By Zack Merhavy
Dr. Renuka George, MD is a 2012 RUSM grad who is now an anesthesiologist, Assistant Professor, research elective mentor, and Medical Director at the Medical University of South Carolina. I had the opportunity to virtually meet her just after the new year and ask her some questions about her experience as an anesthesiologist, as a researcher, and as a Ross alumnus.
How did it feel to win the Ross Early Distinguished Career Alumni Award? What pieces of your career thus far do you feel set you apart for the award?
It felt really good! I think coming from a Caribbean medical school, a lot of us have certain worries and insecurities; especially when you’re up against people at the big names in their medical school degrees. If there’s anything I learned along my path, you don’t have anything to be insecure about. You have to put in a lot of work; you get out what you put in. If you’re willing to work, there’s no real need for you to be insecure about anything at all.
[Winning the award] felt good, and years ago when I was still in medical school, I would have felt very, for lack of a better word, insecure about sharing that award with other people; but now I feel very proud of it. I feel like Ross has helped me achieve that. A big component of that is to always be a little bit afraid and hungry the whole time, so you’re always thinking ‘okay, what’s the next step? What do I need to do? What’s my next achievement?’; and that’s something that Ross really drilled into me because you have to be better than the next applicant or the next student or the next resident to achieve what you want to achieve. That is something I really appreciate about Ross.
Do you feel like it was more difficult applying/matching to a residency like anesthesia, coming from a Caribbean school?
Yes, I had a lot of people saying ‘oh, you’re only applying to anesthesia without a backup? What’s wrong with you? You’re never going to match’. So, I was absolutely terrified to do it, but I didn’t want to do anything else; like, this is it for me. And I’m glad I didn’t listen to them!
I think it’s normal to have those concerns. I will say that now I sit on the Application Committee and the Review Committee for people who are applying for residency spots. And I won’t lie; it’s gotten harder since I was an applicant. MUSC is a very desirable location and residency site, so I don’t know how it is for a lot of other places, but you have to be like, top tier as a student to get into MUSC. The Chair may allow for like 1 or 2 interviewees, maybe; and you’d have to have ridiculous scores. So, in that sense, I think it’s gotten harder, but it’s still doable. Like, if it’s what you want to do and you work hard, you’ve had that hunger, and you’ve got that ‘go get ‘em’ attitude, it’s totally doable!
There is a book that I want to recommend to you guys; it’s called “The Successful Match”, and it’ll help you start that process early. Knowing when and how to ask for letters of rec and what kind of board scores are needed for all specialties. You can get it on Amazon for like $20, I think. Everything from how to ask for letters of rec, how to write your personal statement, writing thank-you notes – which people think are not worth it, but they totally are! – and the type of interview questions you should be asking.
Do you have any advice for students who are expecting to do a Couples Match?
Doing a Couples Match is only going to serve you as long as you’re proactive, because what happens is, let’s say your wife has an interview at a certain program. Either she or you can call and say ‘hey, we’re really interested; you have an anesthesia program there, and I would like you to re-look at my application because we would both like to end up in the same program’. And it works in your favor; obviously not everyone is going to give you a shot, but other people will be like ‘okay, we’ll take a second look’.
My husband and I cold called like all kinds of programs, and we definitely got interviews from it!
Just out of curiosity, since both your parents are in medicine as well, is there anything that specifically made you want to follow in your mother’s footsteps versus your father’s, or is it strictly by coincidence what you got passionate about?
Neither of them really pushed me because they both love their jobs and they wanted me to love mine as well. They both think of medicine as a calling. The idea of medicine has changed in some ways since their time; there’s a little bit more attitude towards medicine now where you need to take care of yourself in order to take care of other people. So, while it is a calling, I don’t think it should be completely your entire life, and I think that’s how they were raised. So, based on that, they wanted me to love what I do so it doesn’t feel painful spending so much time doing something.
That being said, I was all set to apply for peds and I happened to do an anesthesia rotation, thankfully, and I ended up loving it and changed my whole application in July of the application cycle, which is crazy. I’m glad I did it, but it was very painful.
What are some of the specific reasons you chose to pursue pain management and regional anesthesia versus pediatric anesthesia?
So, I ended up choosing between the two of them, and the reason I chose regional and acute pain is that it didn’t put me in a box. Like, I still occasionally still take care of kids. I’ve done ortho, general, and vascular; I do a little of everything, and I’m still able to provide pain relief for them where I provide a very specific kind of pain relief.
For peds, once you go into private practice, you kind of get pigeon-holed to only doing peds in most academic centers. And I didn’t want to do that; I didn’t want to give up all the other aspects of anesthesia.
There’s something very gratifying [about] providing that kind of pain relief for people, because for most of anesthesia, they don’t see what you do. You’re essentially doing magic on people, but they never get to be awake for it, whereas regional anesthesia and acute pain, they are. It’s very gratifying to see that look of wonder that glosses over their face when the pain relief finally sets in. Like, you would have someone writhing in pain in front of you and when you do a nerve block on them, in about 5 or 10 minutes, they’re like ‘wow, I don’t feel anything!’, and it’s pretty rewarding.
What originally got you interested in doing research? When and where did you start?
I had done some research before medical school. I was essentially like a research assistant in that I collected and analyzed data and did all the numbers, but when you’re in that role, you don’t have a true appreciation for what you’re doing; you’re a cog. That has its purposes too because there’s a lot of patient interaction and you get to actually crunch the numbers and appreciate the details behind everything.
I guess when I really started research was when I was in fellowship. I did some research in residency, but I think the key to all of this is finding a very very passionate mentor. I was lucky both in residency and in fellowship to have these really really incredible mentors who were curious about the work, who wanted to know more and were very very good at conducting that research as well. So, then having those people in your life, research isn’t as intimidating and becomes fun to do because you get caught up in their passion as well. And they teach you how to be efficient about it and how to engage people in the process as well. You don’t have to do everything yourself. Like I use medical students and residents for my lit reviews, and they’re all kind of like where you are; you know, they want to get involved. It’s kind of like a 2-way street; I help them, and they help me. Then, [the person doing the research] gets to do the fun thing of finally asking the questions that you want answered and looking for ways to answer that, which is really awesome.
But I would say the key component out of everything, especially when in your shoes, is to find a mentor who will guide you through that process. Because if you work for people who just don’t really care and aren’t there to help you grow as well in their research, then that spark is never really ignited in you.
Finding mentors can be such a numbers game. You never know who’s going to say yes, or who will actually be a good mentor, or if anything is going to come of it. Do you have any advice for students who are still learning to navigate some of that?
It’s hard at Ross. I couldn’t do any research at Ross because you’re studying all the time as a med student, and when you go into clinicals, you’re busy. In your 3rd year, every 6-12 weeks, you’re being changed to different rotations.
They did not have a research rotation when I was there. So, because it wasn’t offered, it’s hard to do research during your surgery rotation or your peds rotation because your whole life gets sucked into that part of your time.
For students at Ross, you can email anesthesia docs and ask if anyone in their department is doing research. As a med student, someone is only going to hand you data collection or a literature review. Those are pretty much the only two things that we can really have you do from an IRB standpoint. Just offer yourself as someone who is willing to do the grunt work. Most academic positions will be thrilled to have help. I’m not saying that there aren’t jerks everywhere; there are people who are full of themselves, but just brush it off and move on to the next person. That attitude of asking how you can be helpful and going that extra mile will serve you well in the future.
How do the research rotations where you are work?
We have a couple Research Coordinators, and every year, the med school will work with them and say like, ‘okay, Zack, Layla, Maria, and Thomas are interested in research. What projects do you have that are ongoing?’ That’s how I get med students, so if they’re interested, the school will say ‘Dr. George is working on these 3 projects and needs someone to collect data for her’. So, that legwork is done for you.
There’s a short research elective they can do during their MS2 year, and then there’s a longer, over the course of 6-8 months, research elective that they can get credit for. [Both students she has now] have worked with me in the past on the short research elective, and they essentially come in and do data collection. When they just do data collection, what they end up with on the papers is being listed in the Acknowledgements. If they actually do write parts of the papers, they actually get put into the citation. You are not automatically guaranteed a citation just because you do some consents.
Because I’m cycling through so many med students, having a long list of citations doesn’t really look very good for the paper, so you just put them in the Acknowledgments
How difficult would you say it is to get a research elective spot where you are?
It’s not, but it can be hard because either not a lot of students want to do research, or they don’t always have the foresight to look into it that early. The few that ask early or cold call those academic institutions to try and do research with them, I think you have a pretty good shot of anesthesia just with them.
Yes, they look at board scores, but what’s important to me is the grit that you show and the foresight and application of what you want to do. That to me is more important than just a board score because anyone can just sit and read and answer multiple choice questions. Your letters of rec are also going to be important, and then your ability to actually go after what you want is very important. That kind of determination is very important in the operating room because you’re going to have crappy days in the operating room, very hard days. So, if you don’t have that level of determination and grit and adaptability, it just doesn’t work.
Would you say anesthesia is a good specialty for having the ability to balance research?
It depends where you are. We have a very robust research department; the Chair is very supportive of research. Not all institutions are like that, and it’s something you should ask when you’re on the interview trail. Ask how many of their faculty have published. If it’s only like 5 out of a group of 80, they don’t get a lot of support, but if it’s 60 or 70 out of the 80, they probably get a lot more support. They probably get time to publish and do research and the residents have a lot of mentors available to them.
Do you have any advice for Ross students in the basic sciences looking to pursue a career in research?
I stand by what I said early about finding a good mentor; that’s key. Also being able to put yourself out there and ask for opportunities – no one will hand you opportunities. So, those two things: being able to recognize a good mentor and going after projects that you find desirable.
Good mentors can be hard to find sometimes; finding someone who is passionate, happy to teach, and who has done a lot of research. It can be challenging, but those would be the things I would look in a mentor.
A huge thank you to Dr. George for taking the time to speak with me and giving such great insight and advice! If any readers are curious to know what kind of research she’s been up to, check out some of her publications below:
· Wilson, SH, George, RM, Matos, J, Wilson, DA, Johnson, WJ, & Woolf, SK. Preoperative quadratus lumborum block reduces opioid requirements in the immediate postoperative period following hip arthroscopy: A randomized, blinded clinical trial. Arthroscopy: The Journal of Arthroscopy and Related Procedures. doi:10.1016/j.arthro.2021.07.029
· George, RM & Wilson, SH. Serratus plane blocks: Not quite plane and simple. Regional Anesthesia and Pain Medicine, 44(4). doi:10.1136/rapm-2018-100338
· Matos, J, George, RM, & Wilson, SH. It is not always the epidural: A case report of anterior spinal artery ischemia in a trauma patient. A & A Practice, 11(6). doi:10.1213/XAA.0000000000000764
· George, RM, Yared, M, & Wilson, SH. Deep serratus plane catheter for management of acute postthoracotomy pain after descending aortic aneurism repair in a morbidly obese patient: A case report. A & A Case Reports, 10(3). doi:10.1213/XAA0000000000000628
· Gumbert, S, Nwokolo, OO, Markham, T, Ramirez-Chapman, AL, Schakett, BE, DeHaan, JB, George, RM, Williams, G, & Pivalizza, E. Observations and suggestions for millennial resident applicant interviewees. Anesthesia and Analgesia, 122(6), 2065-2066. doi:10.1213/ANE00000000000012323