Residency is kind of like being caught in "medicine's hallway." You're a doctor but still in training. Your relatives don't know what that means—"Wait, you're not a real doctor yet?" Is it still medical school or real-life practice? Residency will be one of the toughest but potentially most rewarding times of your life. Here's some of the best advice to get you through, culled from program directors, current residents, and your own potential future colleagues. Tip 1: Put Patient Care First Keith Roach, MD, associate professor of medicine at New York-Presbyterian/Weill-Cornell, shares a crucial piece of advice that he was given during his intern year: "There will be many times when you will be uncertain about how to proceed, given multiple conflicting goals. Making your guide the best care of the patient is always a sure path to the best choice." Without having patient care as a priority, you can easily get lost in medicolegal, administrative, and operational concerns that might have seemed irrelevant in medical school. Tip 2: Practice Self-care in Mind and Spirit Those who have come through residency recommend scheduling free time far away from the hospital with the people you love. "Remember to put in slots for personal time as well so that you can recharge your batteries and come back to work refreshed," says Charlene Ngamwajasat, MD, clinical informatics specialist at the Primary Care Information Project. "It is essential to have a strong support system. Residency is mentally, physically, and emotionally trying. Having a group of people to decompress with and be able to enjoy some semblance of life outside of the hospital will aid tremendously in your emotional well-being," says David Altszuler, MD, chief resident at NYU Langone Medical Center's Internal Medicine Residency. Tip 3: Take Care of Your Body "Diet and exercise!" says Andrea Paul, MD, chief medical officer at Boardvitals.com. "When working long hours and under great stress, it is easy to resort to junk food and not exercising. Make some time to exercise, even if it's just a 20-minute body weight workout in the call room a few times a week, or go for a walk at lunch or during a break. While it is hard to eat healthy, try to choose the salad bar over the pizza; you'll be glad you did." Joseph Glaser, MD, a nuclear medicine physician practicing in Middletown, New York, adds, "Eat when you can, sleep when you can." As complicated as residency can be, sometimes the simplest advice is the most crucial to remember. Tip 4: Learn How to Recover From Mistakes It's not a question of if but when we will make a mistake. Our experts recommend a balance of mindfulness and reflection in the face of an error. "Understand that if you practice medicine, you will make mistakes. The key is to learn from them," says Jon LaPook, MD, professor of medicine at NYU Langone Medical Center and chief medical correspondent at CBS Nightly News. We all make mistakes. The goal is recovery, which can take the form of confiding in a trusted colleague or attending a Deliberate Practice session. Tip 5: Stay Humble and Ask for Help Nurses, therapists, and—most of all—your patients can teach you a great deal if you keep an open mind. "Be the first to admit when you don't know," says Dr Roach. "You can learn from anybody, but you aren't likely to if you think you already know all you need to." "Listen to your patients. If you let them talk long enough, they'll actually tell you what's the matter," says Dr LaPook, who recently founded NYU's groundbreaking Empathy Project, the goal of which is to improve the interaction of health professionals and patients by creating a video curriculum that teaches empathy. Dr Altszuler further explains, "Take advantage of the opportunities to learn from everyone around you. You will not only take better care of patients by talking to them and understanding their history and presentation to the hospital, but that also will help solidify your 'illness script'—the key features—of individual disease. One main role of the attending is to teach, but don't be afraid to ask more probing questions about clinical reasoning and decision-making. It is especially important to ask why, in order to thoroughly understand disease processes as well as the evaluation and management of patients." Tip 6: Accept That Some Patients Will Die Dr Alina Baciu, a fourth-year general surgery resident and chief editor of TryHealthier.com says, "Realize that you cannot save everyone. This is a reality that every medical professional has to face. We treat people, not diseases, and everyone reacts differently to treatment. Even if you do everything right, it sometimes isn't enough. This fact can make even the most weathered physician feel like all of her hard work is futile. Do not get discouraged; death is something that you will be battling every day, yet your work and passion will never be irrelevant." Tip 7: Remember Your Bigger Career Picture Are you artistic, entrepreneurial, or innovative? "If you have outside interests or additional ambitions, don't put them off. Learn to manage time and always work towards the big picture. Sometimes using the other half of the brain is actually a good way to challenge yourself and push yourself to heights you never knew existed," says Dhaval Bhanusali, MD, a dermatologist in private practice and CEO of HealthDigital.com. Tip 8: Communicate Directly "Call consults yourself: Rather than just writing an order for a consultation, make a personal call. One of the best experiences I had as an intern at Yale was calling consultants (which they made all interns do), presenting the case and making a case for why a consultation with them was needed. This not only helps you build relationships with people outside of your area, but it also gives you an opportunity to learn from someone with expertise in an area that you and most of your colleagues don't have," says Dr Paul. Tip 9: Stay Organized "Develop an organizational system," says Dr Altszuler. "There is an incredible amount of medical knowledge to accumulate during residency while simultaneously being expected to expertly care for a large number of sick patients (not to mention assisting patients and their families struggling with the emotional toll of illness, hospitalization, and occasionally death). Adopting a system to organize your tasks for the day will make you a more efficient physician while also ensuring that you provide comprehensive care and don't allow things to fall through the cracks." Tip 10: Ultimately, Become a Leader "Balance camaraderie with setting a good example for other team members. When you're working as part of a team (especially as a team leader), it's important to keep morale up, maintain a sense of humor, and generally keep interactions on the team friendly, says Matthew Vorsanger, MD, cardiology fellow at NYU Langone Medical Center and former chief resident of the Internal Medicine Residency. "However, sometimes in the service of expressing sympathy and commiseration, we can be tempted to badmouth other medical services or even the very patients that we're treating. It's something that can really erode empathy, and perhaps just as serious, can create a negative role model that people earlier in their training may choose to follow." Source
