Congratulations! You’ve survived intern year. You’ve recently transitioned into the coveted role of senior resident. I’m sure at this point you have attended a retreat to help ease this transition, but you’re likely still feeling some stress. There are many important things about being a senior resident which are not often taught. When they come, they hit you like a ton of bricks. Here are the tips for senior residents I wish I had when I transitioned.
Growing into the Role
Unfortunately, your promotion to senior resident physician doesn’t come with a magical transformation overnight. You wake up (assuming you slept through the anxiety) and you go to work. You don’t feel any different, nor any wiser; in fact, you probably still consider yourself an intern until you meet your new actual intern and the medical students for whom you are now responsible as their teacher.
At this moment it hits you. You’re in charge (aside from the attending, of course). It’s you, as you are now, at the end of your intern year, taking on a team with what you already know and calling the shots in the absence of your attending. Did that get your anxiety going?
For the moment, just stop and remember this one thing. You don’t have to know everything. In fact, it’s an actual impossibility. A common mistake is to worry if you have learned enough during your intern year. Another is comparing yourself to recently graduated residents. The sooner you remember that they started from the same place, the easier your year will be.
You’re not supposed to be a great-all-knowing senior from the first day; you’re supposed to grow into the role. You’re still in a training program for a reason. Knowing this from day one allows you to manage expectations, arguably the hardest thing you will do.
Being a Mentor
There are many important things to learn about becoming a senior. One of the most important is the realization that there’s more at stake now than just learning the art of medicine. In some ways, the future of medicine is about to be impacted by your role as a senior resident. You undoubtedly will be working with a wide range of healthcare professionals: from pre-meds to medical students to interns, from young attendings to attendings that are advancing the specialty to those that are five years past their retirement date. Remember, it’s not just about the patients. You’re about to usher in a new generation. The impact one senior resident can have on the path of a future physician is astounding. Some would even argue that this is your most important role as a senior resident.
Introducing yourself to your team and clearly defining your role as a key support source will help you immensely as you progress onward. How you choose to do this will be entirely up to you and will likely require trial and error. It will also vary based on the composition of your teams over time.
If someone is struggling, you are often the first to experience it. As such, it falls upon you to act, a challenge in itself when you yourself may be struggling too. This will give you practice in balancing, leadership under adversity and resolve under pressure. It provides excellent opportunities for introspection and self growth.
However, be wary. There are limitations. You cannot help everyone to the fullest as you will so desperately want. You will come across people who are at various stages in their development. Some are seemingly behind in terms of skillset and maturity, some are ahead, and some are right on track. It is your responsibility to help them grow as much as possible, but their growth is up to them. It will be taxing, but rewarding.
Dealing with Death
One of the biggest hurdles you will face is helping your underlings grapple with death and dying. Physicians do not get enough support and training to deal with death – before, during, and the aftermath. Certainly understanding the diagnosis which leads to a terminal condition is important. But family dynamics and self care and care of healthcare providers is still lacking in our training.
To look at an individual and say “your journey ends here” takes a degree of compassion, kindness, and strength that is immeasurable. To do so in a society that values numbers is even more astounding. Recognize that you have more responsibility now than you ever had before. Your white coat of burden grows heavier with each year you advance.
Prioritizing
Juggling the above with the duties of hospital-centric work is unfathomable. Believe in yourself while carrying a sense of humility. These tasks become easier with experience as you learn to prioritize. There is no need to pre-round on every single patient. Your routine will change from day 1 to day 30 as you figure out what is truly time sensitive and what just seems urgent because of outside pressures.
If, by the end of your first month, you are still feeling as though you are drowning, it’s time for some self reflection. What is it that is preventing you from letting go? Is the bureaucracy getting to you? Is it your distrust of your interns? Whatever your answer is, the only way to truly find out is to make a change to your existing routine and re-evaluate. Additionally, ask for help, even if admitting your weaknesses and limitations makes you feel vulnerable. Without admitting weaknesses and acknowledging limitations, advancement and growth is not possible. Claim these years as opportunities to grow and mature in more ways than just your medical knowledge.
Avoiding Burnout
Above all, remember that burnout is real. The World Health Organization describes burnout as a state of vital exhaustion. The process is slow and creeping, and it will invade your everyday in such small increments that it can sneak up on you. Symptoms (fatigue, sleeplessness, aches and pains, anxiety, forgetfulness, anger issues, depression, and depersonalization) are often confused with the transition to your new position. A 2009 article from the Journal of Graduate Medical Education estimates the rate of burnout ranges from 27% to a staggering 75%, depending on your specialty. Furthermore, this percentage drastically increases as you progress from your intern year.
As senior residents, caring for yourself and your team is equally important – if not more – than caring for your patients. It often falls on you to create an environment that helps prevent the growing level of depersonalization, withdrawal and apathy and address changes in behavior as you notice them. Rather than give explicit instructions on how to prevent the burnout triad (emotional exhaustion, depersonalization, and a sense of decreased personal accomplishment), I urge you new seniors to stop the cycle of hostility and malignancy that still exists in some training programs today.
To the attendings, I challenge you to eliminate the phrase “when I was in training” from your speech. Supporting those who make care decisions for the ill will build a healthier medical system.
New seniors, go out and make those that trained you proud. Be better than your predecessors. Never stop improving. And then take the torch! As Arnold Schwarzenegger says, “If not me, then who?”
Dr. J Lee is a 3rd year Internal Medicine resident. She has a passion for improving graduate medical education and the work/learning experiences for resident physicians of all specialties.