April 24, 2024 monicarose

Chief Lessons: Post 1

Residency

I have always been drawn to “the art of medicine” where we learn things that can’t be taught from a textbook or doing practice questions alone at home. Some of my favorite parts of my job as an ER doc you can’t measure and are really difficult to describe or quantify. I think that many of the most important lessons we learn as residents can only be learned at the bedside or from shared experiences and stories. With this perspective, at the end of my second year of residency as I was debating whether or not I should run for chief resident, I found myself reflecting on some of my “core memories” and most impactful moments as a resident to that point. I started writing down lessons and advice and stories that I wished I had been taught or I wished somebody had shared with me when I was an intern, and so the first drafts of what would become “chief lessons” were born. I had actually written most of my chief lessons before I had officially decided that I would run for chief. 

“Chief Lessons” turned into a curriculum that I shared with my interns throughout my final year of residency. A lot of the content came from stories and reflections and vulnerable honest sharing between me and my interns. With this in mind, and in line with my goal of this entire blog, I have decided to share my chief lessons publicly here. 

This curriculum has become one of the things I am most proud of from my residency career. I am so grateful for my faculty who supported me as I shared this with the interns, and for my interns who responded with such positivity and vulnerable participation in our group and private discussions. 

This is the first blog post in my chief lessons series, with more to come soon. 

…

This is your job.
You should not require prompting or external validation anymore.
Your patients are counting on you.
Demonstrate your best work ethic at all times. 

Everyone’s journey to medical school and residency is different. Some people arrive at medical school having had multiple previous careers and jobs, and some have never earned a paycheck before. With this in mind, my first lesson is really a reminder that now that you’re a resident, this is your JOB. You’re not a medical student anymore, you are the doctor. Your motivation to get things done may need to shift from external to internal factors. You’re not studying for a test score or an evaluation; you’re studying so that your patients are safe and are cared for by your best self each day. Going the extra mile, making the extra phone call, taking the extra time, it’s not just for your own benefit anymore, it’s for the good of your patients. Everyone wants to feel smart and receive positive feedback and excel at things, but your motivation above all else should be doing your job to the best of your ability, realizing what a privilege it is to have this as a job, as a career. 

Approach each interaction with the highest level of professionalism and poise that you can. Treat your patients how you would want your own family members to be treated by their doctor. 

This is the job that you’ve dreamed of. So act like it in each moment, especially when it’s hard. 

Reciprocal Investment: You get out what you put in.
If you don’t give residency your best effort, you’re not allowing yourself to grow into the best ER doc you can be. 

I had actually first heard this term and definition while at a Phi Delta Epsilon Learning Institute. It was being discussed in the context of the intangible benefits that come with joining our medical fraternity. As soon as I heard this term “reciprocal investment”, I wrote it down and immediately related it to this incredible journey of residency. 

In residency, and not to be too philosophical here, but really in life, I think the most important thing you choose each day is your outlook, your inner dialogue, your words you choose to share with others. 

One option: start each day with a bad attitude, spread negativity in your thoughts and your words, stay guarded and defensive all the time, give into the negative self-talk and the negative words of others, be lazy.

Or, a better second option: Start each day with the best attitude you have to offer that day. Spread positivity in your thoughts and your words, be open to feedback, and be ready to be wrong and try to be wrong gracefully. Give space to the negative self-talk and negative words of others when you need to, but try to focus more on the positivity and those who seek to build you up. Give each shift your best work ethic. 

No matter what option you choose, you still have to go to work, patients will still need you, co-residents will still look to you as an example. If you choose the second option, you will get so much more out of the shift, out of the entire residency experience. I’m sure I’ve written this before, but your best will look different each day. Some days, despite whatever best effort you have for that day, you will be stuck in the option-one-energy, and that’s okay. You will keep moving forward, surround yourself with people who build you up, your best will get better, and it becomes easier to choose option two. 

Your humility can save lives. 
Your arrogance could kill people. 

This lesson sounds a little dramatic, but honestly our job can also be a little dramatic. Sometimes when dealing with a challenge, people will write things off and say “it’s not life and death”; however, for us ER docs, sometimes we are involved in actual life and death situations. 

Your number one job in residency is to be teachable. It does take a certain amount of humility, of swallowing your pride…it takes putting your ego aside and just staying quiet sometimes especially when someone is trying to teach you. If you are unteachable, you are doing a disservice not only to yourself, but to your patients. Even if you already know what someone is teaching you, let them finish, don’t interrupt, and you’ll be surprised how much additional insight you can gain just by listening and letting someone finish. 

If you don’t know an answer, DO NOT GUESS or make things up. Ask, learn, look it up. 

“If you do little things well, 
you’ll do the big ones better.”

William H. Danforth (from the desk of Dr. Alainya Tomanec) 

Again, not to get overly philosophical, but this quote could apply to so many life lessons, and is especially relevant in the context of residency. 

Our end goal of being a competent attending physician seems huge and unattainable sometimes, especially as an intern. So, how do we reach this immense goal? We pay attention to all of the little things, and before we know it they add up to the big things. 

We pay attention to every vital sign, every physical exam finding, struggle through chart reviewing our patient’s last admission… And that adds up to the big thing: helping the patient in front of you as best as you can. So much of residency is about repetition, and starting out by getting really good at the basics. Getting to the big things happens sometimes imperceptibly over time. 

More of our job as emergency medicine physicians is composed of the little things rather than the big things. Those consultant and admitting phone calls where your only priority is advocating for what’s best for your patient, getting those pertinent details from your patient and their families, getting more efficient in your EMR navigation and note writing…all of those little skills will indirectly or directly lead to the “big” flashy things like leading resuscitations and running your department. As you get more efficient, you get more reps in. As you build rapport and cultivate your communication skills, you’ll be more successful in advocating for those patients in the gray area. 

Another part of our job as physicians of any specialty is to take care of paperwork, administrative duties, and to stay up to date with evidence based medicine. As a chief resident, I gained extra insight into the headache that it causes bosses when we neglect the administrative side of our job. Even if they’re “little things” indirectly related to patient care, demonstrating your ability to be detail oriented, to adhere to deadlines, to be a good employee, to be a professional, is still extremely important and still adds up to the big picture of who you are as a doctor. 

A common theme of my chief lessons advice tends to be: it’s all about your perspective and your attitude. If you’re grateful for the “little things”, knowing that they’re important learning opportunities or necessary tasks, remembering that it is a privilege to have this big job, rather than being annoyed about some tedious thing on your to do list, you will save yourself from burn out and learn so much more.