Saturday, May 31, 2014

Residency Survival Guide 101: New Advice for the New Resident

Being in fellowship training has allowed me to see how residency training has evolved over the last few years. It has conformed to society's latest fads and the newer graduates of medical school. This is an ever evolving guide to surviving residency training, in this day and age.

1. Be responsible using social media.

It has become a selfie-dominated residency generation. And mind you, this has exploded over just the past 2 years or so. In the age of the selfie, these past few years' crop of residents have been so eager to pose and post their latest outfits (nevermind that their white medical coats cover them anyway), their latest duck-faces (nevermind that a good number of them actually make themselves look worse than their regular faces), and their quote/s for the day, that they do not notice the little things in their statuses. The time stamp and the pictures can place them out of post should they be anywhere else in the hospital where they are not supposed to be. The selfie with the patient in the background can be a breach in the patient's privacy (I'm not a lawyer, but that should qualify right?). The blatant photo op at the ER can arguably be used against them, being that they should be attending to admissions first, and poses the least of their priorities.

Yet, social media has permeated every aspect of our society and its use cannot be prevented. Heck, this post is going to be on it. But careful judgment on what to post, when to post it and who to post it for goes a long way in making sure that you don't get sued.

So if you are a resident or planning to go into training, please think before you post.

2. Do not quote information without basis.

More and more residents are quick to pick up tidbits of information during rounds, most especially so when they like the consultants (criteria includes any combination of physical looks, elite status in the community, treats to free food at the canteen, and the like) and are just as quick to use this in medical conferences with corresponding quotes and name-dropped sources. Please, if you are one who does this, stop. Do not ever answer another consultant's question with, "But doc, Doctor so and so said that the, yada, yada..." (you get the drift). That will surely earn you an eyebrow raise and you'll get laid the smacketh down.

It is just different when you say, "Based on the current practice guidelines..." or "According to Harrison's..." or more if "The latest online issue of the New England Journal of Medicine has an article that tells us..."

3. Do not act like you are infallible.

There is always going to be someone better than you at something. A nurse can outshine you on knowing the patient. Acknowledge them. A fellow tells you to follow up on a urinalysis that you have not gotten to yet. Listen. You are not the perfect specimen of medical practice you think you are walking down the hallways with a stethoscope draped around your neck, white coat billowing behind you. You are in training, and learning from everybody, anybody should be your foremost goal.

4. Know your place

There is this hierarchy in medical training that has blurred somewhat in the past few years because of braver students with gifts of gab and older consultants who are content on quietly getting by treating their patients. The students can appear deceptively good, and the older guard, deceptively incapable of handling their juniors.

This past few years has seen an admitted change of philosophy in terms of medical training. It is geared more towards lifting residents and guiding, nay, nurturing them towards their goal as compared to the old Spartan way of throwing you into to the sea just to see if you can swim and survive. Admittedly, I am a mix of these two philosophies and I see advantages to both nurture and nature (hierarchial, pyramidal, etc) but the key is getting a balance of the two. Nurturing has led to "intellectual arrogance," a blinding of the clinical eye and an often uncompromising allegiance to guidelines. Nature has often seen bullies exploit their place in the organizational system, and those that cannot hack it are scarred for life.

The key is finding the balance. Know your role. You are here to train and learn. Respect those that have come before you even if a few months separate you. They have seen more than you have and are still there standing. And all the more for those who you do rounds with and report to because they do not have those additional letters at the end of their names for nothing.

Do not cross the line between pushy and timid. Once you establish that, do not rock the boat and tip yourself over.

5. Read, study and learn.

Yes, this still does the trick.