Friday Jul 12, 2013

First-year Residents Set Expectations for Themselves

A new academic year started this month at family medicine residencies across the country. The new year means a new crop of first-year residents, who bring with them a great deal of energy, excitement and -- of course -- nervousness about their new roles.

As chair of the Department of Family and Community Medicine at the University of Nevada School of Medicine, Reno, I recently sat down with our new residents and asked them how they are adjusting.

It's worth noting that four of our seven interns are from Caribbean medical schools. I asked them if they felt any disadvantage compared to our American medical school graduates. They all said no and added that their rotations in U.S. hospitals had more than adequately prepared them.

Here is what they all had to say. 

Q: Do you feel confident? Are you appropriately prepared for internship?

A: Meghan Ward, M.D.

I just feel pretty ready to start. I wouldn’t say that I'm overconfident, however, and I know that I have a lot to learn. I do feel that my training has prepared me well. I am sure there will be times when I feel inadequate, but I realize that this is a learning environment and there is a lot of support to make sure I am successful. I am up for the challenge. 

Q: As you become an intern, it can be nerve racking. How would you rank your level of nervousness being an intern? Do you think this is a lot of responsibility to take on, or do you feel ready for it?

A: J. Kevin Daniels, M.D.

I'm pretty nervous about it just because being responsible for all these patients is a big deal, and you are doing it for real the first time. It will make you kind of nervous. I think that I'm ready for it because I feel that I'm well supported on the rotation. The senior residents and faculty are here and seem very willing to help and make sure I succeed. I'm not just out there by myself, so that makes me feel a little more confident.

Q: What have you learned so far that has taken you by surprise in the first two weeks of your internship?

A: Benjamin Hansen, M.D.

I think the most profound thing to me is that we understand that family medicine's emphasis is on treating the whole patient. Treating the social aspect of the disease -- not just the diseases themselves -- is important, but I never realized just how important that really is in terms of promoting wellness. People have a real desire to just have a conversation with you, to interact with you on a personal level. If you can get to understand people in that regard, they are little bit more passionate about taking care of themselves, a little more passionate about getting well. And I think that it promotes wellness a little more than antibiotics can do alone or whatever you are treating with. 

Q: Internship takes a lot of time, and a lot of interns have trouble with time management and getting into their personal life with this year of heavy study.  How do you plan on managing your time?

A: Umar Nasir, M.D.

First year is a huge transition from medical school to being a doctor, so it's basically a huge learning curve. The first priority should be learning new stuff and getting more comfortable with practicing family medicine. It can get difficult to manage your own personal life along with working; however, I think our first focus should be just learning medicine and becoming better. I think that you can have time for personal life; however, it all depends on individuals and how they manage time between their work and how efficient they are. I think it is different with everyone. 

Q: When you start a new training program and you are thrown into a hospital where a lot of people are accustomed working together and you're the new kid on the block, sometimes people don't get treated the best. How do you feel like you're being treated?

A: Kyle Baron, M.D.

I think that I've been very fortunate since I've only so far been working on the pediatric floor. All the staff up there -- from the nurses, MAs (medical assistants) to the techs -- have been very helpful and incredibly friendly. There are times when you get ignored a little bit. What I found is a lot of times when they do not know who you are, they don't make the effort to figure out who you are. Sometimes they think you are just a medical student and were given a task, so they don't need to help you or talk to you or it might be some other similar situation. As soon as you make yourself known, introduce yourself to everyone and be polite with everybody, they will get to know who you are. What I have experienced so far is that everyone is very friendly and helpful, and they know we are all there for the same reason. Even though I wouldn't say they go out of their way, I have found that if you ask for help, they will give it. I have not experienced any situation where someone wasn't willing to give help.   

Q: Why did you choose family medicine? Also, how do you balance internship and personal life?

A: Stephanie Reinhardt, M.D.

I chose family medicine mostly because of my experience at medical school. I just loved being able to see an adult patient with multiple chronic diseases, then pediatric kids that weren’t well and then going in and seeing a pregnant patient. I just loved the variety and being able to be good at a lot of little things. It's kind of what I envisioned doctors being when I was growing up, so it is kind of neat to have all the variety that we get in family medicine and all the prevention that we get to work with. I'm pretty passionate about preventing the long-term diseases that we treat, and I think that family medicine definitely does the best job with that over all the fields that I have seen. The first week is a little hard because we are working so much, but I've managed to always have dinners together at home every night. It is just something we do. My husband and I decided to make dinner together every night so we just have time together, and then we take the dogs for a walk. I think it's just making priorities. For me, my priority is medicine and my husband, so when I have free time, it's just where it goes. You have to have balance in your life.

Q: Are you happy you chose family medicine? How do you see that evolving during the next four years?

A: Satu Salonen, M.D.

I am happy that I chose family medicine. Well, I started on family medicine wards so I'm actually getting to see what family medicine really is. I like the fact that we see newborns, then we see pediatric patients, the obstetrical patients and then adults, so you really do get the whole scope of medicine, which is what I wanted. Hopefully, I will become more confident and comfortable.  As you know, just as you're starting out, it can be a bit overwhelming trying to tackle all the different patients from newborns to adults and multiple different situations. I feel pretty good now. I have a great senior resident, who is helping me out a lot, and I see myself growing as I go along.

Daniel Spogen, M.D. is a member of the AAFP Board of Directors.

Comments:

Internship is a great time in your life. Yes, it can be stressful and you feel the pressure of having responsibility for someone's health, but you have lots of people who "have your back". Use that support and never be afraid to say, "I don't know" and ask for help. This is the time to expand the limits of your knowledge and recognize your strengths and weaknesses. No one expects you to "know it all" at this point in your career, and the habits you develop now to augment your knowledge deficits and ask for help when needed will follow you through the rest of your career. Immerse yourself in the "tough cases" now and you will feel much more comfortable teaching the newbies in a few years when you are the wise senior resident.

Posted by Kin Snyder, MD on July 12, 2013 at 11:38 PM CDT #

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