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We’re joined by Amruti Borad, a family physician, to explore the transformative power of coaching in medical education. From the highs and challenges of medical school to self-doubt and purpose-seeking, we discuss how coaching can enhance resilience and decision-making. Join us to learn how coaching is shaping the future of health care professionals, helping them navigate the complexities of medicine with confidence and compassion.

Amruti Borad is a family physician.

She discusses the KevinMD article, “Coaching medical students: a game-changer for the profession.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Amruti Borad. She’s a family physician, and today’s KevinMD article is titled “Coaching medical students: a game-changer for the profession.” Amruti, welcome to the show.

Amruti Borad: Hi, Kevin. Thanks so much for having me. I really appreciate it.

Kevin Pho: So let’s start by briefly sharing your story and journey.

Amruti Borad: I was born and raised in Southern California. I come from a family where my parents are not physicians, but my siblings are in medicine, and I knew very early on, in high school, that I wanted to be a physician. My parents tried to convince me otherwise, to explore my options, but I knew I really wanted to do it. So I applied to a few accelerated medical programs and ended up choosing Pitzer College, in Claremont, California, which linked to an osteopathic medical school at Western. I applied to the medical school and the college at the same time and interviewed at the same time. Through college and then going into medical school, there were a lot of transitions, a lot of times when I just felt like I didn’t belong, or that I wasn’t good enough, because I was on the younger side. The way the program worked, you do three years of college, go to your first year of med school and then come back and graduate from college. So a lot of people were in different places in their lives than I was, and medical school was a tough transition, because I was a lot younger than the rest of the people there. For most people it was a second career, and this was my first.

I was just trying to navigate that, and then also trying to navigate the match, because at the time the osteopathic and allopathic matches were different, and you basically had to take twice as many board exams just to apply to both. I ended up choosing family medicine and went to UCLA for residency. I really love the variety of family medicine, being able to take care of families and build these relationships. When I finished residency, I realized I really enjoy teaching, so I stayed on at UCLA and taught at the school and in my clinic. Then I got married, moved to San Diego and joined a practice that was nonacademic, and I really missed teaching, so I ended up doing some volunteer teaching.

When the pandemic happened, I became our COVID lead physician, and that started the whole process of burnout for me. I worked really hard for a year, almost every day, and I soon recognized that this was no longer going to work, so I backed off some of the work I could at the time. Then I felt a renewed sense of purpose when I became our clinic medical director, and shortly after that I became our department wellness director. I became very involved in all of that work and was really happy, and then I started to notice the burnout again. It was happening again because the patient volume was rising. So I worked with a physician coach to help me be an effective leader but also to help me with the burnout.

Momentarily, I had decided that maybe medicine was not right for me, that maybe I should go, but in my heart it just didn’t feel right, and I was trying to figure out a solution. I finally had the courage to admit it to my boss, and I went part-time. They allowed it for a short period of time, and then I ended up resigning. I was going to go to a place that supports part-time leadership work, but at the last minute I had the opportunity to join the concierge practice at UC San Diego, and I realized that was the way for me to practice medicine: the time I get with patients, the support I have. That led me to continue part-time work in concierge medicine but also to certify as a coach myself and help both medical students and attending physicians. I really wanted to work at both ends of the spectrum, but over the last few months, it’s really evolved into a focus on medical students, because in speaking to many pre-meds and medical students, I realized there really is no connection in terms of strong mentorship. And I like to be preventive. With all these physicians leaving the workforce, how do we keep people in medicine? I think starting with the students is the path.

Kevin Pho: So we’re going to talk about your article and your coaching of medical students in a little bit, but one thing in your story caught my ear: You mentioned the word “courage” when you had to talk to leadership about potentially going part-time. Why did you feel you needed to be brave, that you needed courage to ask to cut down your hours?

Amruti Borad: That’s a good question. I think part of it was that I was a leader, and I was embarrassed. Here I am, supposed to be the one supporting my physicians and my colleagues, and also being the wellness director, I just felt it was so ironic that I would burn out. So it really stemmed from being very embarrassed, feeling like I couldn’t handle the positions I was in, and not knowing how leadership was going to react to what I was saying.

Kevin Pho: How did they react when you asked for that?

Amruti Borad: I was very lucky. My boss, who’s still my current boss, is a very understanding person. And actually, my medical director at the time, I didn’t know this, had already mentioned to him a few weeks before I even talked to him, “Amruti doesn’t look so good. I think something’s wrong.” So I think he already had it circulating in his mind, and when I asked to meet with him, he told me after the fact, of course, that he was worried something was wrong. When I told him, I came with a solution. I think that’s important. I don’t like to just complain. I don’t even like to call it a complaint; I’m telling you how I’m feeling, and I have a solution for it. And that was some form of part-time work, and allowing me to still be a leader, because that’s what brings me purpose. If you take that away, it’s going to be a lot harder for me to stay.

So I explained all that to him, and he was very understanding. He spoke with our financial team, I guess, and they allowed me to go to 0.6 FTE, so 60 percent, which I wasn’t expecting; I just wanted 80 percent. And they allowed me to stay in my positions, even though it was for a shorter period of time. I couldn’t have asked for a better response, to be honest. And I think that’s something to keep in mind: No matter how someone’s going to respond, if you don’t ask for something, if you don’t say it, you’ll never know what’s going to happen.

Kevin Pho: All right, let’s talk about your KevinMD article, “Coaching medical students: a game-changer for the profession.” Tell us how your article came together.

Amruti Borad: When I started, my original intention as a coach was to help attending physicians like myself, because that’s the world I was living in. But I kept having pre-med students reach out to me, and I would just talk to them about what they needed and what their questions were. I went to an event where I spoke with some students at the dinner table and realized that they really needed mentors. There’s no consistent mentorship. A lot of the schools have some of their wellness activities, but it just wasn’t enough. So it really got me thinking that maybe students are actually the place to be, in terms of who I should be helping. I don’t currently precept students, since I work in a private practice-type setting, but I’ve done it before, and I know the value of it. But I think I can provide more value coaching the students.

So I started looking into what coaches out there are coaching students, and I had friends who said, “Oh, try talking to this person,” or “Talk to that person,” but every person I talked to was not coaching students; they were coaching physicians, which is also, of course, very important. But I felt like the students were left behind, like an afterthought. So I decided, “OK, I think students are the path.” I had already been coaching students one-on-one, through friends or whoever was reaching out to me, but I started thinking back to when I was a student and what problems I had. I hadn’t thought about it in a long time, and then I started to realize, “Oh my gosh, there were a lot of problems.”

Kevin Pho: What are some examples of the problems these premedical and medical students reach out to you about?

Amruti Borad: Typically it’s about “How am I going to make my application stand out?”, especially because of COVID. A lot of them weren’t able to shadow other physicians, which is a requirement for most applications, and I don’t know whether schools changed their strategy when they realized these students couldn’t really shadow somebody for a whole month. That’s something, I think, for schools to think about. But it was really, “How do I stand out? I’ve worked this hard. I took a year off to apply to school. I didn’t get in.” A lot of people don’t get in the first time. They’re trying to figure out, “How am I going to manage my time? How am I going to pay for this?” Most students will go into debt for medical school, of course, and they’re thinking, “OK, well, if I go into this much debt, what am I going to do after? Do I have to be a radiologist?” or whatever high-paying specialty it may be.

And a lot of it, I realized, is very mindset-oriented: “Am I good enough? Why did this person get in when I didn’t? What school am I going to go to? Can I handle it? What’s my family going to think? How am I going to balance my life?” When I was a student, I saw at least one person go through some stage of life that’s not related to school itself: marriage, divorce, kids, miscarriage, infertility, substance abuse, mental health disorders, everything. That’s when I realized that being a student really is the human experience. You just don’t think about it that way.

Kevin Pho: Do you feel that a lot of these students don’t have the proper support at their schools, or even at a local level, and have to reach out to coaches like yourself?

Amruti Borad: I do. With some of the students I’ve talked to, I made the assumption, “Oh, well, your school must have some sort of program,” and a lot of them said, “No, they don’t have a program,” or they just have a peer support program. A lot of students want to talk to somebody who’s already been through everything they’re going through, not just their colleagues. That’s another reason I started thinking about how schools can incorporate coaching. When I started to look into it, I was surprised that a lot of schools actually have started coaching programs, but it’s pretty new. And then I’ll talk to other students who don’t even know what coaching is, who say they have some sort of disorganized mentorship program and might see their mentor once a year. So there’s a lot of room for improvement, and for schools to learn from other schools.

Kevin Pho: Tell us the difference between coaching and mentorship.

Amruti Borad: Great question. Mentorship is really finding someone who’s been through the same experience as you. Say I’m a family doc, and a student wants to be a family doc. It’s very development-oriented: I’m telling you my experience and giving you advice, telling you what you should do to further develop your career. Coaching is very different; it’s the opposite. You are not telling someone what to do. You are collaborating with someone, whether they have the same experience as you or not, and getting very clear on what their goals are for their future. It’s me asking you a lot of questions, like, “Well, what specialty do you want? Tell me why.” It’s really drawing out from you what it is you want, because students, and really physicians, are so used to people telling them what to do. This is the opportunity to really drive professional development, to allow you to be an adaptive, self-directed learner and to empower you to make your own choices.

Kevin Pho: So tell us a success story where a premedical or medical student reached out to you, and of course you don’t have to share identifying information. Just in general, tell us a story where you moved the needle for that student.

Amruti Borad: One of the students I was coaching was about to start medical school, with a lot of anxiety about it, and already had baseline anxiety and depression. So a lot of it was focusing on mindset and getting them prepared for what it’s going to be like at school, but also making sure they made time for themselves before school started. They had a lot of family members who were saying things like, “Oh, you’re going to be gone. We’re never going to see you again.” So we worked on reframing why their family might be saying those things, and reframing what the experience is going to be: that it’s not just your experience; it’s your family’s experience too. They were also an introvert, so I encouraged them to reach out ahead of time: “Join the Facebook group for your class. Post something; it could be anything that’s personal. Just reach out to one person. When you go to orientation, introduce yourself to one person.”

For her, trying to come out of her shell was a big thing. So she joined that group, talked to somebody and made a few friends before school even started. And she spent her whole summer with her family, having a good time, not worrying about “I need to study. I need to do this. I need to do that.” I felt that really helped her get ready for this stage in her life, which is going to be difficult. It’s challenging to be a student, and it’s about accepting that: “Yes, it’s not going to be easy, but I can handle it. I’ve learned how to make time for myself, I’ve learned how to communicate things with my family and I’m learning how to put myself out there.”

Kevin Pho: So we talk a lot about the burnout rate among physicians, but you’re also in tune with students. What’s the burnout situation like among premedical students today?

Amruti Borad: I think pre-meds and medical students have different issues. Of the premedical students I’ve spoken to, a lot are talking to me because they’re trying to decide whether they should even go into medicine: “Should I continue on this course, or should I be looking into other paths in medicine?” So a lot of the coaching has been, “Let’s talk about what it’s like to be a physician, and then let’s talk about all the different options you have in medicine.” It’s not just becoming a doctor and working in a clinic or a hospital. There’s so much out there that you might not know about, because when you’re pre-med, you just have a one-track mind about where you’re going.

With medical students themselves, it’s really time management. They feel like they’re drowning all the time. A lot of it is mindset, because they don’t feel like they’re good enough or that they belong. They’re comparing themselves to their peers, they’re constantly being evaluated and then they have role models, their attendings, who might be burned out and haven’t addressed their own burnout. So it’s essentially a negative feedback loop. A lot of them might come into school with a mental health diagnosis, and burnout just perpetuates it, or burnout causes mental health disorders, including suicide risk, and substance abuse can also be an issue. So with the medical students I’ve seen, it’s really time management, “How do I get everything done?”, and then, “How do I maintain my relationships while I’m in this situation?” And mindset: “How do I make sure I’m learning everything I need to learn, keeping an open mind and staying in a frame where I can grow, instead of just becoming stagnant?”

Kevin Pho: We’re talking about the KevinMD article “Coaching medical students: a game-changer for the profession.” Amruti, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Amruti Borad: I think something I’ve learned in the past year is that whatever you do today can have big impacts later. Whatever the work you’re doing today may be, you’re going to see that it will affect you, or the lives of other people, later on. So whatever you want to start, whether it’s writing, building a social media profile, being a leader in one or two organizations or joining advocacy groups, whatever it may be, you really just want to start. Just take that one step, and you never know what’s going to happen. I think that’s really important for students especially, because you don’t think about that when you’re in school.

And know that your voice matters, so you want to speak up, in whatever way that means, being professional, but speaking up. And just remember, “I am on my own path,” because we get so siloed, comparing ourselves to everybody else, and if you do that, you’re never going to go anywhere. And really, again, take that next best step, whatever that means to you.

Kevin Pho: Amruti, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.