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An Apology from a Resident

Dear Third Year Medical Student,
Congratulations! Your two years of textbook learning are complete and you are ready to launch into your clinical training. It’s an exciting time and you’re likely super-eager to jump in, get involved and save a few lives (or at least stand by helpfully while other people save the lives; let’s not get ahead of ourselves). You have high hopes of becoming a key member of your team, taking care of your patients and learning as much as possible. What you will quickly discover is that your experience will be strongly colored by the residents with whom you will work closely. As a medical student, I had the opportunity to work with some truly great residents. Enthusiastic about their field, they worked to incorporate me into the care process and would take a moment, however brief, to draw attention to valuable teaching points that I might otherwise have overlooked.
Then there were some residents who were, well, not so great. As a medical student, I would think, “Why are you ignoring me? You were just in medical school. Don’t you remember what it was like?” I perfected the awkward lurk of the medical student, trying to simultaneously stay out of the way but be prepared to be “helpful.” And then I became a resident. With my own medical students. It is with this in mind that I write you. This letter is part apology, part advice, part explanation for why we residents are the way we are, which can be frustrating for you, as a medical student. On behalf of my fellow residents, I would like to apologize for the following:
I am sorry that you are often the last to know. During medical school, this would drive me nuts. Why couldn’t the resident just remember to tell me? This seemed like such a simple request and I promised to myself that I would keep my medical students in the loop. Always! Promise! Then just the other day, I realized, midway through a family meeting, that I had forgotten to grab the medical student on my way over, despite the fact that this was her patient. So, sorry about that. Also, apologies for not always communicating the plan for the day. Mornings are often rushed, and it’s easy to neglect to pass along these details. If you are presenting patients on morning rounds (and hopefully you are), it is completely acceptable to pull the resident aside for a minute before rounds and ask, “So, what’s the plan for Mrs. Smith today?” Bonus points if you can start by saying what you already know is happening or what you think should happen.
I apologize when I ignore you. Nothing was more irksome during medical school than feeling like I was being ignored in the corner, but really couldn’t leave because something might happen that I for which my attendance would be expected. I hated being there without any clear purpose beyond perfecting my awkward lurk. Why couldn’t my resident give me something to do? Couldn’t s/he see that I just wanted to be useful? Then I became a resident. Suddenly, I have things that must actually get done and coming up with activities for the medical students can quickly fall to the bottom of the priority list. Just last night, I turned to the medical student who was on call with me and said, “I’m sorry, but I’m afraid I am going to be ignoring you – I have to get someone admitted to an outside hospital from the ED. I’m afraid it’s not going to be interesting or educational.” It was the best I could do.
I am sorry if I give you a task and then ask you if you have finished it only two seconds later when there is no way you could have gotten it done. What medical student doesn’t cringe when being asked, yet again, if you’ve gotten those hospital records and wanted to reply, “I was transferred all over the hospital, put on hold with the records department, faxed the release twice, but, no the records haven’t come”? Instead you say, sheepishly, “No, sorry. Still working on that.” Here’s the thing, from my point of view, the attending wants it done. It has to get done before I can go home. And I really want to be able to go home. And, if issues come up and for some reason you’re unable to complete the task – like you’re pulled away for lectures – it still has to get done. If you won’t be able to finish something because you have other obligations, please let me know. I will very much appreciate the warning rather than finding the task left undone.
I am sorry if I neglect to make clear what the expectations are. There is no way you can join a team and simply intuit what you need to do. Some residents do a great job of laying out what is expected of you to become a member of the team, whether that is ensuring daily blood draws or updating discharge summaries. However, if your resident doesn’t, please ask. A simple, “What do you expect from me on this rotation?” can save you a lot of grief later. For a surgery resident, it is obvious what needs to be packed in the wound bucket and that the medical student should be the one keeping it filled, but for a med student just joining the team, this is all foreign territory. As residents, we forget this as what we once had to learn has now become “common sense.” Please ask. We need to be reminded. And, if our response is a bit snarky, remember we are probably running low on sleep.
Good luck with third year. Before you know it, you’ll have an MD after your name and your own posse of medical students.
All the best,