MetaCast

Hey everyone, welcome to MetaCast, the podcast of the Meta Analysis Academy. Today, I have the honor of welcoming to this episode, Frans Serpa, who's going to share his journey from South America, from Ecuador, into residency in one of the top programs in this country, University of Texas Southwestern. Frans, I'm so excited to have you here. Let's start with introductions. Do you mind introducing yourself to everyone, please?

First of all, thank you, Rhanderson, for this opportunity. It's very nice to see you again, and being seated next to you means a lot to me. And, you know, I hope that everything we share today helps guide or maybe inspires some of you out there. So let's start. Basically, my name is Frans Serpa, and I'm proud to say that I'm a PGY-1 internal medicine resident at the University of Texas Southwestern Medical Center.

Fantastic. And Frans is going to share his journey with us and how he did medical school there, how residency is going so far, the strengths of his application. Like I said, this is one of the best internal medicine residency programs in the country. Before I start asking Frans some questions here, I just want to remind everyone that this podcast, MetaCast, we have a Portuguese and English version. So if you speak Portuguese, make sure to check the other one as well.

And over here, I share — we share — successful stories of medical students, residents, doctors, and other healthcare professionals who have done extraordinarily well in their careers. This is the podcast of the Meta Analysis Academy, a training program that teaches doctors and medical students how to do high-impact papers with meta-analysis, through meta-analysis, with autonomy. Frans is an alumnus himself, and he's going to share a little bit about his experience too. And just as a disclaimer, what we discuss here is not affiliated with the University of Texas Southwestern. It's not affiliated with Brigham and Women's or Harvard Medical School, where I personally work.

Excellent. So Frans, let's talk about the moment you're living right now. We're recording this in September. You started residency a few months ago, a couple of months ago. How's it going so far?

PGY-1 in internal medicine. I know this probably was the dream for a long time, and you've made it. So before we go any further, congratulations to you. And, how's it going? Oh, thank you so much, Rhanderson.

As you saw me, I still have to take a deep breath whenever I say it out loud. Sometimes I even have to pinch myself because it feels unreal, but it definitely is the culmination of many, many years of dedication, hard work, faith in myself, and obviously a lot of support from different people, including the Academy. It feels great. It's been like three months now, and it's just amazing. I just hope that you can visit sometime or maybe anyone out there listening to this can go and see how Parkland looks, how the Clements hospital looks. Everything around the hospital system is amazing.

It just causes that "wow" effect. You get there, you see these amazing buildings, it's just great. Residency-wise, it's been great; it's everything that they promised us. I get a lot of autonomy.

I'm getting good at it, so I'm gaining some mastery as well and have found purpose in everything I do every day. UT Southwestern is amazing because you get to treat different people from diverse backgrounds. We have, I guess, one of the largest county hospitals in the country, which is Parkland, very well known, and we get to serve everyone out there, regardless of their social status or whatnot. But then you also get to offer them everything you can ever imagine in terms of medical treatments and whatnot. And also, then you have the teaching hospital where you treat other conditions and also other types of patient demographics.

Each one of these buildings has over 900 beds, so it's huge. A massive health system, yeah.

So, the private hospital or the teaching hospital that you mentioned, that's the University of Texas Hospital, right? UT Southwestern Hospital. Okay, yeah.

A lot of our listeners have done observerships or know the program in Miami. It's similar in that sense to Miami, where you have this large county hospital, Jackson Memorial Hospital, and then you have the University of Miami Hospital. Like you said, it creates a really diverse population, different types of practices, and really increases diversity in your training, making it more robust. I agree. Great. And what rotations have you done so far?

Well, I started kind of hard. I started with wards and then moved to a month of MICU. Obviously, it's a rough start for an intern, but I think I like that because, you know, there's this adaptation for international graduates. It's very different from the one that local students would go through. For us, probably it's a steeper learning curve, and having those tough rotations at the beginning, I think, is good because it forces you to adapt.

Yeah.

And so I saw that challenge as a positive thing. Yeah. That also means they trust you, that they think you're going to be an amazing resident since they put you in those tough rotations in the beginning. So, guys, MICU, medical intensive care unit, for those of you who don't know yet, and internal medicine wards are the inpatient floors for internal medicine, so you get really diverse pathology there.

Now you're here on a research elective. You started off hard on your residency. I actually started off pretty easy. I remember, as a first-year resident in Miami, I started with a research elective, and it was a couple, like six, eight weeks before I had any outpatient time. So it was a while before I got into the wards and all that.

For me, it was an easier transition. They really put you in the trenches right away. That's good. And now you're in a research elective, but you're here in Boston. Tell us a little bit about that, about the research.

Absolutely. So I'm working with my lab, which is the Smith Center for Outcomes Research in Cardiology, which is affiliated with Beth Israel Deaconess Medical Center and Harvard Medical School. I was working with them over a year during my match application, and I’ve continued to work with them, with my PI, Dr. Daniel Kramer. It's been great for me to come back and work with him and my colleagues over there. Now I've come for two weeks of research elective and am continuing to work on some of the projects I had pending before I matched, and I hope to publish now.

That’s one major advantage of getting connected in research as you apply. Obviously, it strengthens your application, but it also allows you to carry on that research later on when you're busy as an intern or resident. We're going to talk a bit about the strengths of Frans' application and how it was possible that he matched into this spectacular program at UT Southwestern. Frans, what have been the biggest challenges so far in this transition into PGY-1?

What were the things that were hardest for you?

Yeah, that’s a great question. So I think, as I said, being an international graduate, we often have trouble with the electronic medical record system. Obviously, we’ve been in close contact through research and maybe rotations in the past, but it’s always hard. And U.S. grads come in with this very fresh on their minds, so there are definitely some challenges there. But I guess it’s different for everyone, and that’s fine. For me, it took a few weeks, but then I got used to it. And nowadays, I can manage my way through it.

Fantastic. I want to give folks a real practical sense of what it's like to be a resident in a top program like that in terms of workload. Let’s talk about a typical day for you in the MICU. What was your call schedule like? And how many patients did you carry? What was it like doing the rotation?

Yeah. So, during that month—one month—basically, my first two weeks were even harder. I started with census numbers somewhere between 8 to 10 patients, which is tough.

That’s tough.

Very sick patients, medical intensive care unit.

That’s a lot.

Yeah, that was a lot. But again, I think the challenge, you know, when you see this challenge as a growing opportunity, it’s amazing. So I enjoyed every minute of it. Obviously, I was working many hours, but within the range.

Did you take overnight call?

No. No, so our program doesn’t have that system, but, you know, I was basically working three days in and one day off. That was basically my call schedule.

And during those three days on, you would work early on, get there early, pre-round, round, then take care of everything throughout the day, do admissions. What time did you usually leave?

Exactly. So, basically, we knew rounds were around 7 or 8. So it’s up to you whenever you arrive. For me, at the beginning, I was arriving somewhere between 5 and 5:30, just because I wanted to have my time to pre-chart and all of that. And then, you leave after you sign out to your night team, which usually happens somewhere between 6 and 7. So, you know, you can count the hours there.

Yeah, it’s long working hours. I’m going to sound really old with what I’m going to say right now. I’m going to start off by saying, “Back in my day…” Well, this wasn’t that long ago, but in Miami, when I was a first and second year, especially as a second year, I had a lot of intensive care rotations—cardiology, medical. In those rotations, we used to do Q3 call with overnight. So we used to come in and see the patients for rounds. As a senior, I didn’t have to do pre-rounds, so I could come in closer to rounds. But then, I’d stay for rounds, do the whole call, stay overnight, stay for rounds the next day. So that would be, like, 30 hours, and then I’d go home after call, post-call, the next day after rounds, and sleep, of course, and come back the next day, have a short call, and then start it over again. So it was Q3. And I probably had, like, four or five rotations of Q3, maybe four during my entire residency, a lot of them in second year. So that was brutal. It was a month where you couldn’t do anything—like be on call, like 30 hours every three days. It was really busy.

Yeah, that sounds like a lot. I would say that residents are still doing that in my program. It’s just that they decided to take off the 24-hour shifts for the interns.

Oh.

But it’s coming for you.

Exactly.

Yeah, so it’ll come for you in second year. It’s tough. It’s tough. But it’s a good time. You end up learning a lot as well. Have you found the program, the people, the attendings, and everyone to be supportive? And the residents?

Yeah. Everyone, you know, I think something that makes it special, as always, is the people. The people you meet. Everyone that’s working there is amazing. The residents are very supportive. Everyone understands that it might take us some time as international graduates, and they’re all willing to teach you, which is great. And the amount of pathology that you see is just amazing.

Yeah, that’s good. That’s fantastic. I’m glad you’re having a great time. You know, like we said in the beginning, this is not affiliated with UT Southwestern, but it turned out to be a major advertisement for UT Southwestern. But the truth is, a lot of academic centers in the U.S. will have this great learning environment, busy as it is, but the environment is just going to be great, supportive. Obviously, there’s individual variability. There will be attendings who will give you maybe a hard time, but in general, it’s a great place to learn. And not just UT Southwestern, which is one of the top programs in this country, but the advantage of the U.S. compared to Brazil, for example, is that in Brazil, you can get good quality training like this, but in a very select number of centers—a small number. In the U.S., you can have a lot of great places like this to match. I’m not going to ask Frans to tell us his rank order list, you know, how he ranked the programs, but I’m sure if he went to any of the programs in his top 7 or top 10, he would be as great or just as phenomenal as he would by going to UT Southwestern. So that’s a plug for those of you who want to do residency in the United States. Excellent, Frans. So the next step in your career is going to be a cardiology fellowship. We’re going to talk a little bit about how you matched into UT Southwestern. I keep building expectations for that because Frans really had a phenomenal, outstanding application. But before we talk about that, let’s talk about what you’re doing right now to set yourself up for success in fellowship in a few years, I guess. Maybe two to three years from now, you’re going to be applying for cardiology fellowship. Smart man right here. And then you tell us what you’re doing right now. What’s in your mind? Or have you really not given it any consideration yet? Are you just trying to survive intern year? Tell us which one.

Well, I think I have thought this through very comprehensively even in the past. The reason that I came to do research was because I was interested in cardiology. So I knew a few years ago that I wanted that. And I guess the strategy is the same as it was for residency. I always hear people saying, “You know, this guy is so lucky” and whatnot. And it’s fine, you know. We often use “lucky” as a way to refer to people who have these opportunities. But I see “luck” as a mix of different things. So for me, it’s a matter of preparation, one, and then seeking opportunities, taking action, and, at the end, your attitude toward work. And the way that I see the attitude part comes along in two ways. One is the way that you work, as you always say—you overdeliver on the promise. And then the other part, very important, is the way you connect with people. So I put a lot of effort and time into understanding how to build these interpersonal skills and emotional intelligence. This is something I really value, and people end up valuing as well when you work with them. You have to realize that medicine is teamwork. So it’s good to put some effort toward that. And thinking about that, if you think about residency and cardiology, it’s just the same strategy, as I said. So basically, first of all, you have to be very clinically competent. As I always tell other people, this is like a cake. Imagine a cake. So the base of the cake is the clinical competency. You have to show that. For residency, there were indirect measures of that. You have the steps, the exams, your grades in med school, and your rotations, your letters, and all of that. And then the next layers are the other things you can do. One of them is medical education, something you can be very involved in. The next one, and all are equally important, but as I said, the base has to be clinical competency. But the next layers would be, like, research, which is where the Meta Analysis Academy comes in. Then on top of everything, you have leadership positions and maybe community outreach projects—everything that is meaningful. You want to be impactful and meaningful. And at the end of the day, you have to build a story, right? And then the cream of that cake would be your mentors and people who would support or sponsor you. And it’s always easy to think that if the cake looks good, it’s easy to sell, right? So that’s the way. So for fellowships, it’s the same strategy. You know, I’m focusing on building my clinical skills, being a great resident, building that reputation in my program. But now, you know, the pressure is that you don’t have free time to do all the other things. You have to do it in the meantime. Right? So this was supposed to be my vacation, but I decided to do research, and I’m doing that here. And even during the MICU rotation, I was submitting abstracts, papers, and whatnot. So you have to run. And then medical education is important. I’ve been involved with that. We can talk more about it. And then you also need to consider your mentors. And this becomes even more important during the fellowship application, and I’m sure you can tell us more.

Yeah, I couldn’t have said it better myself. I think you hit the highlights. I’m just going to summarize it and give a little bit of my perspective, but you’ve covered everything. Clinical competency is the foundation. You said that yourself—your mentors, your attendings, your program director—they need to trust you to take good care of patients. No one's going to recommend you with a strong letter of recommendation or pick up the phone and call someone for you to get into cardiology or any other competitive fellowship if they don’t trust you with patient care. So that is an absolute must. Those of you who are interested in surgery, it’s the same thing. You have to do well in your residency, become proficient in the surgical techniques, and operate well.

Then I would say that the connection, the interpersonal skills you mentioned, are very valuable. When I was a chief resident, I used to sit in these meetings called CCC or Clinical Competency Committee meetings. Essentially, we were evaluating the residents, and it struck me that, you know, the residents who got along well with everyone, who had a good relationship with people—myself included—people tended to overestimate their qualities and minimize their struggles. It was the opposite for people who were rude or difficult to get along with. So if you focus on being a team player and helping out a co-resident when they need to do a late admission or leave early, or if you can swap a call, that can go a long way. I wasn’t even a guy who went out to social events, you know, and I’m not saying you have to do that or not, but in the work environment, always trying to be helpful and friendly to others really goes a long way.

And I can tell you for sure, Frans—we’ve had limited interactions, but I saw you as a student in the Meta Analysis Academy, and I’ve seen you in meetings—and Frans is just a phenomenal guy, easy to get along with. Everyone who works with you in research projects loves working with you. He even brought me some chocolate and coffee from Ecuador! So these little things will make you stand out, and people will remember you when it’s time to apply for fellowship.

And then being a good educator—you mentioned that too. I remember simple things like presenting as a night float, where you would present cases and bring up a teaching point. Just simple things like that helped me stand out, win awards, and become a chief resident. It goes a long way if you educate your co-residents, your interns, and your med students rotating with you.

And then we’ll talk about research in just a second, but those are the elements. And like you said, mentors are crucial. The mentorship you develop, especially those clinical and interpersonal skills, will naturally evolve and become strong relationships. And then, if you do research as well, that’s just icing on the cake.

So I think I just restated everything that Frans said, but still, it is what it is.

No, no, you’re making it sound nicer.

[Laughs] No, no, that’s great! Let’s talk about research a little bit. I’m going to get into the research you did before you applied, but let’s talk about meta-analysis for a moment. I know for a fact that in the last year, either after residency started or right before, you’ve published a couple of papers as first author and co-author. Tell me how meta-analysis fits into this very busy routine you’re doing now and a little bit about your journey as a student of the Meta Analysis Academy, and the results you’ve accumulated so far in terms of publishing meta-analyses.

Yeah, absolutely. My story with the Meta Analysis Academy is amazing. I love telling this story. I think it was actually mentioned in some of the previous episodes. Basically, I joined the Academy when I was applying for residency, so you can imagine that’s a busy time in your life, and you’re stressed out and all of that, but I knew I wanted to add this skill to my set. So I knew I wanted to learn. And actually, I want to go back and say that when I arrived in Boston, I heard from colleagues about the Academy just because I had lived in Brazil for a couple of years, and I knew Portuguese, and I was following some people that were sharing stories. I was very interested in joining the Academy. At that time, I wasn’t able to do it, unfortunately, but then the next year, I told myself, “If I match, then I’ll never have the time to join.” Of course, I know there are people who do it while in residency, and it’s amazing, but I thought, “This is the best time.” So I decided to join, and I remember talking to Jinani. She really helped me a lot to get along and get the subscription.

At the same time, I traveled to the European Congress of Cardiology. I had a presentation there.

Last year, right?

Yeah, last year, 2023, in Amsterdam.

In Amsterdam, amazing city.

Yeah, amazing city. So I remember just from following social media that there was going to be a gathering or group from the Academy meeting at the congress. So I texted them, saying, “Hey, I’m here and very interested in the program. Maybe we can meet up.” So I remember Nicole Felix replied, and we met up. And I met, you know, some of my now-colleagues like Andre Rivera and Mariana Clemente. We had lunch, we had amazing times. And the one thing that struck me at that time was that I asked them, “Hey, is this your first time here, or how does this work?” And they were like, “No, we’re med students, and we’re having orals here in the largest congress of cardiology in the world.” And I was like, “Wait, wait a minute. How is that possible?”

[Laughs] Exactly.

“When I was at your stage, I wasn’t doing that.”

When I was a med student, I didn’t even know what the European Society of Cardiology was at that time.

[Laughs] Exactly. Yeah, the ACC, American College of Cardiology—I think I learned about that as a resident! These kids are presenting at these conferences—it’s just unbelievable.

So I was amazed. I said, “I need to do this. There’s no other way.” So I went back to Boston, and at the same time—this is a funny story—there was a Brazilian student rotating with Dr. Andrea Davila at the BI, and I met her, and we became friends as well. I’m mentioning her because she, Julia Margus, became one of the people who helped me in my projects, and I helped her in hers. So everything was fitting together. I joined the Academy, and I’ve done many programs in the past, but I have to say, I’m not sponsored by the Academy, but I always tell people in my country—I hope they’re joining already—that it’s just an amazing program. Rhanderson is a natural educator, and I’ve told him this while I was a student and even now, as we’re friends. It’s just a great program. In only a few weeks, you develop autonomy, you get to publish, you get to present. It’s amazing. Most of my publications nowadays are actually meta-analyses, and they have come even faster than the publications I worked for years to get in my lab. Obviously, it’s different, but still, it gives me the same opportunities to connect with mentors, to publish in high-impact journals, such as the Heart Rhythm Society recently. It’s just amazing. I can’t say enough about it.

Yeah, I’m so proud to have you as a student, one of the greatest recruitments we’ve had for sure. It’s been less than a year since you finished the program. Can you just share with folks the number or a rough estimate of how many abstracts or publications you’ve had during this time?

Yeah. I think for abstracts, it’s somewhere around four or five, and for manuscripts already published, three, with two others under revision.

That’s incredible. Congratulations, especially as a resident with how busy you are. Just before we move on to another topic, talk a little bit about the connections you built with Andre, Mariana, Marcelo—you know, these guys.

Yeah, these guys are amazing. Now they’re friends, and we all work together. I learned a lot from them. They’re amazing with biostatistics and all of that. They’ve come a long way with this. The good thing is everyone has something to offer. I was working in research in electrophysiology, so I had opportunities and ideas, and I was talking with Andre, and we discussed potential projects. And there, I found an additional tip, on top of the ones you provide during the program. I don’t know if you said this, so forgive me if you already did, but one thing I realized is that if you are working at an institution, you might find people around you working in research that could be a great opportunity for a systematic review or meta-analysis. You not only publish but also connect with those doctors. There’s a lot of value in that.

Of course.

Exactly. So I found this idea from a research publication by one of the EP fellows at Beth Israel Deaconess Medical Center, and I thought, “This is a great idea. Let’s do it.” And Andre—he’s worked on many projects—when he said it was a good idea, I thought, “Okay, this is going to happen.” And then we worked, and the rest is history.

Yeah, that’s super. I’m really proud of the results you guys have had together as a group in the Meta Analysis Academy. Frans, let’s move on and talk about this amazing application you built. How many interviews did you have for residency?

18 academic programs, and you matched at UT Southwestern. So I really want to dive deep into how you checked every box for a competitive application. Let’s go back in time and talk about where you did medical school. What was it like for you during medical school? When did you start thinking about residency in the United States, and why? Why did you decide to come to the U.S. for residency?

Yeah, absolutely. Well, just before I go into that, I was born in Ecuador, as Rhanderson mentioned, and I lived a few years in Brazil. It’s good that people know that because learning Portuguese has opened doors for me, including connecting with mentors and understanding patients, not only in Boston, where there’s a huge community, but also in other places in the U.S. So that’s my disclaimer. Then, as a family, we went back to Ecuador when I was in high school, and I wanted to pursue a career in medicine. I went to medical school in my country, at the University of San Francisco de Quito, which I think is one of the best medical schools in Ecuador.

Early on, I was exposed to the U.S. residency path, and this was because many people from my university were coming to the U.S. I just heard from them and saw them carrying these huge books full of high-yield material, and I thought, “I want to know more.” So I kind of knew the pathway. I was fortunate enough to have a clerkship in the U.S. when I was in my fourth year of medical school, right in the middle. This was in cardiology, and I think it set the pace for what I like and want to do. I became aware of how the system works here and how people approach medicine. From then on, the rest of my medical career was focused on coming to the U.S. I started studying a lot for the exams.

When COVID hit, I studied for them, and as soon as the airports opened, I traveled and took the exams. I wanted to take them with high scores because, coming from a small country in South America, sometimes I thought that might be the only way to get into the system. So I focused a lot on that but didn’t let too much time pass because I wanted to be efficient. It took me a few months to take both exams, and I did well. At the same time, I was applying for a research program called the International Research Initiative.

Before we go into the IRI, sorry about this, but just a little bit more detail if you don’t mind, because this is something that’s on people's minds—the preparation for the steps. How long did you actually take?

Yeah, for me, Step 1—which at the time was the most important; it has changed now, obviously—but at that time, it took me about five to six months.

And during that time, you were still going to med school, or were you...?

I was teaching at my medical school. I had a position teaching embryology and other subjects.

So you had finished and were teaching.

Yeah, I had graduated and continued to be associated with the medical school, and I was studying at the same time. For Step 1, it took about five to six months. For Step 2, it was about three to four months.

So pretty much studying full time.

Yeah, most of the time.

That’s great. You don’t have to share your scores, but I know for a fact that you did extraordinarily well. Is that right?

Yeah, I think I did well, yes.

So that’s an important component of the application. Back in my day—here I go sounding like an old man again—back in my day, Step 1 also had a numerical score, just like when Frans took it. At that time, it was probably one of the most important elements in the application. You have to understand that it’s where there is a quantitative and objective assessment of performance. You can criticize that system if you like, but it’s still a fact. When programs receive thousands of applications for a few positions, they need to have some way of making determinations. They look for objective quantitative parameters, and Step 1 provided that.

Now, with Step 1 being pass/fail, this is just my opinion, but I think it harms strong IMGs (international medical graduates) because it removes one more opportunity for people like Frans or me to stand out with a high Step 1 score. But anyhow, that’s irrelevant now because Step 1 is pass/fail, so it doesn’t matter anymore. But I do want to emphasize the importance of Step 2 now, because with Step 1 going pass/fail, Step 2 together with the number and impact of publications are probably the few remaining objective, quantitative parameters that programs can look at quickly to differentiate candidates. I’m not saying that’s how it should be, but it’s just a fact.

The other objective parameter, in my opinion, is the number and impact of your publications because everything else looks very similar. Frans is going to tell us more about his application, but letters of recommendation are hard to use to differentiate applicants, and personal statements are highly subjective. So I want to emphasize the importance of a high Step 2 score nowadays. For Frans and me, it was a key element in our applications. Sorry, I didn’t mean to go on a tangent. Go ahead, after Step 2...

No, you’re right. So after Step 2, I applied for the IRI, and I was accepted, so I came to the U.S. and started my fellowship position.

Can you explain a little bit more about the IRI?

Yeah, sure. The International Research Initiative (IRI) is a program based in Boston, specifically affiliated with Beth Israel Deaconess Medical Center at Harvard Medical School. It pairs international medical graduates with researchers at the institution in various fields. For me, it was cardiology. Interestingly enough, I was paired with Dr. Usman Tahir, who is the chief of cardiogenetics at Beth Israel. So cardiogenetics was something I had never heard of before in Ecuador, but I thought, “Well, this is great, it’s cardiology.” I came, and that’s where my story really started.

When I was learning about these conditions—like inherited cardiomyopathies and congenital arrhythmias—I thought, “This is fun.” I found rhythms and the science behind it amazing, and I wanted to learn more. So, since I was doing research, I started thinking about how to combine clinical work and research for the next year. I was fortunate to get the opportunity to be at my current lab, the Smith Center for Outcomes Research, but that transition was a bit of serendipity. Dr. Daniel Kramer, my current PI, was living in the UK and came back to Boston just when I was applying for a new research position. No one else wanted to work in electrophysiology (EP), so I was like, “Great, I’ll take it!” [Laughs] So I moved from cardiogenetics to outcomes research in EP.

So you spent one year in the cardiogenetics program, and then you transitioned to the outcomes research?

Yes, I completed the first year in cardiogenetics under the IRI, and then, for my second research year, I transitioned to the Smith Center for EP outcomes research.

How was that first year with the IRI?

It was amazing. The IRI opened the doors for everything that’s happened to me in the U.S. Of course, as I mentioned earlier, success is the result of many years of hard work, but getting into the U.S. system is difficult, especially nowadays, with many people looking for research positions. The IRI basically created a bridge for me to come from Ecuador to Boston. It’s a highly valuable program.

Totally. Maybe because we’re in Boston, there’s some bias, but I’ve brought several guests on the podcast who were fellows in the IRI, and it’s definitely an avenue worth exploring if you’re interested in doing a research fellowship in the United States. It serves as a gateway for many people to get started, just as it did for you. Then you transitioned into EP outcomes research at the Smith Center. Besides the research experience, what other benefits came from these fellowships? Were you able to publish papers, make important connections, or get strong letters of recommendation?

Yes, I was able to publish, and I formed connections with mentors who wrote letters of recommendation for me. That was key to my application.

And let’s talk about the other components of your application. You had high Step 1 and Step 2 scores. You were in your second year of research. You had publications. Let’s discuss the other pieces—medical education and leadership, for example. You mentioned before that you always had a strong component of medical education. Can you give us some more detail about that?

Sure! I love education and teaching. I’ve been doing that throughout my medical training. In Boston, I was fortunate to meet some incredible people who were part of the IRI, and together, we created a program for the Harvard Extension School, where we taught cardiology to pre-med and medical students. We taught through the Harvard Extension School, which was a bit surreal. People were calling us “faculty” and “instructors,” and we weren’t even cardiologists! But we were able to teach the basics—things like ECG interpretation, cardiology diseases, and so on. This was something meaningful and impactful.

I want to emphasize the importance of doing things that are meaningful to you. You might encounter situations where you feel pressure to do something just because everyone else is doing it, but you need to pause and ask, “Is this going to be meaningful to me?” And even more importantly, “Does this align with my story?” Because at the end of the day, you want to tell a coherent story that connects everything you’ve done. In the U.S., people love stories. You as an applicant need to build your story too.

Totally agree. The story of medical education is a strong one for residency, fellowship, academic jobs—everything. Make sure if you have a genuine interest in teaching that you get that on your CV. As I’ve said before, it was a key element that helped me stand out and be chosen as a chief resident, win awards, and become a competitive applicant for fellowship. It will help you do well and stand out during residency too. I’m glad you had that. You also mentioned leadership and community outreach. Could you talk more about that?

Yeah, so, during medical school, I was part of an organization called IFMSA—the International Federation of Medical Students' Associations. I served as the national leader for research in my country. That was more of a leadership position, but it was meaningful as well. We worked on several projects that were important for the country, particularly in areas like organ donation and transplantation. That was impactful, and I was able to share that part of my story too. So, that was my leadership experience during medical school.

That’s great. What I want to emphasize with these questions, everyone, is just how complete Frans' application was as a whole. I’m probably even forgetting some things, but we’ve touched upon his scores, his publications, his networking from the research fellowship, his leadership experience, and medical education. When you sit in front of an interview panel with all of that, you have so many stories to tell, and you can easily connect what you’ve done so far with what you want to do in the future. An easy way to do that is through medical education. You can relate your past experiences to what you want to do as a resident, an attending, and eventually, an academic cardiologist.

This is a story that resonates with interviewers because it's something that people are really enthusiastic about. It's a strong application, and that's how I believe you matched at UT Southwestern. What were the interviews like? You had 18 interviews, you said. Did you attend all of them?

Yes, I did. We were lucky because all the interviews were online. So, I was able to manage the interviews with my busy schedule. I was still working as a research fellow, doing the Meta Analysis Academy course, and applying to residency, so it was a busy time, but I was able to attend all 18 interviews.

That’s incredible.

At the same time, I was teaching at the Harvard Extension School and thinking about projects for the Meta Analysis Academy, so everything was happening all at once. It was a hectic time, but amazing. I always remember that time with a lot of gratitude. Interviewing with all these top academic programs in the nation felt unreal. I took screenshots and pictures during the process because I thought, “How is this guy from Ecuador interviewing at top 5, top 10 programs in the country?” I always feel grateful, and I think gratitude is very important in our lives.

That’s amazing. You’ve done incredibly well, Frans, and this is just the beginning. Like I said earlier, the next steps in your career—fellowship, academic appointments, everything—will be just as successful. You’ve made a huge leap from Ecuador to UT Southwestern, but there are equally important leaps ahead in your career, like matching into a great cardiology fellowship program. Maybe UT Southwestern will even want to keep you!

[Laughs] We’ll see.

Exactly! And then after fellowship, you’ll continue on to academic jobs, become an electrophysiologist, and all that. You have great things coming your way, my friend. So, what recommendations do you have that might be relatable to other people listening from Ecuador, Brazil, India, Pakistan, or other countries who are going through this process? Obviously, we’ve talked about many different recommendations, but what would you say are one or two key things that were helpful to you in this process?

Absolutely. As you can tell, I’m a very optimistic person with big dreams, of course. And I’m sure everyone listening has big dreams too, so I don’t need to tell you to dream big. But I will say, have a growth mindset. This means seeing every challenge, every setback, as an opportunity to learn and improve. The next thing I’d emphasize is the importance of strategic planning.

Remember my analogy about the cake and the four ingredients for being “lucky”? Keep that in mind: preparation, opportunity, action, and attitude. Never forget those four elements. They’ll help you in this journey.

A positive attitude definitely helps. Now, in the last few minutes, I’d like to talk about life as a resident, but outside of residency. You’ve mentioned to me that your wife is also a PGY-1, and she’s here in Boston while you’re in Dallas. You’re both very busy with work and personal responsibilities. How has it been balancing everything? Obviously, share whatever you feel comfortable with, but how are you managing your residency, the pressure to do research, and personal responsibilities?

Yeah, I think for residency, as people always say, it’s a marathon, not a sprint. You have to find time to do other things. For me, for example, I love playing soccer. I actually play with the cardiology fellows from UT Southwestern every week.

Nice!

Yeah, and that helps a lot. I also love running, and now I run every day along the Charles River. I love that.

Boston is a city where everyone runs.

Exactly! It’s great. And, of course, spending time with my loved ones, including my wife, is really important for me. I have amazing friends in Dallas as well—my co-residents—and that’s been great too. You know, if you ever move to Dallas, you realize you have to buy a car. I bought my first car, and I’m so happy about it. [Laughs] It gives me the freedom to travel and do other things with friends. So yeah, life is good.

Speaking of cars in Dallas, I remember visiting some friends in Dallas when I was in Miami, like eight or nine years ago. I remember we’d be at their house, and they’d say, “Let’s go grocery shopping,” and it would be a 20-minute drive on the highway! The city is so huge, and everything is far. Do you live close to the hospital?

Yes, I live close to the hospital, about 5 to 10 minutes away by car.

I want to talk a little bit more about Dallas because I often bring people on the podcast who are from Boston, and we talk about the cost of living here, but what’s it like in Dallas? If you don’t mind, give us a sense of the cost of living, rent, and how your salary as a PGY-1 goes compared to that. How does it all compare?

Yeah, sure. So, I’m not complaining, by the way! [Laughs] But having lived in Boston, I can say it’s a very expensive city. In Boston, I could only afford a small place with my wife, and it was tough. But now in Dallas, with my salary, I have a nice one-bedroom apartment—big compared to Boston—and I have a car, as I mentioned. The place I live in has a pool, parking, and everything. I can also do things with my friends, so the cost of living is definitely lower compared to Boston.

I’ve also read that Dallas is one of the fastest-growing cities in the U.S. A lot of companies are moving there, and the city is expanding, so there’s a lot to do.

Yeah, Dallas is a great city. Texas is a great state. By the way, for those of you interested in the financial aspect, Texas has no state income tax, so your salary stretches further compared to states like Massachusetts, New York, or California. Florida is another state without income tax. So, in Texas, your salary goes a longer way.

That’s one of the benefits for sure.

Yes, absolutely. And it’s one of the major academic hubs too, not just UT Southwestern in Dallas, but also the Texas Medical Center in Houston. Texas is a phenomenal place to train and live. My wife and I have even considered Texas as a potential destination for the future because I hear so many great things about it.

It’s a great place to be.

Well, Frans, it’s been a phenomenal conversation. I’m really proud of you, as I’m sure the Meta Analysis Academy is proud to have you as a contributor, partner, and friend. Congratulations on all the great work you’ve done, and I look forward to seeing the next steps in your career.

Thank you, Rhanderson. It’s been a pleasure.

So, everyone, this was MetaCast, the podcast of the Meta Analysis Academy. I had the honor of welcoming Frans Serpa today to discuss his amazing story, his journey from Ecuador to residency as a PGY-1 in internal medicine at UT Southwestern. If you’re interested in more topics like this and want to hear other incredible stories like Frans', make sure to tune in to future episodes. Also, check out our Twitter/X account and Instagram at metaanalysis.academy. If you speak Portuguese, don’t forget to check out the Portuguese episodes as well.

And for those of you interested in learning meta-analysis and systematic reviews to advance your career, make sure to check out the Meta Analysis Academy, where I teach students like Frans how to conduct impactful research with autonomy that can transform your career. Frans, thank you so much for being here today—it was an honor.

Thank you, Rhanderson. The honor was mine.