I recently took an extended vacation at the end of residency, and had some time to reflect upon nearly an decade of medical training. I write this as an letter to my younger, naive self, in hopes that trainees may learn from my experiences.
Dear PGY-1 Shahbaz,
I have some big news for you: things are going to change. Don’t bother memorizing the SIRS criteria, its going to be gone in a few years. Severe sepsis? That isn’t a thing anymore. Also, it turns out that you can totally treat appendicitis with antibiotics, oh – and Dabigatran will have a reversal agent. A lot is going to happen to you in the next five years. Residency is going to shape you into a new person. There are going to be some tough moments, and many lessons you will learn along the way.
You’re going to make mistakes
A whole bunch of mistakes, and you will feel horrible each time.
You’re going to see a trauma patient with a reasonable mechanism – but because he is stable and pain-free, you’ll decide not to do the pelvic XRay. That’s a mistake. You’re going to miss his unstable pelvic fracture. Thankfully one of your colleagues will find it and the patient ends up being ok. But, know that this will eat at you for weeks.
You’ll talk to friends and colleagues who will make you feel better, but honestly – nothing makes a mistake easy to swallow. You just have to learn from it, it’ll make you a better doctor, and ensure you don’t make similar errors in the future. Don’t think you’re invincible. These things will happen – discuss them, learn from them, and don’t let them break you.
Find a mentor
Your mentor(s) are a critical component to getting through residency. You’ll realize you have some official ones that meet with you and ensure you’re on track. You will also have some ‘unofficial mentors’ – the ones you look up to, who help shape your practice and how you view emergency medicine. Take the time to thank these people, ensure they know that their influence on you is appreciated. Because these mentors play such a critical role in developing you into the physician and person you become.
Don’t yell at consultants
The only downside to this letter is that I can’t use it to reach back in time and knock some sense into you. You’re going to do it. You’re going to have a yelling match with another resident in the middle of the Emergency Department. Don’t be happy about it. You’re going to grow up as a senior and realize what a mistake that was. Getting angry with consultants serves no purpose, learn this lesson quickly. The best thing you can do is to always keep your composure and advocate for your patients.
You’re going to have pervasive thoughts
You’re going to have a really traumatic case. A staff will ask you if you’ve ever had pervasive thoughts. You won’t give it much consideration, because the answer is no, and you’ll brush it off. Don’t do that.
The staff was right, the pervasive thoughts are real. They’ll jump into your head at the worst of times – like the week before your Royal College exam. Can’t sleep? Excellent time for a flashback.
Early in your residency, learn to debrief these traumatic and troubling cases – talk to residents, nurses and staff. You talk to your loved ones about a lot, but you need to shield them from some of these cases, because they don’t need to hear it.
I already know about the worst case you’ll have in residency. Here’s the spoiler: a 6-week old child will die, and you have to tell the parents. That one is going to hurt, a lot.
Your emotions are normal, and you should feel them. Don’t become jaded and closed off to the world. What you need to remember, and you won’t appreciate this until later – is how important a role you hold for that family, for your team members, and for your future patients. As difficult as these experiences are, they are why you do this job.
This one seems obvious, right? However, you’ll witness careers ruined and reputations tarnished by poor interactions with allied health professionals. When someone is being rude to a nurse, stand up for them. It isn’t until you’re more senior that you have the confidence to this, and you’ll regret not doing it in some situations, but remember that your allied health colleagues are advocating for patients, and don’t deserve any abuse, from anyone, ever.
Real ones. Where you completely step away from working / studying, and relax. You’ll come to realize when you’ve worked a ton, you’re grumpy – and your patient care suffers as a result. You don’t love being there, and you count down the moments until your shift is done. That is when you know you’re long overdue for a vacation. Step away, and come back feeling recharged and refreshed.
Learn how to do the job
Being a physician is complicated – there are lots of little components that you need to master in order to do the job well.
PGY-1: Learn to be a resident, be helpful to your teams and your patients. Learn the ins/out’s of life in a hospital and residency. As you do the medicine will start to fall into place.
PGY-2: Learn to take on responsibility, be a leader, and take care of sick patients. Learn what skills are required in your specialty to become an independent physician. Notice what your staff do (with handover, learners, outside calls, etc). Make a list of these things that you need to learn to do well and, as you reach the end of PGY-2, start to take on one of these things each shift – or ask how your staff approach these tasks.
PGY-3: Start doing those skills you’ve identified independently. Work to become a resuscitationist, miss nothing, and learn from every opportunity. Towards to end of your PGY-3 year, start doing 2-3 of the ‘staff tasks’ on each shift.
PGY-4: Excel in your area of interest, and make this a priority. Take on more ‘staff tasks’ on each shift for the first few months. In the second half of PGY-4, every shift should be a trial at being the staff person. Take on their responsibilities and function as independently as you can.
PGY-5: Consolidate your knowledge. One goal for this year is to memorize minutia for your exam. However, the real goal is to try and take things previously in your Type II thinking (i.e.: thinking slow), and push them to your Type I thinking (i.e.: thinking fast). The approach to hyponatremia should no longer require a quick review of ‘uptodate’. This final step in your training will push you to becom a skilled clinician.
You’re going to grow up a lot in the next five years. No matter what stage you’re at, continue to be collegial, and nice to everyone. A smile and ‘how are you doing?’ goes a long way. Don’t let residency change who you fundamentally are as a person, but allow it to help you grow, develop, and mature.
You’re going to survive, residency is tough – but its temporary.
ps: During your residency, the Patriots’s will win two Super Bowl’s, the Red Sox will win a World Series, and the Flames are going to be fun to watch. Make sure you find times to enjoy yourself.