The Ghost Note: Navigating the virtual match

Resident Fellow Council, AAP
3 min readOct 27, 2020

By Roshani Patel, OMS-IV

Photo by Vlada Karpovich from Pexels

It’s my final year of medical school. Ordinarily around this time, students embrace the nomadic nature of the fourth year, traveling to new cities and hospitals of residency programs across the nation. Except it’s 2020. Things have changed, to put it lightly, and it’s become the metaphorical wild, wild west. There are no rules, no precedents of what the world of medical education must do during these times.

After most of our carefully planned rotations cancelled, a myriad of virtual rotations emerge in response. The hunt begins, but also the inequities widen. Students who have shunned the addictive nature of social media to focus on studying start to miss out. The ones who have children at home are now having to balance being a teacher and a zoom student. The ones who are still studying for boards because that was the only reschedule date available but must balance it all. Those who don’t have a home institution. These are only stories I have heard from peers so far, but I’m sure there are plenty more.

Off I go chasing every whisper in the virtual winds of an upcoming info session or a Q&A to gain a glimpse into the in inner workings of residency programs. It seems like everyone is chasing a program that fits their medical love language. Do you express your medical interest by research? Or do you enjoy playing with all the fancy toys/tech? Is it the community outreach? Everyone is different, but that’s the beauty of it. The things I chase are the things that can’t be described in black and white that do not translate well on to virtual screens an hour at a time. For me, it’s always been the people. It’s the great professors and preceptors who have inspired me to grow, to be better, to work because the work we do but also the how matters. It reminds of a time I spent countless hours trying to learn how to play a ghost note on the guitar. Trying to wrap my head around how can you play a note that no one agrees on how to play. Some say you play it lightly, some say it’s just muted. Some say it’s the sound the string makes as the result of another string played. Still to this day every time I try to play this hauntingly beautiful song it does not sound right, but it’s these ghost notes are what makes it truly one of a kind. So the question I must answer now is what ghost note is being played at each institution and does it harmonize with my own.

Instead of being able to witness firsthand the moments in between, and minutia that matters. These reveal the qualities that make up a great preceptor. Now in the virtual wild west of zoom medicine my notebook isn’t just filled with the possible electives offered or number of calls per month it’s also filled with things that hold more weight to me. It’s filled with the ghost notes I have heard. I know the note that rings out because the string above being plucked is the moment a resident had some technical issues and their PD offered encouraging and supportive words. The residents from that program will ring out into the world with kindness and understanding because of the influences they had. Or it’s the barely played note that makes the greatest difference like the moments of chatter before the start of an info session which show that they all genuinely care about each other. I know they will bring that spirit of comradery which was instilled in them early on in their medical careers. However sometimes it’s the muted notes of witnessing the dark circles, what’s behind the fatigue are to be noted as well.

The loss of in-person rotations means I miss out on seeing the light behind a person’s eyes when they speak about what’s important to them, the corny jokes they tell to make a patient more comfortable, or the lines of years of laughter which show a happy life within medicine.

Roshani Patel is an OMS-IV, Class of 2021 at Arkansas College of Osteopathic Medicine.



Resident Fellow Council, AAP

Resident and Fellow Council of the Association of Academic Physiatry (@AssocAcademicPhysiatry)