Hello everyone, and welcome to our interview with Dr. Jason Ryan, creator of Boards and Beyond.

My first year neurology course was frustrating, confusing, and difficult. I passed, forgot everything, and life went on. Early in the fall of my second year, I watched an online video on brainstem lesions. The video was fantastic, but after I watched it, I simply put my face in my palms and let out a deep sigh. If only… If only I had discovered this twenty-six minute video during that neurology course, I could have saved myself hours of frustration, I would have actually understood the material, and I would have retained it.

I can’t think of a better way to describe Boards and Beyond – a comprehensive, clean, concise video series that teaches you just about everything you need to know for the USMLE Step 1 exam. If you know, you know. If not, get with the times and read more here. I am extremely thankful that I discovered Boards and Beyond and I can’t imagine where I’d be without it.

And because of that, we have to thank the creator, the teacher, and the voice of wisdom behind all of those helpful videos – Dr. Jason Ryan, M.D., M.P.H.

Dr. Ryan is a cardiologist at the University of Connecticut (meaning his cardiology videos are an absolute must-watch). After earning both a bachelor’s and master’s degree in chemical engineering, Dr. Ryan attended medical school at the University of Connecticut. He completed his internal medicine residency, including a year as chief resident, and his cardiology fellowship at Harvard’s Beth Israel Deaconess Medical Center. In addition to his work as a cardiologist, Dr. Ryan gives lectures to medical students at Uconn and perfects the consummate preclinical medical resource in his free time.

Recently, I was fortunate enough to get in touch with Dr. Ryan. We discussed Boards and Beyond, clinical rotations, life in medicine, the New England Patriots, and much more. While we know him as the voice of Boards and Beyond, Dr. Ryan delivers insights, laughs, and gems of advice throughout. Enjoy.

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JS: Hi Dr. Ryan. First and foremost, thank you for taking the time to speak with me. On behalf of medical students across the globe, I would like to express my appreciation and gratitude for Boards and Beyond. Let’s start by taking it back to the beginning – can you tell us about how and when the idea for Boards and Beyond came to you?

Dr. Ryan: I have always loved teaching. After my cardiology fellowship, I took my current job at the University of Connecticut specifically for the opportunity to teach medical students. When I started at UConn, the classroom lectures were video recorded so students could review later. A student of mine told me he watched my lecture on anticoagulants five times before his Step 1 exam. That put the idea in my head that I should start recording more of my teaching. Then I began to hear about students using websites to watch teaching videos and the light bulb went on.

JS: In that case, I think we all owe this student a ‘thank you’ as well. Balancing your career as a cardiologist while creating over 100 hours of high quality video content had to be a difficult task. Can you describe a little bit about the process and work that went into creating this medical school masterpiece?

Dr. Ryan: To make my videos, I start with First Aid for the Boards. It’s always been one of my favorite books both as a student and a teacher. You can’t learn a lot from it but it distills the universe of topics down to a manageable number. Think of my field of cardiology. Volumes have been written about heart disease. Which topics should students focus on for Step 1? First Aid is the only book I know of that gives an answer to that question.

Once I choose a topic, I basically put myself in the shoes of a student. What would I most want to learn? What would be most difficult to understand? I am aware that most of my students will not become cardiologists. They will be pediatricians, radiologists, or psychiatrists. They will never diagnose a STEMI by ECG. I try very hard to tailor my teaching so it hits just the points that students need for a basic foundation. Those that want to learn more can follow me around in clinic to discuss the high-level stuff.

At the same time, however, I make sure my teaching goes deep enough for Step 1. The exam has certain pet topics that come up a lot in questions. Few cardiologists could identify a pressure-volume loop for restrictive cardiomyopathy but the boards will test this topic. First Aid does a good job of identifying what’s covered on the exam and I use this as a guide. 

JS: And that’s the beauty of it – I have always viewed First Aid as the “what”, while Boards and Beyond gives us the “why”. Setbacks and doubt are natural components of any creative endeavor – throughout the process of creating Boards and Beyond, were there any roadblocks that you encountered along the way? Did the initial response to the release of Boards and Beyond meet, exceed, or fall short of your expectations?

Dr. Ryan: Launching Boards and Beyond was a huge leap of faith. A website that streams hundreds of videos on demand does not come easy. I almost did not proceed once I saw how much time, money, and effort was involved. The encouragement of my students at UConn helped a lot. They told me my teaching style was unique and believed it would capture a broad audience in time.

The initial response to the website was lukewarm. At the time I started Boards and Beyond, I did not realize how many other resources are available to medical students. This may have been a good thing because if I did know I might have chickened out. When the site launched, many students saw it as just another resource competing with hundreds of others. I had to give away a lot of free accounts and wait for word of mouth to build.

JS: Between the time, money, technical hurdles and the saturated market, I can’t imagine how daunting the project must’ve felt when you started. I recently caught up with a few friends who attend other medical schools, and it seems that just about everyone is talking about Boards and Beyond. The popularity of your site has seemingly propelled you to cult-hero status among the ranks of Dr. Sattar of Pathoma. I am not sure if you are aware, but websites sell T-shirts and coffee mugs with Dr. Sattar’s face on them. Would you buy a T-shirt with your face on it?

Dr. Ryan: I would not. And I encourage anyone considering buying something like this to seek help.

JS: I will certainly let them know. Did you ever show your grandmother the Boards and Beyond shout-outs?

Dr. Ryan: Ha! Unfortunately, she died at age 92 before Boards and Beyond launched. She came from a family of coal miners in Scranton, Pennsylvania who rode out the Great Depression. She had seven children and put each one through college even though she and my grandfather never went. She loved that I became a doctor. I wish I could tell her about what I’ve done with Boards and Beyond.

JS: My sympathies. I think making the most of our opportunities and blessings while being cognizant of their sacrifice is the ultimate display of gratitude towards our elders, and you have done just that. It seems that Boards and Beyond is becoming a “household name”, so to speak, amongst medical students. And at this point, many medical students agree that your content is superior to the lectures provided by their schools. Obviously your intent was not to undermine the work and expertise of other professors, but the reality is that many students ignore their class lectures in favor of yours. How do you think other professors and instructors feel about this? Has there been any sort of “backlash” from colleagues or other teaching faculty?

Dr. Ryan: The other faculty members at UConn have been supportive of my work. We have moved away from a lecture-based curriculum to team-based learning. Students are encouraged to identify their own resources to learn the material before class. My videos are just another of the many tools students learn to prepare for the team-based sessions.

When I was in medical school, there were no videos like Boards and Beyond. But I read a lot of board review books like the BRS series to give me an overview of topics. This helped orient me so I could understand the lectures better. I feel like Boards and Beyond is a video version of those books. It’s not meant to undermine anyone’s teaching, just to guide students as they learn.

JS: That’s a good way to put it. With so many different lecturers and styles of teaching, it’s easy to lose the big picture. Having a resource like Boards and Beyond to guide you through the maze of Powerpoint purgatory is invaluable.

JS: I think it’s safe to say that every student experiences self-doubt at some time or another – From your first day of medical school through residency, which aspect of your medical training was the most difficult for you, and why?

Dr. Ryan: My first year of cardiology fellowship was the hardest year of my training. Beth Israel Deaconess is a large city hospital with a busy inpatient cardiology service. On call, anything related to cardiology went through me including STEMIs, cardiac arrests, cardiogenic shock, urgent echocardiograms – everything. I loved it. I learned more that year than probably any single year of my training. The best way to gain confidence in clinical medicine to treat lots and lots of patients. There is no substitute for experience.

JS: Many students currently using Boards and Beyond and reading this post will soon begin third year rotations. Given your training at Beth Israel Deaconess Medical Center and your current appointment at Uconn’s Cardiology program, what behaviors, attributes, and characteristics impress you the most among students who rotate in your department?

Dr. Ryan: My best piece of advice is to think like an attending which only comes with practice. Patients are complex with hundreds of items pertaining to their care. Don’t just unload a laundry list of facts when you present a case. Try to put yourself in the shoes of the attending. What information would be most helpful? What information is extraneous? For every case you see, try to think of what the attending will do before you present any clinical information. With practice, you can predict what the attending needs and have that ready. This will make you really stand out.

JS: As medical students, we often obsess over board scores, research, and ensuring our applications put us in a competitive position. After you’ve decided an applicant looks good on paper, what virtues and qualities impress you the most in the interview? Can you share any particular moments that made you say, “We need this person in our program”?

Dr. Ryan: The most important thing at an interview, in my opinion, is to be relaxed and interactive. I care less about what you say and more about how you say it. Applicants eventually become colleagues. I look for people who are friendly, interesting, and good listeners – the kind of people I would want to work with for a long time. I also like it if applicants can talk about their patients in a way that shows compassion. Every case has its technical aspects: the physical exam findings, the diagnostic test results, the treatments. It’s okay to talk about these things, but I love it when an applicant also mentions the emotions of the patient and their family. Were they scared initially? Were they relieved after treatment? Mentioning these things shows me an applicant views patients as people.

JS: That is exceptional, unique advice that I hadn’t really considered before. After two years of medicine existing solely in the realm of multiple-choice questions, it’s easy to forget and overlook why we’re here in the first place. Thank you for sharing. On the opposite end of the spectrum, what is the worst thing that an applicant has done in an interview?

Dr. Ryan: One medical school applicant was an EMT. He told me that most of the calls he received were people who faked a fall at the mall or a supermarket so they could later sue for damages. This is not a good observation to share at an interview. Even though it may be true, it does not paint a picture of compassion and caring.

JS: Yikes. Additionally, I’ve been longing to know – what is the best answer to the dreaded “what are your weaknesses” question?

Dr. Ryan: In my opinion, it’s okay to be honest. One applicant told me he was disorganized and that he used notes to make sure he didn’t forget anything. He was courageous to share this. And this showed he had insight into his strengths and weakness. His application was otherwise strong and I had no concerns about recommending him for our program.

JS: Aside from the general “do what you love” advice that we’ve heard reiterated endlessly throughout the years, do you have any specific advice or wisdom to give medical student approaching the decision of what to field of medicine they will go into?

Dr. Ryan: Every medical specialty has its bread and butter. For cardiology it’s coronary disease, heart failure, and atrial fibrillation. If you do not like managing these conditions pick another field. It’s okay to be fascinated by a case of cardiac sarcoidosis but if you expect to see this every day in practice you will be disappointed. For any field you are considering, don’t depend on the rare, exotic cases for excitement and satisfaction. Learn the common pathologies and make sure you enjoy those.  

JS: I have invested a lot of brainpower into memorizing the details of lysosomal storage disorders, and I feel robbed. On a more serious note, why did you choose cardiology? Was there a particular moment or experience that made you say, “This is what I want to do for the rest of my life”?

Dr. Ryan: During my 3^rd year internal medicine rotation, I spent one day per week in a cardiology clinic. I had never considered the specialty before then. I loved it. There was a great mix of patient interaction, physical examination, plus high-tech stuff like echocardiograms and angiograms. Going forward, I compared all other fields to cardiology and nothing could beat it.

JS: I really hope I have the same feeling this year, because I’m already anxious about choosing the wrong the field. So, here’s a hypothetical: The year is 2020-something and Elon Musk has announced an Artificial Intelligence program that will replace all cardiologists. In our new dystopian world, you can switch into any field of medicine – which do you choose and why?

Dr. Ryan: Ophthalmology. I had almost zero exposure to this in medical school. I have since come to learn more about it and think I would love it. Learning about the eye as a student can be difficult, but clinical management of eye diseases is fascinating. There are so many modern treatments in terms of medication and surgery.

JS: (Paging Dr. Glaucomflecken). Shifting gears here, what do you like to do to de-stress and enjoy yourself when you’re not fixing hearts or teaching?

Dr. Ryan: My wife and my children are the joy of my life. My son, Luke, is nine and my daughter, Ella, is seven. I love them more than words can capture.

JS: And that’s the greatest achievement of them all. Congratulations. I think I remember you mentioning that you play guitar. Which kind of guitar(s) do you own and what music do you like to play?

Dr. Ryan: I have an acoustic guitar and I play very poorly. I know about five chords and learn songs from Youtube videos. Please don’t expect my debut album anytime soon.

JS: A cardiology themed folk album included with each Boards and Beyond subscription would’ve been a big hit. What is your favorite song with “heart” in the title? Perhaps Springsteen’s Hungry Heart? Neil Young’s Heart of Gold? Or maybe Bonnie Tyler’s Total Eclipse of the Heart? This is a judgment-free zone.

Dr. Ryan: Rolling Stones: Heart of Stone. Also, my favorite heart-related movie line is from the Coen Brother’s movie, Oh, Brother, Where Art Thou. Ulysses McGill (George Clooney) says, “Only a fool looks for logic in the chambers of the human heart.”

JS: Definitely an underrated work in the Coen Brothers’ filmography. I’ll have to revisit that one soon. As a New Englander, what emotions do you feel when you hear the name Nick Foles? Are you dreading the inevitable collapse of the Brady-Belichick empire? (There is always room on the Steelers bandwagon)

Dr. Ryan: The loss in Superbowl LII was hard to take. I console myself by re-watching Superbowl LI which is on my DVR never to be erased. I go to one or two Patriots games at Gillette every year. Tom Brady will play until he’s 50 when his son will be old enough to take over the job.

JS: Cherish those memories, because Tom Brady’s son will be drafted by the Cleveland Browns. And at last, balance will be restored to the league.

Moving on to a more serious topic, I do have one question regarding your response to the professionalism issue – can you use your connections in the US Residency Matching Program to land me some interviews in the surgical subspecialty I’m interested in? Please.

Dr. Ryan: Yes, I have just done this now. And it’s good you asked because we had you slated to match in a remote section of Siberia based on a pirated version of Costanzo found on your laptop.

JS: Thank you, my mother would have missed me. Throughout the eight months I’ve been using Boards and Beyond, you have made many additions and updates to the site. What can future students expect from Boards and Beyond going forward? Furthermore, are there some short-term goals (i.e., more quizzes) and/or long-term goals that you’d be willing to share with us?

Dr. Ryan: We have lots of exciting things in development. The website is getting a makeover this summer. There are a few topics that our videos don’t cover. We’re going to finish those up soon. It will take some time but eventually every video will have a handful of associated questions. We are also releasing new books with color images.

JS: Dr. Ryan, it’s been a pleasure to hear from you. Thank you for your time. Thank you for Boards and Beyond. And thank you for all you have done to help medical students across the country.

Dr. Ryan: Thank you for this opportunity. I am grateful to you and all of the students who use my videos. I am very fortunate to be able to teach so many bright learners.

 

And that concludes our module on interview with Dr. Ryan.

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Click here to check out the Boards and Beyond website and start your subscription. For quick doses of wisdom as well as Boards and Beyond updates, follow Dr. Ryan on Twitter.

While I am currently in a Step 1 hibernation, I am very excited to get back to writing after my exam in a couple weeks. Upcoming posts will include my Step 1 experience, what I’d do differently, reviews on various study resources, and much more – there’s a lot of stuff I can’t wait to get off my chest once this beast is over. For news on my latest posts, follow me on Twitter: @JordanSoze

 

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