Brysen Keith, DO, MS, PGY-1 is a recent graduate from the A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA) and is beginning an internal medicine residency with the University of Miami/Jackson Memorial Hospital Internal Medicine Program this month.
Brysen Keith, DO, MS, PGY-1 is a recent graduate from the A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA) and is beginning an internal medicine residency with the University of Miami/Jackson Memorial Hospital Internal Medicine Program this month. He serves on the Special Commission on Osteopathic Medical Licensure Assessment, which was formed to review the current COMLEX-USA exam and explore new, evidence-based ways to evaluate and verify fundamental osteopathic clinical skills and other competencies as osteopathic medicine, medical education and healthcare continue to evolve. We were very excited to get the opportunity to sit down and interview him on his Road to DO Licensure thus far.
What inspired you to become a DO, specifically? Tell us your story.
I didn’t take the typical route into medical school; my background is actually in biomedical engineering. I loved what I was doing but I really enjoyed working with patients more than anything, which is why I made the switch into medicine. Why I chose to become a DO came from my foundation as an engineer in that the idea of body, mind, and spirit with the addition of OMT seemed so naturally rooted in the idea of structural medicine. Therefore, going into osteopathic medicine just made sense to me because there was that understanding.
How does it feel to be part of the Special Commission? Tell us your thoughts.
I’ve spent a lot of time both before and in medical school working in advocacy; it’s something I enjoy and am passionate about. Being my school’s student government association (SGA) president and working through the council of osteopathic student government presidents was very rewarding. Part of what drove me towards pursuing innovation, particularly in medicine, was my history as an engineer in a past life. To be selected for the Special Commission was not just an honor, but has also been very enjoyable.
In the Special Commission, there are a lot of people who have been involved in medical licensing for a long time—so I try to push the boundaries for innovation in medical assessment as far as it can stretch. That’s what I see my role as, but I also want to make sure that the student voice is heard, which is very important because it’s the students who are being tested. I love it and have enjoyed it so far, but overall, I’m very touched and excited to see what comes out of it.
We often hear the phrase ‘osteopathic distinctiveness’ used across the profession. Having taken COMLEX-USA, what does that phrase mean to you personally?
Having taken COMLEX-USA Level 1, 2-CE, and PE, what I think defines the distinctiveness of osteopathic medicine is how we approach our patients. I love it, and it’s something I’ve seen a lot of in clinical; DOs really take a hard look at the person. I know we often talk about treating the patient as a person and focusing on the whole body, but that makes such a huge difference when you’re actually having those one-on-one conversations with a patient and their family.
I love that I was taught to balance clinical medicine with social medicine. Being able to have those human-to-human conversations and interactions is what brings the osteopathic touch to medicine. It’s extremely powerful—just taking a couple extra minutes to have a conversation with someone. For example, in internal medicine, a single patient may see upwards of six different physicians, so I always take the time to explain to them who their team is and who is in charge of their care and how I fit in that role. They always appreciate that. Especially in today’s healthcare, that connection is something that is often lost, but it’s also something that I want to make sure we continue to instill in our graduates—it’s something that I am very proud to carry forward.
Looking back at how you prepared for your most recent level of COMLEX-USA, would you have taken a different approach to studying? What advice do you have for other COM students who are preparing for COMLEX-USA?
This is a tough question because the approaches I took to studying for COMLEX-USA Level 1 versus studying for Level 2 are very different. When I was preparing for Level 2, I definitely did a lot more practice questions versus overall content review because when you’re taking Level 2, you’ve already seen all the content at that point. The preparation involves refreshing your brain a lot more on clinical aptitude.
The advice I would give to COM students is to make sure you program in days or even a half a day every week to take some time for yourself. There is a lot of anxiety involved in board licensure and exams, and it’s really easy to fall into the trap of getting burnt out. It starts with thinking that you need to do everything right now, and that isn’t true.
When prepping for my Level 2 exam, I allowed myself to take a day when I needed it. I know it’s something people say a lot, but I think we also don’t realize how important that is. You can say it all day, but actually doing it and putting it into practice is something else entirely. I literally had it written in my calendar [to] shut my phone off. In all honestly, I think shutting my phone off was one of the most helpful things because then you’re not even thinking about it.
The Road to DO Licensure has many unexpected challenges that I’m sure you’ve experienced, including burnout, stress, and anxiety. Talk about some of the major challenges you’ve faced while taking COMLEX-USA and how you personally overcame them.
What I had a hard time battling was the anxiety around boards, and thinking that this is one thing that will either make or break my career in medicine. For example, after getting up every morning and doing a 40-question problem set and not performing as well as you’d like, it’s hard not to fall into the thought process of questioning your abilities. “Am I ready for this? No, I’m not—what am I going to do? Do I need to push my exam back?” That anxiety and imposter syndrome starts setting in, and it’s really hard to get yourself out of that rut. I think what helped me through that was having a really good friend group who were all going through it at the same time. We’d compare notes with each other and also be reminded that we’re not the only ones who have those feelings and are going through this—we’re not alone.
Everyone has off days, especially when you’re doing boards. I had a really good friend during mine, and we would always keep each other accountable—talk each other off the ledge when we were freaking out about things. In medicine, when you hear about others doing so well, you start to think, ‘Oh, crap, I’m not doing that.’ So having those people—maybe even a couple years older than you—with similar study habits can help you take a deep breath and move to the next thing.
Did you only take COMLEX-USA and why?
I only took COMLEX-USA. I had debated taking USMLE, but I knew early on that I wanted to go into internal medicine, therefore I didn’t need to take it. For other specialties, it’s said to be more important—this is an issue that is being addressed.
I definitely will say that I think something we as DOs can work on is recognizing that there are still specialties where programs require USMLE along with COMLEX-USA. The level of anxiety and money that students have to pay to make sure they are competitive in that space is something that we need to look at really closely. That said, it is nice to see—at least in my tenure in student leadership—that a lot of programs are doing better in no longer requiring USMLE for DO students. We still have a long way to go.
Change is slow—especially good change. I am appreciative to have the 30,000-foot view that I have because it allows me to see that change is happening—it allows me to talk to other students and give them hope. It’s easy for them to say, “Why is this not happening right now?” But unfortunately, that’s not how policy change works. We are heading in the right direction, and I’m happy to see the progress we’ve made collectively as a profession over the last few years.
What are you looking forward to the most in the next stage of your journey?
I’m excited for the learning aspect of residency, but I’m also really nervous—like how I mentioned imposter syndrome earlier. Even though you’ve been told so many times that you shouldn’t be nervous for residency and you’re going to do great, you still can’t help the feeling. I also can’t wait to be in a space where I have the flexibility to learn and to also make mistakes. I feel like I’m going to become competent very quickly with the program I’m going into because they do a lot of teaching. I can’t wait to have students under me that I can help guide through the same path that I took a few years ago. I think I bring a good world view, especially when rotating and in third-year where there’s a lot expected of you. I am excited to help mentor students through that.
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