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When is the most powerful thing a medical student can do in a patient’s room simply to stop talking? Medical students Jay Pendyala and Jonathan Berg draw on years of competitive chess to explain how the game quietly trains skills that medical school rarely teaches directly. Their episode is based on their KevinMD article, “What chess taught me about clinical reasoning and humanism,” Pendyala and Berg break down how chess mirrors clinical encounters across three phases, from the structured opening of patient intake through the ambiguity of the middle game hospital course to the high-stakes endgame of discharge or difficult family meetings. You will hear why prophylaxis, the chess concept of anticipating your opponent’s threats, maps directly onto anticipating disease progression and surgical complications. They explore how playing thousands of games under time pressure prepared them for real-world urgency like door-to-balloon times and trauma bays, and why resilience built at the chessboard transfers to moments when a clinical plan falls apart. Perhaps most striking is their reflection on silence, the comfort with saying nothing that chess cultivates and that proves essential in psychiatry rotations and conversations with seriously ill patients. If you are looking for a fresh lens on clinical reasoning, pattern recognition, and preventing medical student burnout, this conversation delivers all three.

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Transcript

Kevin Pho: Hi, welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome medical students Jay Pendyala and Jonathan Berg. Both are medical students, and their KevinMD article is “What chess taught me about clinical reasoning and humanism.” Jay and Jonathan, welcome to the show.

Jay Pendyala: Thank you for having us.

Jonathan Berg: Yes, thank you.

Kevin Pho: All right, perfect. So, Jay, I am going to start with you. Just tell us your connection between chess and medicine, and I am going to ask you to briefly summarize the article for those who do get a chance to read it.

Jay Pendyala: I first grew up playing chess when my uncle introduced it to me at 7 years old. Ever since then, I played in local tournaments as well as some competitive play at the United States Chess Federation tournaments, and then played on online platforms like Chess.com and Lichess. Since then, I focused more on my studies. Now in medical school, I was fortunate to meet like-minded individuals like Johnny and other students as we founded the chess club.

It was not until we started our third-year clerkships, being thrown into the ambiguity of the clinical experience, that I think in those instances we tend to root the ambiguity to something we are already familiar with, whether it is the literature we grew up with or the people we met. In my instance, I often find myself referring back to the same thought processes I had when playing chess. In between the clerkships, when all the students would gather together, Johnny and I noticed some similar patterns despite seeing different patients and being at different places within our clerkships.

We thought it would be a refreshing way to express our own thoughts from a medical student perspective through our article. This was over a year ago. More recently, when I had that humanistic interaction with the patient, I thought it would be a nice addition to the parallels we were already drawing between chess and medicine.

Kevin Pho: Johnny, tell us a little about yourself and your connection with chess and medicine. Jay mentioned that both of you are part of the chess club at medical school. Tell us about that connection between chess and medicine from your perspective.

Jonathan Berg: Absolutely. I am originally from California and am now in Philadelphia. I first started playing chess when I was young. My grandfather taught me. I had not played for several years, but I picked it back up in high school after my grandfather became sick. Since then, it has been something I love to play. I would say I play pretty competitively now for about nine years.

When I got to Jefferson, I wanted to continue that passion and hobby and find other people like Jay, our officer board, and other club members who might be interested in participating. Originally, Jefferson did not really have a club. There may have been one in previous years, but it had not been kept up, so we wanted to restart that. We were fortunate enough to organize an officer board. We polled our class and subsequent classes, and there was some pretty good interest in students wanting to come out and play chess in a social, low-stakes environment. The club blossomed from there.

Kevin Pho: Awesome. Johnny, how often do you meet, and when these members play chess, tell me how that breaks up what they are doing clinically or pre-clinically within a medical school education context.

Jonathan Berg: We try to have the club meet once every two weeks. Obviously, it might vary depending on exam schedules and where people are at in their training. Sometimes there is some flexibility, but usually, we try to meet once every two weeks. Most of the meetings are general club meetings, which comprise some snacks and food for people to eat, and we come and socialize. We like to start off the club meeting with puzzles as a great way to analyze positions and talk through reasoning and different key concepts. We try to curate these puzzles in increasing difficulty so people can practice different themes.

Then it is whatever people want to do. Some people stay and talk. Some people want to get straight into playing chess. Sometimes it is conventional chess. There are variants of chess where you can get more than just two people playing in one game at a time. There are lots of different ways that the club naturally flows. Once in a while, every couple of months or so, we try to host a tournament as well. We have been fortunate enough that even non-regular members come out to those tournaments. We have had over fifteen members come out for a single tournament before, which is a great number of people. There are casual and competitive opportunities for people to play.

Jay Pendyala: To add to that, in the socializing aspect of it, a lot of it tends to shift into a peer mentor setup where the preclinical students in their first and second years ask us, or even the fourth years who attend, for advice about selecting their rotation schedules, locations, and how to decide specific routes within their clinical avenues. Interestingly enough, the tournaments that Johnny mentioned have gotten a really good turnout to the point where more recently we were able to donate some funds from these tournaments towards a mental health awareness campaign after a recent tragedy in the chess community. We have had a lot of good turnouts and growth from there.

Kevin Pho: It is wonderful to hear that medical students like yourselves have developed passions outside of medicine. We talk a lot on this podcast and on KevinMD about medical student burnout, and one of the ways to combat that is to have passions outside of medicine and build communities with those with similar interests. This is a way to connect outside of the classroom and the hospital. It is wonderful to hear this story.

Jay, when you were introducing yourself, you mentioned one word that really struck me, and that was patterns. Patterns in chess and patterns in medicine. Tell me about some commonalities between those two when it comes to pattern recognition. Obviously, you have been playing chess most of your life and are in your third year of medical school. Tell me about some of the common patterns that you see between those two worlds.

Jay Pendyala: Absolutely. In the article, I mentioned how chess is broken up into the opening, the middle game, and the end game. Similarly, the way I approach patients, mostly working in an inpatient setting, is the intake, their hospital course, and their eventual discharge.

When it comes to the intake, it follows a general process of getting their history, getting the old HPI and physical, and getting their baseline of where they are at. Similarly, when you come to chess and assess the position, there are openings that are tried and tested throughout time. You do not follow them because they are beautiful, but because they are reliable. Similarly, you follow the same pattern when you do intake, making sure you cover all your bases and having a comprehensive idea or even a focused idea, depending on the specialty that you are on, whether it is surgical or medicine-related.

When you come to the middle game, that is where it opens up into having to think more on your own. You have to balance between gestalt and evidence-based medicine. Similarly in chess, you have these patterns or tricks. There are fancy words for all of them, like pins, en passant, or zugzwang. I am sure anyone hearing this podcast with an idea of these will smile when they hear these words because they are fancy little tricks within the game.

Similarly, when you do the hospital course, you are trying to understand the etiology of their presentation, but also being able to follow the lab trends and see what is working. Are they having any side effects from medication that we are prescribing, or are we overprescribing antibiotics? What does the current literature say? You are balancing your own tricks and tips that work for the attending and then being able to pass that down to the residents and medical students as well.

Ultimately, you come to the end game or the discharge. Did we fix them? Are they better off post-op when they were coming in for a small bowel obstruction? Did we stabilize their condition and follow up with the PCP outpatient? I hate to say it, but sometimes I had the privilege to work in the neuro ICU where a lot of the discharges ended in family meetings where we had difficult conversations and had to involve power of attorneys and advanced directives, where DNRs were usually the last resort. These are just some of the parallels that I reflected on when we were writing this article.

Kevin Pho: Jay, during those meetings, do chess metaphors often come up to address clinical stories or issues that your fellow medical students are facing in the clinic or hospital?

Jay Pendyala: I personally have not used any chess metaphors. Keeping in mind the gravity of the situation and the seriousness there, I think we are both becoming more mindful of reading the room and knowing when to make things lighthearted versus respecting the gravity of the room.

I had the fortune of working with doctors, and so did Johnny, working with one of our hematology-oncology doctors, as well as our neurologists who are on the ethics committee here at Jefferson. They have a very natural way of addressing not just families, but also students, addressing their burnout and their well-being. We make it a constant point for that. I use chess within my personal life and I advocate for it, but I have not personally used it in those situations.

Jonathan Berg: I know one example off the top of my head where a chess term is frequently used in medicine, and that is prophylaxis. The term prophylaxis means thinking ahead or anticipating different consequences in a patient’s course, such as how their labs might trend and what we expect to see. In a chess game, it means considering what my opponent is thinking, what their threats are, and what I should be preparing for.

I think that is a very important skill to have and to practice. One can look at medicine or chess from the perspective of their own plans, but it is detrimental to not consider the opposing side and how diseases might progress on their own despite our efforts. Being able to anticipate, at least from a surgical perspective, what sorts of consequences might come up and being prepared for that is crucial. Prophylaxis is one key example that I can think of.

Kevin Pho: Johnny, as a competitive chess player, I assume that you have been playing for most of your life. How have the traits of a competitive chess player influenced you as a soon-to-be physician during your first couple of years of medical school?

Jonathan Berg: Thank you, that is a great question. That is what led us to talk about the similarities between chess and medicine. When people hear chess, they think of foresight and being able to plan and think critically several moves ahead. While that is true and critical to the game, there is much more nuance than that.

It is also relying on experience and trusting one’s own instincts when you have played thousands of chess games. It is similar to being able to assess a patient who comes in with chest pain, knowing what their symptoms might suggest, and going with that intuition. Equally important is being able to synthesize all of the information presented before you. While you may have that gut instinct, and it is correct several times, it is also important to consider the broader position in front of you. How is this unique patient different? What are they bringing in that you might be missing? What is your opponent threatening despite this seemingly benign position that could be serious? Being able to take information and synthesize it as a whole is key, along with developing plans in different stages of the game.

Another aspect of chess that is somewhat more nuanced and not talked about as much is resilience. Medicine needs no explanation for how resilient students, physicians, and especially patients have to be. In chess, one’s best-laid plans might not go according to plan. It is important how one mentally changes their framework and is able to recover when that happens. If I play a move and you play something unexpected, I might not be ready for that, but I need to take a step back, reframe my perspective, and adjust accordingly. That is incredibly important in medicine each day. Lab values change. In a surgery, it is important to be able to address any complications that arise and have that resilience trained through thousands of chess games, never giving up.

Jay Pendyala: I would like to add a very small footnote to what Johnny said, and we talk about this in the article too, which is this concept of time. Very often in a chess game, you are playing against the clock. You are playing as much against the position and your opponent as much as you are against time. For me, this was most accurate during my time at the emergency department here at Jefferson, where I had the fortune, or unfortunately in the patient’s case, of witnessing door-to-balloon times in real life. People go into cardiac arrest, and I was in line to administer chest compressions. We had the fortune of having a neurology resident there for stroke alerts and even trauma cases where patients are wheeled into a separate trauma bay, the trauma surgeon comes down, we undress them, and do a full examination. That is another very interesting aspect that I think chess has primed me for. If it did not, maybe I would have just been flabbergasted and like a deer in headlights. I was able to adapt to that situation given these time situations in chess.

Kevin Pho: Jay, one of the things that I read in the article was the term, “The discipline of silence at the chessboard.” Talk more about that concept and how it relates to medicine.

Jay Pendyala: Absolutely. I mentioned that, especially as medical students, we are awkward when the room is silent. It feels like we have to fill a space. I am speaking from personal experience. I feel like I have to offer something and fill the silence because it is awkward.

However, in chess, you are not making moves immediately. You sit at the board. You have to have the humility of understanding how dire the situation is or how well your position is so that you do not make careless mistakes that may lose an advantage, make your position worse, or change the dynamic of an otherwise balanced position.

Similarly, this is something that I have had the pleasure of experiencing with patients. Oftentimes they will say something, and you do not have to address it all the time. Just let those words sit, let them understand the weight of those words, and work around that. Especially in psychiatry, I had this opportunity during morning interviews with our patients in the inpatient psychiatric unit. Letting them be silent is important because eventually they will follow it up with something more impactful or additive to their current journey or story. Having the humility and discipline to not always have to say something, holding back, and being patient to let others take the wheel is crucial.

Jonathan Berg: May I add to that? So much of chess and medicine is unspoken as equally spoken. Jay, you said it beautifully. Being comfortable with that silence is important. In a chess game, a lot of it is psychological. Knowing how an opponent moves, how forcefully they put their piece down, or how they hit their clock are all psychological aspects of the game. I am not speaking with my opponents. Much like seeing a patient, it is okay to have that silence in the room to communicate without words, being able to comfort patients, feel their pain, and be there for them in their times of need without necessarily conveying things through words.

Kevin Pho: We are talking to Jay Pendyala and Jonathan Berg, both medical students. Today’s KevinMD article is “What chess taught me about clinical reasoning and humanism.” Now I am going to ask both of you to share some takeaway messages with the KevinMD audience. Jonathan, why do you not go first?

Jonathan Berg: I think it would be a missed opportunity if I did not talk about and promote chess in this moment. I encourage everyone to take up chess as a great hobby. Like we talked about, it is a great way to relax, socialize, and train clinical skills in a low-stakes environment. Going beyond chess, I encourage anyone to take up hobbies that they may have lost over the years as they pursued medicine. These hobbies are a great way to separate oneself and directly influence how we take care of patients.

Kevin Pho: Jay, we will end with you and your take-home messages.

Jay Pendyala: For anyone listening to this podcast, the one thing I would like for you to take home is that while we emphasize chess as an outlet, for someone else it could be playing an instrument, running, or a social circle. All these things, at the end of the day, are avenues for you to ground yourself, to humble yourself, and understand why you are practicing medicine. Why are you doing this particular activity? What joy does it bring you? What intrinsic motivation does it spark in you? Whether it is chess or anything else, keep reminding yourself why you are doing this, why you are playing the game at all, and why it matters.

Kevin Pho: Jay and Jonathan, thank you so much for sharing your perspective and insight. Thanks again for coming on the show. I appreciate that very much.

Jay Pendyala: Thank you for having us.

Jonathan Berg: Thank you.