John Andrews, MD, has decades of experience working in residency programs. Currently the AMA's vice president for GME innovations, he offers tips to freshly matched residents-to-be on how to ease their transition to the next level of their training in this episode of Making the Rounds.
- John Andrews, MD, vice president of graduate medical education innovations, American Medical Association
- Brendan Murphy, senior news writer, American Medical Association
- Todd Unger, chief experience officer, American Medical Association
Unger: Welcome to Making the Rounds, a podcast by the American Medical Association. In this episode, we hear from Dr. John Andrews, vice president of graduate medical education innovations here at the AMA. In today’s episode, he’ll share what you can do to prepare yourself for residency. Here’s AMA senior news writer Brendan Murphy.
Murphy: Hello and welcome to Meet Your Match on Making the Rounds, a podcast by the American Medical Association. I'm Brendan Murphy, senior news writer at the AMA. Today I'm joined by Dr. John Andrews, the AMA's vice president of graduate medical education innovations. A veteran of many residency selection cycles, Dr. Andrews is going to share with us what happens now that you've matched, ways to prepare for residency and what to expect in those first weeks as a physician.
Well, we're so excited to have you on because students have matched, so we look forward to getting into some of the post-Match tips you have. Thanks for being here today with us, Dr. Andrews.
Dr. Andrews: Sure, Brendan, it's great to be here. And please, call me John.
Murphy: To start out, can you give us some background on your work in GME and your experiences working with new residents?
Dr. Andrews: Sure. Well, I've spent my career working in medical education, Brendan. I'm a pediatrician. I've worked as a medical student clerkship director. I directed a pediatric residency program for six years and also served as the associate dean for graduate medical education in the DIO for six years at the University of Minnesota, so I've spent a lot of time thinking about graduate medical education and talking both to applicants, residents and program directors about the application cycle and some of the consequences of the Match.
It's an exciting time. I would offer congratulations to all of the people who recently matched and happy to talk with you further about the best ways to prepare for residency.
Murphy: I think our listeners will be really excited to hear about that. Do you have any advice on where students should be in processing this news, on accepting what might have been a disappointment or even just if it was their first choice, it is still moving on to another area of your career, and there's surely some nerves associated with that?
Dr. Andrews: Yeah, I think for most applicants, the reality of the Match is the thing to come to grips with. Even if you matched your first choice, you suddenly realize that this is now a commitment and that this is the next phase of your professional development. And that's both exciting and daunting.
It's worth noting that for the vast majority of applicants, the results of the Match are typically quite positive. Many, many applicants match to one of their top three choices.
Now, obviously, that varies depending upon the discipline to which you've applied and your own background. But for most people, they've matched to a program that I hope they're excited about and it's a chance for them to now think about what the reality of actually going to work in that program is going to be.
Murphy: It's not the case at every medical school. We're going to be speaking in generalities throughout this because circumstances are different across the board. But in many instances, students do have some time in medical school post-match. How is that time best used?
Dr. Andrews: Yeah, that's an excellent question because the time between the Match and graduation, I'm concerned, has increasingly become sort of a fallow time in one's professional development.
The huge sense of relief of having gotten through the Match, and I think, there's a legitimate interest in recharging your batteries before starting residency. But to simply allow yourself a three-month vacation before starting residency probably isn't the best use of that time.
It is an opportunity to take advantage of elements of the curriculum at your medical school that you may not have the opportunity to be exposed to and the specific specialty in which you're training. For example, I'm a pediatrician and you might have considered as a pediatric resident using that time in medical school to take an anesthesiology rotation or some other clinical experience that would be harder to access perhaps as a resident.
I think it's also obviously a time to think about a lot of practical aspects. You may be moving to a new city. There may be details related to that, that you need to process. And you do need to build in some time to recharge.
And so, some time away, engaged in advocation, something you're really interested in doing, something that refreshes you before beginning the hard work of residency is a reasonable thing to do as well. But I think considering some of those clinical elements that will round out your experience as a medical student is a reasonable use of your time.
Murphy: So is that learning, those final chances to gain these skills, is that mostly self-directed or can you consult with a faculty member about your weaknesses? How would you go about that as an incoming resident?
Dr. Andrews: Yeah, I think the advice of mentors is helpful. I think sometimes students are in close contact with residents either in the program to which they've matched or in the program that is in the same discipline at the institution where they're currently a medical student.
And I think preying on the experience of those residents and saying, “Gosh, I'm going to enter this residency program in July. What sorts of things might you have considered doing during that time? Or now that you are a resident, what's missing? What might I take advantage of?”
So the mentorship of people who are walking the same path that you are, perhaps a year or so ahead of you can be quite helpful. Students may have mentors at their medical school who know them well and understand gaps in their professional development can help to guide them, and that's a reasonable thing to do as well.
I don't want to put too much pressure on this. It's a limited period of time. You're not going to completely reinvent yourself as a medical student in the three months between the Match and graduation, but it's good to have some experiences during that time that are edifying and make you feel confident that you're well-prepared for residency.
Murphy: You sort of touched on this, but this is a life change in addition to just this advancement academically. What do students need to do to make that transition as seamless as possible?
Dr. Andrews: Yeah, that's going to be different for students depending on their specific situation. If you're moving all by yourself, you don't have a partner, you don't have a family, you don't have obligations to others.
That move is probably about ensuring that you understand the environment in which you’ll be living and have access to the things that are going to help you feel connected and healthy outside of residency.
You may have vocations related to fitness, or related to the arts or you may have specific things about the environment in which you live, the neighborhood in which you live that are going to enhance your well-being. And I think paying careful attention to those is important. Understanding those things.
And this sounds kind of general, but once you get on that treadmill that is residency and you get sucked up in it, it becomes harder to look outside and to set those experiences up.
And so to take some time between the Match and beginning your residency to understand the resources in the community which you're moving that are going to make you feel happy, living there, I think, is a really important use of your time. Those considerations are very different for people that are moving with others.
So if you have a partner or a spouse or family members, those same considerations about the neighborhood and access to activities are going to be relevant, not only for you but for the other members of your family. If you've got children, things like schools or daycare are going to be important considerations.
And so, I think these are obvious to most people. But you have the time between the Match and residency to think about those things, and that time is going to be in shorter supply once you begin the work of residency, so I encourage some focus on that.
Murphy: At what point do you recommend students reach out to the program they matched with, and when they do, what type of information should they be seeking?
Dr. Andrews: Yeah. Again, many students will be training in the same city or in many cases the same institution where they were medical students. And the challenges for them are different.
They may be looking to refresh, to move to a new neighborhood, to change their relationship to work in some way. But those are a group of people who probably have enough local experience that they aren't going to require a lot of external input.
If you're moving to an entirely new city, many programs make available to their incoming residents’ resources related to relocation, to schools, to activities outside of residency. And so, I think immediately following the Match, it's entirely reasonable to reach out to your program and say, "Hey, I'm really excited to be there. And oh, by the way, I'm going to be moving to a new city. Are there any resources that you would suggest I take advantage of as I do this?"
The other thing to do is to make contact, seems obvious, but with the residents in the program to which you're moving. If you're moving to a new city, the residents that are already there have essentially been living the life that you're moving to for some time, and they'll have some experience and can tell you about the successes or the things that they might have done differently had they had that advice coming in.
So, I think reaching out to them is a really helpful source of information as well because that's boots-on-the-ground experience.
Murphy: From what you've experienced in your time working in programs, will programs facilitate those conversations with current residents and possibly now, in the era of social media, set up some sort of connection with incoming residents?
Dr. Andrews: Yeah, I think programs very interested in doing that. And honestly, residents in a program are interested in having those connections to the incoming interns. They want to know whom they're going to be working with and are happy to share their experience. That's been my experience that current residents are very interested in those conversations.
Murphy: When it comes to the actual moments on the wards, what are some of the pain points you've witnessed? And I'd like to start with the non-clinical pain points because this is a job and that is different.
Dr. Andrews: Yeah. I think one of the things that a lot of graduating medical students don't realize is that they're well-trained from their experience in medical school. They're technically skilled and they understand enough from a knowledge standpoint about the field in which they're entering to get by.
The struggles that residents encounter have to do more with organizing their work as a resident. Students have typically provided care to patients in the same way that they'll be providing them to patients when they're residents, but not at the same pace and not at the same volume.
And so, time management, prioritization, organizing the work that you're doing are the things that I think present the biggest challenges to new residents and are the biggest revelations over the first couple of months of residency.
And so, preparing yourself for the fact that you'll be doing things that you're well-trained to do, but at a pace and in a volume greater than what you're typically accustomed to is one of the things to try to prepare yourself for.
And once again, conversations with current residents about tips and tricks, things that they've learned about the best way to get through the day, can be really helpful at allaying any anxiety that people may have about that.
Murphy: So, we know that every resident is unique, every specialty is unique, every program is unique. I want to put those caveats out there before I ask this question. Have you noticed some common knowledge deficits among new residents in the clinical arena?
Dr. Andrews: Boy, Brendan. I think the answer to that is no. And that sounds like an oversimplification. But as I said earlier, if you've paid attention in medical school, if you're excited about the field that you're entering, as a graduating medical student, your knowledge base should be adequate to begin residency where clinical issues are concerned.
And frankly, the things that you don't know are the very things that residency is designed to teach you. And so, with rare exception, most people are well-prepared clinically. It's just a question of managing that knowledge and applying it to the care of a large volume of patients in perhaps a shorter period of time than what you're typically accustomed to.
So, I think it's really the complexity compression that happens in residency, not the knowledge base itself that presents a challenge to many residents.
Murphy: We touched on this a bit earlier, but can you talk on the role a mentorship plays in the successful transition to residency and if you need to seek out new mentors, perhaps?
Dr. Andrews: Yeah, I think mentorship's critical. It plays a couple of roles. Mentors are typically people who have some relevant experience and can advise you about your own trajectory. And I think that's a big help in addressing a lot of the insecurities that people experience as they begin residency.
A good mentor will tell a student or a resident, you're okay. This is where you're supposed to be right now. And help them navigate some of the challenges that they face moving forward. So a mentor on the medical school side will have seen many people graduate and move on to the specialty that you're pursuing and can help you to level set and understand that you are well-prepared in the areas you need to be prepared in, and these are the challenges that you'll face. I think a good mentor helps to do that.
I think it's important on the residency side, especially if you're moving to a new institution, to quickly understand who those mentors are going to be for you at a new institution, whether that's a senior resident with whom you work on your first rotation, whether that's someone in program administration, maybe an associate program director, someone whom you can just bounce things off of.
And I would encourage people beginning residency to be open about some of the concerns that they have. Medical school is an exercise in personal achievement, and a lot of people are uncomfortable admitting that they don't know something or admitting their weaknesses. And I think being comfortable talking about those things is one of the things that most guaranteed success in residency.
In other words, to be able to say to a trusted colleague, "Boy, I've never done this before," or, "This is new to me," or, "I'm anxious about this. I did it once before and it didn't go well," I think to have those conversations and to get some advice and some reassurance from someone who's been through it before can be really helpful moving through residency.
Murphy: Well, this is a broad topic and I know you've spoken on it before. I've been in a room where you told a group of incoming residents the importance of socks. What else would you like our audience of future residents to know?
Dr. Andrews: Yeah. I think residency training is pretty consuming. It's important to remember that you can't give every ounce of yourself over to it, that you have to preserve those things that make you feel complete as a person, that give you some perspective on the work that you're doing and that maintain your connection to others.
And so, I would encourage people to make time for the things that they love to do so that the things that they have to do are more satisfying. And it's not simple. It has to be done on a conscious level. If you're a musician and you want to spend some time, I don't know, playing the guitar, you need to think about when you're going to do that and how you're going to make time for it, and where you're going to make sacrifices in order to make that happen because you know how important it's to you.
So I encourage people to think about those things critically and to make time for them. Also, to make time for the people close to you who are going to be support to you outside of work. You're going to have plenty of close relationships in residency. You're going to make new friends, you're going to find new mentors.
But there are people who are a part of your life, who are outside of your medical training, who are important as well, and you need to figure out how you're going to maintain those connections.
Murphy: Well, John, thank you so much for the valuable insight.
Dr. Andrews: Well, I hope it's valuable.
Murphy: This has been a lot of fun. To our listeners, I hope you've enjoyed this special series on Making the Rounds. A special thank you to our production team, Stephanie Voss and Tyler Oranger, for making this happen. I am AMA Senior News Writer Brendan Murphy. Please take care and stay tuned.
Unger: Be sure to subscribe to Making the Rounds and other great AMA podcasts anywhere you listen to yours or visit ama-assn.org/podcasts. Thanks for listening.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.