Interview with Dominique Cosco, MD, FACP

Dominique Cosco is an associate professor and program director of the Internal Medicine Residency. She is a nationally recognized medical educator and has held significant educational and leadership roles. She is the director of teacher development for the Academy of Educators at Washington University School of Medicine. Dr. Cosco is an active member of both the Society of General Internal Medicine (SGIM) serving on the education committee as well as the Association of Program Directors in Internal Medicine where she serves as the vice chair for the program planning committee. Dr. Cosco is the current director of the SGIM TEACH faculty development program.

Elizabeth Terry: Tell me a little bit about how you chose your specialty.

Dominique Cosco: I thought I was going to do OBGYN up until the beginning of 4th year, and then I started thinking about it and I hated being in the OR. I felt trapped inside the OR. When I started thinking about it, I really wanted to treat high-risk OB patients, and I realized that treating those patient was actually practicing medicine. I really liked knowing a little bit about everything and thinking about the breadth of internal medicine, being able to apply it to any adult patient. In the end it was about not limiting myself with what I would be able to think about for a patient and ultimately having that knowledge base.

Terry: Was there any reason you went into medical education?

Cosco: That I sort of fell into. I had an interest in infectious disease (ID) and contemplated doing an ID fellowship. But at the end of residency, I felt that I was finished with training and didn’t feel a desire to go into fellowship. I also didn’t want to give up the control of knowing about everything. So I decided to join the division of general medicine at Grady (Hospital) after finishing residency and the med ed stuff just sort of happened. I was 100% clinical but working with residents and students all the time and realized that I had an affinity for working with residents.

Terry: What was your first day as an intern like?

Cosco: I was on inpatient wards at Grady. What I remember the most was the first page I ever got. Radiology called to ask me if I wanted contrast with whatever study had been ordered. And I was like, “I have no idea. I don’t know. I’m going to ask some people and call you back.” I just hung up and called back when I knew the answer. The beginning of intern year is just really hard because you are scrambling all the time, just learning so much and figuring stuff out and every day your knowledge base has grown a thousand percent. I remember very clearly returning the page and being like “I have no idea.”

Terry: Favorite on-call snack?

Cosco: Grilled cheese. Especially when I was on overnight.

Terry: Do you believe in a work-life balance?

Cosco: Yes, although the balance tips at times. I think it’s hard for me to disconnect, especially from email. I read a quote once that said “no one ever died because you didn’t send the email that night.” Sometimes I have to remember that. I try to remember the other things that are really important to me and make sure that I am carving out time for that. Exercise, connecting with family and spending time with my significant other and the dogs. We’ll cook dinner every night. I think this past year has been really challenging with everything going on, but I do work better and feel like I’m more productive when I have times when I work really hard and times when I don’t need to work really hard. Because if I just try to push and push, I get distracted and am not productive. So, for me, it works to have a schedule, have things planned out and that helps me time block.

Terry: What has been the biggest challenge as a female faculty member in medicine?

Cosco: I think ensuring that my voice is always heard. So when I first started, clinically, there were times when I had imposter syndrome being the attending, especially when working with consultants or other specialties. So I really relied on people in my division and asked for advice on how to approach something. As I moved into education leadership, I had to continue to make sure my voice was heard. I quickly established some mentors who helped me navigate difficult situations, or just think about what I wanted to do career-wise. But I think it is still a challenge working in a male-dominated career to make sure your voice is heard and to do so in a way that will make an impact as well. And so, I think, for me, it was trying to think about how to make what I wanted to say action-oriented. I tried to move away from a space of complaining that things weren’t working, and instead thinking about how I could use my voice to advocate for ideas to move things forward. I find, in academics, that if you bring an idea to the table and you’re willing to put in the time and effort, someone is going to take you up on it. 

Terry: What aspects of your work bring you joy?

Cosco: Definitely conversations with individual residents … to really think about career goals for residents, what they really want, what they are thinking about, what is important to them not only in work but in life. When I’ve been able to meet individually with residents that always rejuvenates me and gives me more energy.

Terry: What advice would you have given your younger self based on what you know now?

Cosco: In residency I would have told myself that everything is going to work out. You don’t need to feel pressured to figure everything out and know exactly what you want to do. Once I was on faculty and had established mentors, it was like, ‘okay, I can do this in a stepwise approach, and I’m going to check in with someone every few months and we’re going to re-evaluate things.’

Terry: Are there opportunities you said ‘no’ to?

Cosco: I’m really bad at saying ‘no.’ I didn’t say ‘no’ much in the first half of my career. In the second half, I’ve started to say ‘no’ to some things, like specific presentations at some meetings that wouldn’t contribute to a next step, or that weren’t feeding my interest or that wouldn’t help me grow or meet new people. But I don’t say ‘no’ very often. I do think that’s a skill that I should be working more at. Not just saying ‘no’ to an opportunity but recommending another person for the role. In the past three years, I’ve done a better job at trying to recommend people for other positions or committees. It’s always a work in progress.

Terry: What can we do to empower more women to join your field? 

Cosco: I always try to mentor women through national organizations. Usually at every meeting there is an opportunity to serve as a mentor, so I sign up for that. I think, moving forward, I want to not only put people forward for opportunities, but to build my sponsorship skills for women that I’ve mentored to continue to sponsor them even if we are not in a structured mentoring relationship anymore.

Terry: What makes you most proud of yourself?

Cosco: I think I’m most proud of the work product and the network I’ve build for myself in academic internal medicine. I’m action-oriented, I do things to completion, and I really built a network to support myself as well throughout this whole process. I think what I feel really proud of is (when I think about) some of the individual residents, for the first time this year, during recruitment season, I had letters of recommendation for medical students from faculty (for whom) I wrote their letter for medicine. I was like ‘wow, that’s awesome!’ You know, just reflecting back on the individuals you impacted.

Terry: If you could give one piece of advice to a young female physician, what would it be? 

Cosco: I think definitely have a mentor, maybe more than one, and don’t underestimate the power your peers can have as mentors to you. Knowing someone out there whom you can ask the hard questions, and who is going to give you the hard answers, making you examine what you want, someone who will always be there to support you. If you have a mentor like that, even when things get hard, you will have someone to lean on and ask for their guidance.

Dr. Elizabeth Terry is a third-year internal medicine resident with an interest in hospital medicine and gastroenterology.