What I wish I'd known before I got out into practice

Commentary. By Randy Pilgrim, MD, AMNews contributor. June 11, 2001.

My last rotation as a senior resident was almost 10 years ago, but I remember it clearly. I felt good about my training, reasonably confident and eager to emerge into practice.

However, despite all my training, that first year provided some unanticipated lessons -- core content that was critical to becoming a successful physician. Whether they were new ideas or variations on old themes, these lessons have grown in importance and, I believe, should be integrated into daily practice.

So for what it's worth, here are a few things I wish I had fully appreciated before I got out.

After years of gaining knowledge and refining clinical performance, most residents are expert students. In practice, however, the challenge of continual learning is notably different. Now, one has to learn without the support of a learning environment. This can be exceedingly difficult when one encounters the myriad tasks and unrelenting expectations of practice. Keeping up-to-date often comes last.

After residency, it is critical to continue consistent habits of perpetual study. It is hard to anticipate just how difficult this can be. Before you drown in details, make a plan, set aside time and track your progress. Whether it's self-study, journals, tapes or programmatic courses, just do it. The alternative: You may get a rude awakening one day when you realize you don't know what you need to.

Patient care remains the top priority in full-time practice, but it takes place on a different stage. Local physicians, administrators, budgets, flow studies, insurance rules and the federal government will have a new place in your life. Welcome or not, their collective view of you will be different than that of your current audience. Thus, your patterns and priorities must change as well. [...]