bit more leadership as a part of your roles.

SPEAKER_00 1:06

Yeah, very cool. Um, if you don't mind sharing where you're doing your residency. Yeah, I'm at general. Very nice. And where did you go to medical school?

SPEAKER_01 1:16

I went to Tufts School of Medicine here in Boston.

SPEAKER_00 1:19

Are you a Boston native or did you come here for No?

SPEAKER_01 1:22

I'm from I'm from Long Island originally, um, but I came here for undergrad. I went to Northeastern and then Tufts, and now I'm still here. So I've been here for a while now.

SPEAKER_00 1:31

Nice. And just some logistical questions first, because I also have some confusion about this. Why intern year? Like why does that exist? What exactly is it? I actually thought you only did it for more specialized residencies, like neurology and things like that. So I'm curious to hear about it in the pediatrics context and context and what that is.

SPEAKER_01 1:52

Yeah. Um, so I think it's it's more of a title for the first year in in um programs like pediatrics and and internal medicine that are a little more general. Um, so everyone who's a first year is called an intern.

SPEAKER_00 2:07

Okay.

SPEAKER_01 2:07

Um during in my program specifically, we also had prelim preliminary interns, and they kind of after the first year peel off into their respective specialties. So we had a dermatology resident, a radiology resident, and an anesthesiology resident. So sometimes intern year means that you're just doing your first general medicine year before you go off into the advanced specialty. But for something like pediatrics, where your whole residency is going to be pretty general, intern year is just the first, the first year.

SPEAKER_00 2:40

Okay. Oh, interesting. So that that makes a lot of sense. And do you feel like people are then usually saying prelim when they're going off to a uh like a different specialty? Okay, and intern year.

SPEAKER_01 2:50

Yeah, usually they call themselves a prelim, but okay.

SPEAKER_00 2:53

That makes sense. Um, well, tell me a little bit about what it's been like leaving medical school, and then we can talk about what it was like being in medical school, but I'm curious to hear. I'm I'm sure it was quite the change. You're sort of like really working for the first time.

SPEAKER_01 3:08

Yeah. Yeah, I think I really enjoyed the like actually being a doctor for the first time and like actually having a job and getting paid for the first time was pretty nice. Yeah. Um, I think there's a pretty big jump just in like responsibilities and expectations from med school to inter year. Um, even though like you graduate med school and you start intern year with the same amount of medical knowledge, um just having that title of like being a resident, being an intern in the program, um, there's a lot more responsibility and expectations placed on you. And I really liked that because it felt less like I was just there to learn and more like I was really there to be incorporated into like the medical um team and like I am there to learn, but I'm also like feels like I'm making more of an impact on my patients as well. Um, and so I I'm like very happy with the transition from being a student to now.

SPEAKER_00 4:10

That's awesome. How would you compare it to rounds and rotations in third and fourth year? Because I know third year can be really intense with you know the six-week rotations that you're doing. And I do feel like a lot of med students will say that you feel like you're working, but you're not quite working. So I wonder what what that was like for you.

SPEAKER_01 4:29

Yeah, I think as a resident, um, and this might be different for different programs, but at least in my pediatrics program, where which is pretty small, um, you feel more invested and like it feels like the attendings are a little bit more invested in you because, like you said, it's not just a six-week rotation. Like we rotate on and off service, but we're really gonna be there for the full three years. And so it feels like people are a lot more invested in our learning. Um, and you also just get to know people a lot better, so it feels like a more of like a tight-knit community.

SPEAKER_00 5:04

Yeah.

SPEAKER_01 5:05

Um, but rounds are the same as med school and and intern, the format of rounds is the same, it's just a different responsibility that you're taking on. Yeah. What made you choose pediatrics? I probably was always gonna end up in pediatrics, um, but I'm someone that feels like I need to make sure nothing else is like a magical world first. And so I was a pediatric medical assistant before um medical school, and then I went to medical school, thought I was gonna be a surgeon for a minute, had my first day of surgery rotations third year, and immediately was like, this is definitely not what I want to do. Um and so that third year of med school was like really helpful for me, just like actually being able to try out every specialty and and see um what was really it for me. And I I love pediatrics because I really just love working with kids. Um, and I think most people that go into pediatrics will tell you that it's really the kids that that bring you in. Um I just like I can't I actually cannot imagine doing medicine with adults. Like I kids make me so happy, they are so they get better and they have such like a positive outlook on life that it's like it's hard to be in a bad mood when you're with kids all day. That's awesome.

SPEAKER_00 6:28

Yeah. I um I tutor a lot, and so I tutor kids and I do, especially when they're young, I really enjoy it. I I don't unfortunately love working with like middle school and high school kids as, but young kids are are awesome and very excited about everything. So I I actually totally understand that. Um I'm gonna ask you almost like a question that I always think about because I've thought a lot about pediatrics and pediatric subspecialties because I love working with kids, but I'm always worried that I won't be able to handle sick kids, that'll make me too sad. And I wonder, so general peds, I know is a little bit different. You're not usually seeing, unless you're a hospitalist, you're not seeing as severely sick children. But I'm curious, like what if you've seen any kids that are really sick, like how it's impacted you, how you've thought about that, how you thought about dealing with that.

SPEAKER_01 7:17

Yeah. Um, so at least in residency for pediatrics, you do see a lot of really sick kids because we're rotating through everything, and we spend a lot of time on um the oncology service. Okay. And so I have seen a lot of sick kids, and I I've seen some kids that didn't do as well as others. Um, and I think it's it's really hard to to see that, of course. Yeah. Um and I think there's like something special about pediatrics because we don't see it as much that when it does happen, it's like everyone, the entire community is so affected by it. And there's there is an emotional response, which I think sometimes in adult medicine is a little bit more subdued or pushed down. Um, so I actually really like that about pediatrics. It is obviously really hard to see like bad outcomes, but like being with a group of people who are not afraid to like be emotional and be like, hey, this is a really abnormal and horrible thing. Um is something that I felt really supported by like going through that during my intern year.

SPEAKER_00 8:26

That's awesome. It sounds like you have a great program as well to feel that way. I'm sure not for residency. I will plug, I will plug the MGHPs program. That's great. That's awesome. Um, and then are you thinking about specializing at all or doing any sort of like fellowship or anything like that after uh residency, after general residency?

SPEAKER_01 8:46

Yeah, um, I'm super interested in allergy and immunology, um, which is actually a weird specialty because it's adults and kids. Um I hope to one day get back to just doing kids though, but we'll see how where my career takes me. Yeah.

SPEAKER_00 9:03

What uh led why why does allergy interest you or like immunology?

SPEAKER_01 9:07

Yeah. Um, so I think whenever you're thinking about what specialty to go into, um it's important to kind of like figure out what your values are and like what you enjoy throughout residency. And for me, I realized pretty quickly that the outpatient setting is more um my speed. I like having a schedule and I like knowing what my day is gonna look like. Um just something that inpatient medicine doesn't really allow you. Um and so I knew that I wanted to do something outpatient. Um, and I did a rotation during my fourth year of medical school um with an allergy and immunology clinic. Um, and I really loved that it was like so specific to specific problems that patients were coming in with, but it was also like affecting every system in the body, and it was like you can have so much, so many diverse um presentations that fall under the allergy umbrella. Um, and I also really love like the the kind of problem solving of figuring out like what is this patient allergic to? Was this anaphylaxis, like hearing their story and like working backwards to figure that out is really fun.

SPEAKER_00 10:20

Yeah, that sounds super interesting. And allergy immunology, I think, is one of the specialties with the highest rates of like happiness and satisfaction and lowest rates of burnout. So great choice.

SPEAKER_01 10:31

Um that that makes me very happy.

SPEAKER_00 10:33

Yeah, I've heard actually great things. It's it's up there with like physical med and those kinds of specialties that have really nice schedules and like people really like their jobs, and so especially I'm sure if you're with the cherry on top. Yeah, yeah. Um, do you have any like personal experience with allergy? I feel like sometimes when people go into these neat more niche fields, it's because like they had a lot of allergies as a kid, or maybe they, you know, in physical med, like they had a lot of PT needs or something like that.

SPEAKER_01 11:00

Yeah, I actually don't, um, other than like eczema, which I feel like most people have. I don't have any food allergies, which I'm like blessed to have.

SPEAKER_00 11:09

Yeah. No, I was just curious. Um, yeah, I don't either. I have no allergies to anything. So I feel like I'm on top of the world.

unknown 11:16

Yeah.

SPEAKER_00 11:17

Um, and more logistically, you mentioned that you were a pediatric medical assistant. It sounds like you took gap years then in between undergrad and med school. Um, how many years did you take?

SPEAKER_01 11:29

Oh, I didn't actually quite take gap years. I I went to Northeastern where we do like six months of working. Yep. So I did co-ops and then I just continued to work as a medical assistant. I did take a six-month kind of gap year because um I graduated in December and I didn't start med school until July, but it was 2020.

SPEAKER_00 11:51

And so I didn't do anything with that time. Oh, what a bomber. Yeah. Um, well, so I'm gonna explain and tell me if I'm explaining it wrong for people that don't know what Northeastern does throughout. You basically do internships throughout the school year, and like Northeastern helps you organize them. And so it sounds like as one of these, you were a pediatric medical assistant, I assume, at Math General or somewhere around there.

SPEAKER_01 12:18

Yeah, I was at um a pediatric practice in Roslindale. Oh, nice. Okay. But so still in the Boston area.

SPEAKER_00 12:26

Yeah. And then what are some of the other co-ops that you did? Because I do think even though it's a unique system, it's really good, like sort of inspiration for regular internship people and like gap year jobs. So what were the what were some of the things that you did?

SPEAKER_01 12:39

Yeah, um, I also did I worked at um a biotech in Cambridge, so just doing like bench research, um, which was great. And then I did some time working doing bench research with Dana Farber as well. And I think it was nice to get like a biotech perspective, yeah, which might be a little bit harder to get into, um, versus like Dana Farber's more of an academic center. So it was cool to see both sides.

SPEAKER_00 13:05

What was some of the stuff that you or slash your company that you were in was doing in biotech?

SPEAKER_01 13:11

Both, both of them um were actually looking were actually doing um cancer and like car T cell work. Um yeah, when I was um at the biotech in Cambridge, I was doing like um a lot of work with viruses, learning how to like transduce and um like working with cell lines um in order to like basically deliver the vehicle of which we were trying to insert into um cells that were gonna be like from the patient. Basically, we'd get the cells from the patient. This was like the long-term end goal of the company was like you get the cells from the patient, you you add something to them, and then you put them back in the body so that they can eventually have tags so that you know which are the cancer cells.

SPEAKER_00 14:01

Okay. Okay.

SPEAKER_01 14:02

Um, and so I was working with viruses to figure out how to exactly deliver that tag to the cells. Um, but it's like when you work in research, you're working on like such a small little part of like this huge plan. And so that was kind of my little little part.

SPEAKER_00 14:19

Yeah. Um, did you ever do any clinical research? Or I guess this is clinical, but more like interacting with patients and being with patients.

SPEAKER_01 14:28

Um I actually have never really been super involved in clinical research. Um I did a lot of like research in medical school that was looking back at like patient charts, so like retrospective chart review, um, but never any like retrospective clinical trials now.

SPEAKER_00 14:51

Just curious. Um, because I have never really liked benchwork wet lab stuff. Um I've grown more like fond of thinking about doing it. Um, but yeah, I was part of a schizophrenia research lab for a few years in undergrad, and that I really enjoyed because we were like directly with patients all the time.

SPEAKER_01 15:12

Oh, that's awesome. Yeah, so that was like and that's like you do not have to do wet wet lab research. I I don't do it.

SPEAKER_00 15:19

I haven't done it since college. Like I feel like it's also getting less almost popular.

SPEAKER_01 15:25

I feel like they're like medical are more like specializing, like you're either a researcher or a and some people do both, but I think it you're right, it's like becoming less common.

SPEAKER_00 15:36

Yeah. What was research like in medical school? Because I I hear it all the time that you have to do research and you have to get publications, it's just sort of uh how it works.

SPEAKER_01 15:44

Yeah.

unknown 15:44

Yeah.

SPEAKER_01 15:45

I think that it's so it's definitely a plus for like residency applications, but I also think it's a little bit overhyped in that like if you I mean, if it depends on the field you want to go to into, obviously. But I think as long as you like have a passion during medical school and you like if that's advocacy or if that's like medical education and you really pursue it and like are fully in it, I think that it like serves the purpose that research can also serve. Um when I during my medical school, I was a part of a surgery project because I thought I was gonna go into surgery. Um I ended up presenting a poster. It was like I said earlier, it was like a retrospective chart review. So I was going back and looking through um, I was looking at geriatric rib fractures, which like couldn't be further from what I'm doing now. Um, and it was still helpful because I like learned how to do the research process and like I got to present at a national conference. Like it was totally a great experience. Um, but it didn't really like affect where I am now. I didn't really talk about it in my PEADES interviews because it wasn't super relevant to PEADS, and that that just is what it is, you know.

SPEAKER_00 17:02

Yeah, it's fine. It's it sounds like it was a good like useful experience anyway. Um exactly, yeah. Was there like a passion project you had or research that you did that you feel like you did talk about a lot in your interview? Like what was it that you decided to pursue in that respect?

SPEAKER_01 17:18

Yeah. Um, so I think, and still to this day, I'm super interested in medical education. Um, and so when I was um in medical school, I volunteered with a program that went um to um a middle school in Chelsea um where we taught science lessons to seventh and eighth graders after school. Um, and it was so fun. We would teach them like just basic science lessons, like what is gravity? Like I did a lesson about neurons and I brought in different types of candy for them to like eat figure out what each part of the neuron was. It was really fun. Um and so that was like something I really enjoyed doing, and I think like I did that throughout my preclinical years, and then um when I was like in rotations, um I got to do like a month-long medical education elective, um, which was really fun. So I think that was like my passion that I talked about a lot in interviews.

SPEAKER_00 18:16

Yeah. Do you think that's also part of what drew you to peeds? Is like there's a lot of educating, I think, and like explaining that you do with kids.

SPEAKER_01 18:26

Yeah, totally. I I love like the counseling part of peeds too. It's it's so fun. And like being able to counsel kids, but then also like reassure worried parents is like such a nice feeling.

SPEAKER_00 18:38

Yeah, yeah, yeah. Only last question is actually a logistical one. I'd love to hear what your schedule was like during intern year. And I know it's very different depending on the specialty, but I think it would be interesting for me and for others. What is the general PEEDS intern year of residency look like?

SPEAKER_01 18:55

Yeah. Um, so I think PEEDE is an interesting specialty in that we are pretty like half and half inpatient and outpatient right now. Um and so our um my program does two-week blocks. So we actually only rotate on something for two weeks and then we switch to something else. Other programs do like four weeks at a time. Um, and so I had about like 12 to like 14 weeks of inpatient time. Um, and then had a lot of like outpatient rotations where I'd just be in clinic for two those two weeks straight. Um, and then we have newborn, we have the NICU, both of those we spend a month in. Um yeah, that's most that's where we spend most of our time, I'd say.

SPEAKER_00 19:44

What are the hours like?

SPEAKER_01 19:46

Yeah, on the inpatient wards, it's it's tough. It's usually like um our program is 6 45 a.m. till sign outs at 6 p.m. So you leave whenever sign out is done, usually like 6 30. Um, so it's like 12-hour days, and we do of the two weeks, you get one weekend off. So we do um other programs do it differently, but we do they're called this is terrible name, but they're called golden weekends and then black weekends. Yeah, a golden weekend's just a regular. Um, but luckily our program does make up for like the long stretches in those outpatient blocks. You have some more wiggle room in your schedule, so it like it balances, but yeah, that's that. And then the outpatient is more just like typical nine to five weekly.

SPEAKER_00 20:34

Some of the outpatient rotations that you do.

SPEAKER_01 20:38

So we do in our inter year, we did um outpatient subspecialty where we rotated through heme onk, um, GI, palm, and oh, I can't remember the last one. Endocrine. Um, and then we also do like a community medicine rotation. So we rotate at some of the um school-based health clinics in Chelsea and Revere um here around Boston. And then um we also do like our continuity clinic. Um, so we spend time like every week in the same clinic with the same preceptor throughout the year. Um, so it really varies. There's there's a clinic for everything here, it feels like that's super cool.

SPEAKER_00 21:22

Yeah. All right. Well, that's awesome. Um, I'm so excited for you. You so you just start did you just start your second year a week ago?

SPEAKER_01 21:30

Yeah.

SPEAKER_00 21:30

Okay.

SPEAKER_01 21:31

I just started two weeks ago, yeah. We were done with our first two-week block. Okay, so exciting.

SPEAKER_00 21:37

Um, well, you I will say to people that can't see Kaylee, she looks relatively well rested and very happy and very excited about residency. This is super encouraging.

SPEAKER_01 21:47

It's not as bad as people say. Okay, good.

SPEAKER_00 21:50

Good. That's great. Would you say the same about med school? Do you feel like med school was like accurately described, or do you think it was work?

SPEAKER_01 21:56

Med school third year is hard. The rest of it is totally doable. Okay, in my opinion.

SPEAKER_00 22:02

Yeah, that's kind of what and third years is doable.

SPEAKER_01 22:05

It's just I mean, you have clinical clinical duties, then you have to study. So it's a lot.

unknown 22:12

All right.

SPEAKER_01 22:12

Well, thank you for having me.

SPEAKER_00 22:14

Yeah, thank you so much for taking the time. Um, I would love to follow up like at some point and hear about where you were past residency and everything. Yeah, let's do it. Excited for you. Um, and super exciting to hear about everything you're you're working towards.

SPEAKER_01 22:29

Yeah, thank you so much. This was so fun. Thank you.