Medscape asked some of our contributors and our community to offer advice to soon-to-be residents. The responses that poured in went far beyond the expected tips to help achieve success during residency. Most submissions included insights from years of professional experience, along with wisdom to help all young doctors, not just those in training. In fact, the scope of the advice is likely to trigger reflection in those of all ages. Here are just a few highlights of what they had to say. Prime Directive One of the themes that emerged among the advice that was offered involved a need to prioritize. Dr Brad Spellberg suggested that times have changed. He told us, "We must engage our patients in decision-making and move away from the traditional, physician-centric paternalism of medicine, which is contrary to achieving high-quality, safe, efficient, and patient-centered care." Dr Spellberg was not alone in suggesting a shift from "physician-centric" attitudes. An emphasis on listening to, and learning from, patients was repeated as a guiding dictum. As Dr J. Greensmith explained, "The patients are your best teachers, followed by the nurses, then your attendings." In fact, developing a fast appreciation for nurses was another common refrain. Dr Mark Morris was explicit, as he laid out his advice: "Please remember that the only thing between you and disaster is the nurses. Honor them; respect them; and, if you're a DO, treat them. Don't go to sleep when you first can; sit and talk with them, learn from them. And they will feed you and protect your sleep." Much of the advice suggested considering those who surround young doctors as new family units. These groups include nurses and fellow residents, and beyond residency, peers who will grow to be very familiar faces. Cheerfully, Dr Brent Mothner offered, "Never pass up the opportunity for a meeting, or even a quick coffee together. Great things can happen simply by chatting along the way. Oh, and good cookies make almost any day better!" A Resident State of Mind In terms of advice specific to the residency experience, Dr Lisa Gobar offered some quality reassurance: "You are starting all over again. You will feel like you know nothing. Fear not, this is normal." Encouragement permeated the advice provided from our contributors and users, with many sharing personal stories of doubt that gave way to experience. The overwhelming attitude was that although young doctors are sure to face personal crises, they can be overcome. While accepting that a certain amount of fear is normal, other situations in residency can be avoided with preparation. As Dr Merius Atangcho specified, "Scan the ACGME curriculum requirements. Probably no medical student ever looks at ACGME curriculum/resident experience requirements to graduate from a residency. Especially when deciding between different fields, however, these requirements can inform you of what your entire residency will look like." Others recommended concrete suggestions that involved surveying the medical literature thoroughly and learning to approach the resident experience as a rebirth. Practical Magic Although a good portion of the suggestions for young doctors had to do with mental attitudes and personal perceptions, some of the advice was far more practical. As Dr Frances Pang recommended, "Live close to work. Don't waste time commuting or risk falling asleep behind the wheel. Exercise regularly. If this is not your thing, it must become your thing." In fact, the need to cut down on the commute was easily the most frequently mentioned bit of help offered, followed closely by the need for physical exercise. Many pointed out that these are seemingly obvious, but increasingly disregarded, facets that have the biggest impact on having healthy, successful experiences in residency and beyond. Speaking of happiness, relationships were also another oft-commented on subject. Some were cautiously optimistic, like Dr Annette Hulse, who offered, "If you are married or in a long-term committed relationship, take every single opportunity to connect with your partner. Even if you don't feel like it at the time." Some contributions were more on the blunt side. As Dr James Hernandez stated explicitly, "Do not get married or divorced during your academic career. This includes the residency years." 'Embrace the Suck' -- or Don't Much of the advice encouraged readers to accept the unknowable and uncertain aspects of the profession whenever possible. Dr Janet Marley-Rose offered, "How do we know whether tomorrow's change is good for our patients and us? We don't." As she concluded, "What my residency programme taught me was to learn every day, teach every day, do good every day, and enjoy the ride every day." Dr Alexander Garza had a list of things he wished he had known as a younger doctor: I wish I had known more about socioeconomic impact on healthcare, so that I would have focused more on the issues outside of medicine that affect health (even more so than medicine, really). I wish I had known more about wellness and taking care of yourself. Working 36 hours at a time is not healthy, nor is eating hospital cafeteria food. Lastly, as we say in the military while deployed, "embrace the suck." In other words, it is going to be hard, so just embrace it. Some users were a bit more "tough love" in their advice. Dr Charles Barrett put it bluntly, stating, "'Work/life balance' is a term that is being tossed around lately. Get over it. Medicine is a lifelong commitment, which has tremendous rewards and sacrifices. To excel at this trade, one must give their all and nothing less." In contrast, many people advised directly confronting stressors that may arise and not simply "getting over it." Specifically, if a specialty seems like a poor fit to a young doctor, listening to those concerns may be key. As Dr Steven Lampert mentioned, "If you discover that you made the wrong choice in specialty, don't be afraid to make a change. It is not always easy, and it's not convenient to change specialty, but it's important to acknowledge the error and move on." Business Savvy Is Key Many users, such as Dr James Rohde, focused on the need for business acumen. "I started an MBA in healthcare at age 69," he recounted. "I wish I had gone back to school sooner and used the MBA for part of my practice years." Several respondents indicated that a full MBA is not as important as a basic understanding of, and respect for, the financial demands and concerns inherent in the profession. More than anything, the importance of an overall business education was pointed out as an often-overlooked component of happiness. Dr Curtis Graham went so far as to state: My one single regret from my residency is that absolutely no one during my medical school training nor in my residency ever took 20 minutes to tell me how critical a business education is to private practice. I found out about that after I lost my practice for financial reasons and retired early. I then discovered not only why I lost my practice, but also why thousands of physicians today are losing their private practices for the same reason: no business education whatsoever. The contributions also contained specific practice recommendations. Dr Janet Chene reminded others, "Private practice isn't dead, and don't be afraid of it if you are willing to be your best and offer patients a higher level of care and compassion." Unexpected Advice Some of the suggestions offered were slightly surprising. For example, Dr Gobar expressed a need to protect fellow physicians. As she advised, "Don't let other physicians or institutions use you to attack another physician; it happens more often than you know within the hospital staff offices. Stand up for yourself, and know your legal rights." Many commenters suggested viewing other doctors or doctors-to-be as a makeshift family, but this particular recommendation stood out in terms of a need for awareness of legal ramifications. But not all unusual advice was so dire. Take, for example, Dr Nabeel Zafar, who encouraged an end to "delayed gratification." The demands and constraints of this challenging career are well known, but Dr Zafar's suggestion is to avoid surrendering certain aspects of identity that are tended to in free time. He noted, "Instead of saying, 'I'm going to give up such-and-such hobby, socializing, et cetera for the next few years,' learn how to do it all together." Maybe not truly unexpectedly but quite poignantly, some users focused on specific concerns faced by women. Dr Ruby Kapadia poetically stated, "I wish I knew that as a woman, you will learn the art of mastering motherhood with career and appreciate that the balance is as unique, potent, and satisfying as the balance of sun and the moon around the earth's orbit." The life/work balance factored in often extended beyond gender-specific concerns, but the unique demands of motherhood and acknowledgment of "paternalistic" attitudes emerged as common concerns for young doctors to confront. The advice covered far more than can be simply summed up here, with suggestions ranging from dietary concerns to general "pep talks" about life inside medicine. The contributions are worth reviewing in total, but the final note included here is one that is hopefully a bit tongue-in-cheek. The pithiest advice may have come from Dr Sandra Stedinger: "Too late now, but you should have gone into engineering." Here's hoping that this trove of advice helps make this particular sentiment one that's not quite as accurate. Source
