Commentary
residency

You’re a doctor, Harry! Welcome to residency

It’s July 1st. A brand new gaggle (gaggle: a flock of geese when not in flight) of residents has started at the hospital. The beginning of residency is a pretty stressful time, especially when the last few months of med school were on zoom. This year is certainly a little extra special. The end of med school is supposed to be a fun, celebratory time, but COVID-19 has put a major damper on plans. The ability to travel, celebrate, see loved ones etc. has been stolen away.

Not only that, but new residents are walking into an unfamiliar environment – PPE, visitor restrictions, uncertainty around the spread of COVID, and potential educational limitations (i.e.: airway management).

Trust me, everyone wishes it was different. But it isn’t, and perhaps Gandalf the Grey said it best:

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So for those of you starting residency (or perhaps are still in the thralls of it) I’d like to share some wisdom of lessons learned and mistakes made over five years of residency, and a few years as a medical educator.

Before we dive in – remember, your first month of residency is about finding out where the cafeteria is, where the bathrooms are, how your EMR works, where to find the best parking spot(s), and where the best food/drinks in town are.

Don’t be a jerk

Seriously. It sounds obvious, but I come across about one each week. You know what good it does? Nothing. Snippy with nurses? Poor form. Rude to consultants or ER docs? We will find out who you are. Nothing good has ever happened to a resident that was rude, unprofessional, or just impolite. Worse yet, is when you’re rude to patients – this can only lead to patient complaints, and certainly nothing helpful.

Just be nice. It is easy, you’ll be happier – and you’ll have a stronger reputation because of it.

Trust me, reputation matters, and it will follow you around the hospital. Once you’ve established a reputation of being difficult to work with, unfriendly, or a jerk – it can be impossible to shake that mold.

I always thought once I had gotten into medical school that I was done jumping through hoops – nope, more hoops. Then as a resident – still more (turns out as a staff, still many hoops to jump through). A bad reputation can make it hard to find fellowships, jobs, or even learning opportunities. Plus, no one will like you. Seriously.

Cultivate relationships

Residency goes by quickly, but you’re around a lot, and for a long time. Be friendly to your consultants, people you encounter regularity – it just makes your life easier when you call someone and a familiar voice answers. Plus, oftentimes – you’re in a new city, and a new stage of life, so it is helpful to cultivate new friendships and relationships. It is also a great idea to have friends outside of medicine so that your world view isn’t so silo’ed. (Pro tip: when spending time with people outside of medicine, don’t talk about work. They don’t understand it, and it is not fair to them. Especially if you have non-medical partners! Our rule; you can talk about work, but you have to take a drink every time you do;) ). Some of your best friends you will make through residency, so take the time to foster these relationships

Also, remember to take some time for yourself! Engage in your own hobbies and interests for your own mental wellbeing. Become the person you want to during your residency, don’t let life pass you by during these years.

Be a sponge

There will come a day (#StaffLife) when you’re in charge of the final decisions. Perhaps Dr. Seuss said it best:

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Residency is the opportune time to soak up any knowledge you possibly can. Explore techniques, methods, therapies under the watchful eye(s) of your supervising physicians. The more experience you gain in residency, the more comfort you will have with atypical or challenging cases when you’re staff. Never used a drug like etomidate for sedation? Try it at least once in residency (…on a patient) so that you’re comfortable with it during your training!

Jump into any procedures you can, there is no such thing as too much experience. You will quickly hit a point where you won’t be supervised doing routine things (i.e.: suturing, LPs), but there are still lessons to be learned – so occasionally invite your staff to observe you. Watch seniors or staff perform challenging tasks, and learn from them.

Remember, it is just a job. AKA: Live your life

If you want to take one pearl into residency, it is this one. You’re training for a job. A satisfying, intellectually stimulating, enjoyable job. But still, just a job. Take time for your loved ones and yourself. Wellness often feels like a fluffy topic, but it shouldn’t be. It is critical to your ability to function as a physician and a healthy individual.

IT. IS. JUST. A. JOB

Take vacations, breaks, make sure you exercise, and partake in any hobbies you may have. Burnout in medicine is common, and is often a result of not taking the time for yourself. Mitigate mental health disasters before it happens by staying on top of your own wellness.

I remember hearing a lot about wellness as a junior resident, but I didn’t take it seriously until later in life, and I have always regretted that.

Have a ‘board of directors’

Mentorship in medicine (or life in general) is important to your success and ability to thrive. To have a guide to help you with decisions that are novel to your career trajectory, life decisions, etc. What you’ll find to be the most helpful, however, is to have a ‘board of directors’ – a panel of experts to help guide you. These mentors are so important to your development as a resident (shoutout to my board of directors, there’s 10 of them), so lean on them! You may have your life coach, the research supervisor, the physician whom you want to model your practice pattern after, or your failure buddy. Utilize these resources! You can’t do it alone, so let your board of directors help you out.

Learn where the spectrum of disease exists

Personally, I have an interest in rational resource utilization – I think we often harm patients by doing unnecessary tests and investigations. However, it took my training to fully appreciate where the spectrum of disease was in order to help guide my practice pattern. As a resident (especially a junior), it is wise to lean towards the ‘over-testing’ side of things, because without understanding where a spectrum of disease lies, you are likely to miss critical things. Residents are often quick to dismiss disease entities over the phone in consultation (how you can dismiss a disease without seeing a patient is beyond me, but it happens daily), or think that some testing is unnecessary. The key is to remember that rational resource utilization is about doing the right tests, in the right patient, for the right reasons.

For example – as a junior resident, I once diagnosed a venous sinus thrombosis, and over the next year, I spent a lot of time over-investigating this entity. I did a lot of normal scans, then I found another one! The key hallmark between those patients – focal neurologic deficits. So I had a better appreciation of where that disease spectrum lies. Without doing more testing in your younger years, this is a lesson that you may fail to grasp.

Don’t be lazy & Don’t be afraid to ask for help

Nobody likes a lazy resident. Show up on time, put in the work. Challenge yourself. When you have weaknesses, identify them, and work on them. It is natural to not want to address weaknesses – but this is only to your detriment. I will never judge a resident for asking me for help on any specific topic; this is how you get better. You’ve got a limited time in residency to master your skills, may as well use all the resources at your disposal.

Don’t be afraid to ask for help! Residency can be over in a blink of an eye, and only you know what you don’t know – so don’t finish your training with large gaps in your knowledge base, because that benefits nobody.

Never lie. (Duh). But it happens every day! Staff asks you a question about a patient – one that you never asked, you don’t want to look like an idiot, so you make up your answer. Nothing is worse than finding out a resident lied to you, just tell me you didn’t ask the question! I don’t care, we’ll go ask about it together, but finding out you lied is soul-crushing.

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Develop your own style

There are things in medicine where we have clear evidence that things do or do not work. However, most of medicine exists in this ‘grey area’ where practice variation rules supreme. When you are taught something – file it away in your brain as evidence-based, or opinion/practice pattern. When something is evidence-based, hang your hat on that – it is super useful. When it is opinion/practice pattern, take it with a grain of salt, and see where you want your practice to lie as you gain more experience, and see what others do. Over time, in your more senior years – you’ll develop your own style.

One of my favourite residents to work with (shoutout to Rajivwill often ask how I would manage a particular patient – I’d tell him what I would do, and invariably he responds with: “Cool. I’m not going to do that, but good to know that is an option”.

Closing thoughts

Residency is a fun time, honestly. It may have been the best five years of my life.

Sure – lots of work is involved, but it takes place during some of the most formidable years of your life. During residency, people often discover the person they are/want to be, they travel, finally have an income, some settle down – start families, own pets, buy houses, etc. Residency often is the base that establishes the rest of your life. Use it as a stepping stone, develop good habits and coping strategies, and most importantly – enjoy the years, they go by quick.

Shahbaz Syed
Dr. Syed is an staff Emergency physician at the Ottawa Hospital, with an fellowship in Digital Scholarship and special interests in rational resource utilization.

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