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Making the Most of Your Residency

Part 1: Successful Life Balance in Residency
Written by Sheila Roundtree, MD, Internal Medicine, Columbia, South Carolina, AMA-MAS Governing Council Member-at-Large

Physicians in training can extract an invaluable lesson from the wild.  The female lion is responsible for securing prey for her family to consume for sustenance.  Typically, the lioness partakes first, then shares the remainder of the kill with her cubs and mate.  You can learn from this scenario.  Make certain that your needs are met and you will be well positioned to provide the best of care to patients and the most of yourself to your friends and family.  Although the residency years are almost uniformly mentally and physically taxing, one can emerge healthy and successful.

Network Effectively
Interns and residents often relocate to a new city to pursue post-graduate training.  Networking prior to the move may provide a unique opportunity to establish new relationships and gain insight into the community.  For example, I contacted several physicians who worked in the Southern town where I trained (weeks before I moved).  My new acquaintances provided me invaluable information concerning housing, travel routes and employment possibilities for my husband.  Additionally, I developed a support system with people who enthusiastically invite me to social functions and are always available to offer professional advice.

Most communities have at least one established minority sponsored organization for health professionals.  Those who join such groups benefit from ample opportunities to make new friends and, possibly, build a referral base for the future.  Entities such as the National Medical Association, National Hispanic Medical Association, and the Association of American Indian Physicians offer excellent educational venues and impact the healthcare system via political vehicles.  Also, join the AMA Resident and Fellow Section, and get in touch with your local county and state medical associations, most of which also support, resident and young physicians sections.  Involvement in professional organizations also often provides a vehicle for your spouse or significant other to develop new relationships as well.  Moreover, consider allying with members of your Greek letter organization, religious affiliates, and other groups of interest in your new town.

Maintaining Healthy Relationships in Residency
Most people find that the happier their loved ones, the greater their potential for personal happiness.  Be sure to keep the lines of communication open between you and those closest to you .  This is a critical time in which you are launching a career; solidifying your personal identity and establishing committed relationships.  Keep in mind, however, that those who comprise your support system need you as well. Remain in tune with their goals, struggles, and triumphs.

Stay connected with life events.  Try to tailor your schedule so that you may attend weddings, baptisms, graduation exercises and the like.  Although you may not be able to attend all such functions, your effort and interest will be appreciated and you will be able to find support when you need it as well.

Try to have at least one meal a day with your family or significant other when you are not on call.  On call days, perhaps they can join you at the hospital for a brief visit, should your workload permit.  If visits are not feasible, however, communicate via email or phone.  Fiercely protect your leave allotment, and plan time away from work strategically.  I find that taking a vacation in the midst of a demanding stretch of call months is particularly helpful. Seize every opportunity to rejuvenate your spirit, mind, and body.

Getting the Work Done. Early in your intern year, obtain practical information regarding your residency program and the functional aspects of your institution from upper level members of the housestaff.  Quickly identify at least one senior resident who is especially knowledgeable and willing to help a newcomer.  Keep a good pocket guide specific to your specialty accessible at all times.

Work efficiently, and lay out clearly defined goals in your mind and/or on paper.  Lurie et al. discovered that during a typical twenty-four hour call, most housestaff spend a mere eighty-seven  to one hundred and seventy-five minutes on true patient-related activities.  Surprisingly, most of their time was spent starting intravenous lines, drawing blood, transporting patients and similar activities.  Delegate these types of tasks where appropriate.  Take advantage of the specialty expertise available in your place of practice e.g. radiology, pathology, . . .  In the long run, these consultations may save time and facilitate better patient care.

Ascertain that each member of your team, including medical students, has clearly delineated responsibilities. Foster a sense of team spirit.  Remember that cohesive teams are much more likely to operate efficiently.  You may find it worthwhile to convene with your team doing the course of the call day in order to assess everyone's progress and identify those who need assistance.  Prioritize tasks, realizing that priorities may change pending patients' status.

Healthy Habits for Life
Exercise. I strongly recommend engaging in aerobic exercise balanced with low to moderate level weight training several times per week. Initially, such frequent exercise may seem unrealistic for the house officer committed to frequent call and long in-house hours. Take advantage of your days off as well as the days you are able to leave work early. Those who exercise regularly are less likely to miss time from work due to illness, and physical activity is one of the best diffusers of stress.

Furthermore, exercise is proven to enhance one’s sense of personal well being, facilitate weight control and decrease the incidence of vascular diseases. (Does this sound familiar?) I often power walk in the morning when I am due to work later in the day. Interestingly, a post-call workout may set the backdrop for more restful sleep.

Diet. Unfortunately, many house officers gain a significant amount of weight during residency, and the number of overweight residents seems to be on the rise. Plan to eat at regular intervals, and resist the temptation to consume snacks high in fat and concentrated sugar content. Opt, instead, for fruit and lower calorie snacks. Substitute spring water or flavored water in lieu of soft drinks.  Limit total fat consumption to 35% or less of your total caloric intake. And, when ordering take-out meals, select a lighter fare entree on (at least) some occasions. We must display the level of discipline that we expect from our patients.

Sleep. Obviously, ensuring that one receives adequate rest is of paramount importance for the house officer. Although most trainees fall asleep readily once relieved from their duties, a surprising number complain of sleep pattern disturbances. Most authorities recommend going to bed and awakening approximately the same time daily in order to establish a stable biological clock.

The average adult requires seven to nine hours of sleep nightly in order to feel well and rested. Keep in mind, however, that there are physiologically short sleepers who need only three to five hours of sleep per night. Conversely, the physiologically long sleepers require more.

Remain cognizant and respectful of your personal sleep requirements. Avoid working in the bedroom; preserve this sanctuary for relaxation and sleep. While some folk sleep well after exercise, others may notice that they experience difficulty resting after a vigorous workout. Furthermore, heavy caffeine intake should be avoided in those who are vulnerable. Although a regular sleep schedule is advisable, by all means, take naps whenever you can when you are on call!

Go Forth Boldly. You are destined to complete residency successfully. Never doubt yourself or your abilities. Admittedly, the learning curve is quite steep during these formative years. Nevertheless, you are well equipped to effectively negotiate any challenges that lay ahead. After all, you graduated from medical school, remember?

Part 2: Life in Residency and Beyond
Written by Erica Phillips, MD, Resident, Department of Medicine, Hospital of the University of  Pennsylvania

The philosophy of most training programs is twofold: 1) to provide a core curriculum designed to promote the acquisition of basic clinical competencies in a particular field and 2) to tailor the educational experience to meet the career objectives of its trainees.  This latter principle is challenging given the uncertainty that many trainees have about their career goals.  In addition, during graduate medical education  there is the likelihood that a trainee will change their career goals several times.  One of the most difficult tasks during graduate medical education is to look forward to the future when the present day is wearing you down.

The first year, post-medical school completion, is spent predominantly developing survival skills. These skills will develop in areas such as time management, and team development. At the same time there is the adjustment for friends and loved ones to a new environment, and your busy schedule. The truth is you will often find yourself pondering over the same two questions “When will I sleep” and “When will I eat”. In between these thoughts, it is advisable to try and think about the following;

Feedback from fellow interns, residents, and faculty is key. If it is not readily offered then initiate the discussion at least midway during each rotation.

Talk to your program director early on, especially if you are having difficulty adjusting…because, whether you realize it or not, they already know. Don’t wait to be called into the office.

Seek out a mentor(s) early in your training.

If you have done research or have a research idea that you would like to develop talk about it, talk about it, talk about it…. someone will be listening and opportunities will open up.

Based on the specialty of the program, after the first graduate medical education year the trainee will gain a higher level of responsibility in the form of supervising medical students, interns, coordinating patient care, and performing procedures to touch on a few. The active pursuit of fellowships, and employment will vary based on the length of each individual training program but the general principles remain the same.

If your institution is lacking individuals with similar career objectives or mentors who can advise you on achieving your objectives, contact your local/national medical associations and neighboring institutions.

Join and attend a national meeting in your specialty. Many programs provide funding for trainees to attend national meetings. Remember to take your business cards because networking is key.

If you do not have a curriculum vitae, start writing one. Ask your program director to review it on completion. Update your CV on a continual basis. Document all curricular activities (conference presentations, submission of an abstract to a journal, an award, etc.) as they occur. When presenting or teaching, consider having the attendees complete an evaluation. Compiling this feedback will allow you to carve out a “clinical expertise”, which is especially important when pursuing a career in academia.

Choose wisely when requesting recommendations from faculty members. The status of the faculty member (i.e.; chairman, well known researcher) is less important than how well they know you as a house officer and person.

If applying for fellowships, speak to as many faculty members in your respective department.  They will be able to offer advice on the reputations of other programs, as well as provide referrals. Remember the application and interview process for fellowships is far different than residency. Overall it is a less competitive environment, whereby honesty is your best policy. Don’t tell a program you are truly interested in them and make a verbal commitment if you are not. The word gets around.

Be prepared to apply broadly for competitive fellowships (i.e. cardiology, thoracic surgery) and keep your options open when looking for employment in popular cities like New York, or San Francisco.

When searching for employment, talk with those who have recently completed the process to gain a sense of the market for your specialty and skills. Throughout training you will be approached by at least one if not several head hunter groups. Ask around about the individuals groups before providing personal information. Overall they are a useful source. Faculty members, program chairs and directors are excellent sources for employment referrals. Be open with them about asking around on your behalf. Journals are another excellent source for identifying openings in various market places. However, remember there are hundreds of other physicians reading the same ad, so do not expect a quick response.

Have a lawyer that specializes in medical contractile agreement review your contract before signing.  Don’t hesitate to ask for special amenities like coverage of moving expenses and licensing fees. The worst that can happen is they say “no.”

These are just a few key points that may seem obvious, but often take the back seat in the hectic schedule of a house officer. The most important thing to remember is that its never to late.