Written by Rebekah Apple, Senior Manager of Physician Services and Support at the American College of Physician Executives and co-editor of LeadDoc. This post was originally published on the NPA Blog on June 28, 2013.
“You are entering a phase of your life in which many different things will occur . . . bad things that seem good at first and good things that seem bad at first.”
― Haruki Murakami, The Wind-Up Bird Chronicle
Dr. Anup Vora, in his second year of residency at Georgetown University/Washington Hospital Center, wishes he’d spent more time doing independent thinking. “Medical students are good at reporting back with the goal of finding out what to do next,” he explained. To Vora, medical students would be better served by gaining an “early grasp and thinking things through, then seeing if you’re right.” When working with interns, Vora frequently asks them clinical next steps they’d recommend. While the opportunity to expound may provide a medical student with the necessary emotional buoyancy to get through the day, a fresh resident may cringe when put on the spot.
The transition from medical student to resident includes a lightning rod assumption of responsibility. For Vora, this was most challenging. At the start of his first year, he felt his confidence ebb as the hours wore on. “When you’re on call at night and something happens – you’re responsible. When you’re in those sticky situations, it’s nerve wracking.”
Veronica Sikka, MD, completed her residency at Virginia Commonwealth University in 2012. She, too, felt that developing a sense of decisiveness was the most important and difficult thing to do in order to make a successful transition. “Going from saying, ‘I’m just a medical student,’ to knowing that the buck stops with you is daunting,” said Sikka.
Both Vora and Sikka say that confidence – and a comfort level – blossoms with experience. “Through experience, you get your bearings,” said Vora, who also recommends relying heavily on nurses for support. “They can be harsh sometimes, but they understand a resident’s lack of familiarity with things and they want to give their guidance.” Vora acknowledges that it can be difficult to reach out for help. “The medical students work with nurses and then on day one when they become an intern, the relationship changes.”
When considering resources she relied upon, Sikka described her mentor as a father figure, but acknowledged that other residents experienced a less valuable connection. She found it vital to maintain a disciplined approach to study, and suggests other residents depend upon their strong academic sense, as well. “I thought being done with medical school meant studying was out of the way. I thought, ‘Now, I just have to be a doctor.’” Instead, Sikka discovered herself challenged to a greater degree, and wishes she’d been prepared for the increased level of pressure. According to Sikka, “Residents are learning on a whole other level. I actually have to read that much more because the perception is that I know something.”
For Sikka, finding her groove took approximately six months. Vora felt it takes a minimum of a month to get a routine, and that his timeline was altered because his residency is in a different facility than where he completed his rotations. “That made me immediately rely more on the residents who were familiar with everything,” he said.
Jennifer Packing-Euben, MD, feels she is still finding her groove. In her first year of the Florida Hospital Family Residency Program, being overwhelmed is, in her mind, exactly how she should feel. The harrowing transition from medical school will include errors and failures. “Learn to find a positive experience in every mistake,” she said. Sikka offered a familiar sentiment: “Cry or laugh your way through residency.”
Dr. Vikram Brar, Residency Director for Ophthalmology at the VCU Medical Center, estimates most residents get into the groove in approximately 3 months. Harkening back to Sikka’s realization, Brar said, “Residents can find it hard to adjust to the fact that what they say is what is actually done. There is lots of increased accountability.” Brar, too, stressed the importance of knowing where to find important information and encourages residents to investigate ancillary services within the facility that can provide insight and assistance (for example, social workers).
The pain of personal sacrifice can also prove shocking to new residents. “I wish I knew exactly how hard it was going to be to find R&R time,” said Packing-Euben. “At some point you just stop trying to go out and use every moment off duty to sleep.” Any previous control over the work-life balance becomes void once residency begins. Packing-Euben advises against sacrificing the same thing every time. For example, don’t skip two important family gatherings – skip one and attend the next one, and anticipate that rounds the following morning won’t necessarily be stellar.
Absorbing the realities of residency may not be possible until steeped in the experience. The long-anticipated, less frenetic fourth year of medical school can provide the opportunity to consider what resources may provide the most value in the future. Such an exercise precisely aligns with Dr. Vora’s recommendation: thinking things through independently, and seeing if you’re right.