I knew residency was going to be hard. I had anticipated the long hours, weeks in a row without a two-day weekend (which, in an attempt to see the glass as half full, I have come to call vacations), and the mountain of new knowledge I would need to master. None of this came as a surprise and I was braced for them from the day I showed up for orientation. However, I’ve found that residency comes with a whole set of challenges I did not expect. If anyone had told me about them in med school, I guess I wasn’t really listening (or, more likely, was too preoccupied trying to figure out my patient’s acid/base situation by the time we rounded to take much notice). For each of us, these unexpected challenges in residency are likely to be a little different, stemming from our own strengths, weaknesses and pet peeves. Here are some of the difficulties I wasn’t expecting:
The path to becoming a doctor can feel daunting. For those of us that don’t come from a medical family, it can be challenging to navigate what all you need to do to be a competitive candidate. As a third year psychiatry resident looking back on my pre-med days, I realize just how lost-in-the-woods I felt at times trying to figure out how to get where I wanted to go. Here are half a dozen steps you can take to help pave the way to medical school.
1. 2 Days off in a row = Vacation!
In high school, I looked forward to winter break, spring break, and summer break. In undergraduate, it was the two weeks off over winter break and the week off between quarters. Anything short of a week off felt like barely time to catch your breath – definitely not a vacation. As a medical student, there was still winter break and most bank holidays. Now, as an intern, any time there are two days off in a row, what most of the rest of my non-medicine peers would simply call “the weekend” constitutes the most luxurious vacation.
I had a certain level of (I thought well-justified) terror anticipating the start of intern year. No longer able to hide behind the protective “I’m just the medical student” blockade, I was worried about not being able to live up to the burden and the privilege of being someone’s doctor. Third year was rough and I could only imagine the horrors that awaited me as an intern. Yes, it has been a difficult year, filled with long hours and intense days. However, what I found was that contrary to my fears, intern year has been so much better than medical school. If you recently walked across the stage and accept your diploma, congratulations! Here’s what you have to look forward to:
It has been nearly a year now since I walked across the stage at Carnegie Hall to accept my diploma. Now approaching the end of internship – let’s say that again, one more time, with appropriate emphasis: the end of internship – I can look back with a little more objectivity on my four years of medical training. As with everything else, hindsight is mostly 20/20 and, while there are a lot of things I did right in medical school, I now realize I made some mistakes, or, if they weren’t outright blunders, at least things I would do differently if I had to do it again. Let that these not be your mistakes:
The days are long, the nights short – unless you’re on call or night float, in which case that is reversed. Regardless of where you are in your training, whether in medical school or already out of residency, there will be days when it all just feels like too much. Too much work, too much emotional energy expended, too much illness. Too many petty tasks or meaningless phone calls or purposeless turf wars. Hopefully, those times will be few and far between, buoyed by the days where you make a tricky diagnosis, have an appreciative patient, or just get out of the hospital with daylight left and go for a run. However, for a significant number of physicians, these despondent days stack one atop the next, stretching into weeks where they feel to exhausted to invest energy in their patients, let alone themselves. These individuals are likely suffering from burnout.
Dear Incoming Interns,
Congratulations on matching and reaching the end of medical school! I am sure you are very excited to be graduating, and we interns are equally excited for you as it means we are about ready to say “so long” to our intern year. (Right now, I have 62 clinical days left – but who’s counting?) Intern year is one steep learning curve after another. Just about the time you figure out a particular service, you switch to the next. Over time, however, themes emerge, the transitions become easier, and the mass of random lab values, medications, signs and symptoms, slowly gel into cohesive patient narratives. Below is some of my own hard-earned advice from this year, some practical, some personal.
My stomach sunk. The results of the biopsy were back and it was not good. I had met Ms. Jones eight days ago when she was admitted for a pneumonia that antibiotics couldn’t seem to shake. Once hospitalized, we’d brought out the big guns and she had been clinically improving on that well-loved duo of vanc and zosyn. (Med students take note: vanc/zosyn is almost always an acceptable answer when pimped about which antibiotics to start – they may be overkill, but you’re unlikely to be wrong.) Despite her improvement, things had not been adding up – we kept putting 2 and 2 together and getting 6. A young woman in her late 30s, she had no good reason to have this month-long pneumonia and her chest x-ray looked, in a word, terrible. Even I as an intern could see that what had been a right middle lobe infection when she first presented a month ago was now also in her upper lobes and – oddly – her left lung was looking increasingly cloudy.
I am about 45 minutes from the end of my night float shift, that dangerous hour all residents learn to wait through with baited breath, when my pager goes off. Pushing the button to silent its insistent beep, I read the text: “STAT 4-9876.” I am slightly bemused. STAT pages in psychiatry are few and far between. If one of the patients on the psych floor has had an MI, stroke, or something else that necessitates an immediate response, I may be the last to find out, as the nurse will often call a code and bring a medicine team running before letting me know what is going on. Even a consult for a suicidal patient on a medicine floor, considered a psychiatric emergency, doesn’t exactly necessitate the same sort of urgency as anaphylaxis or an acute abdomen. I like pondering and deliberation, making me naturally suited for psychiatry. Rather than engendering excitement, the word STAT makes my blood run a little cold. Besides, I typically assume that if someone is paging me, urgency is implied, and I return the call immediately; the two year old inside me smarts at being told to hurry up.
When did you know you wanted to be a doctor? the pre-med asked. Maybe it should … Read more
“To sleep, perchance to dream – ay, there’s the rub” ~ Hamlet The irony of … Read more
On Thanksgiving, while many my friends and family gather around the table with roasted turkey … Read more
“Go forth and do great things.”
No one gets into medical school without a considerable dose of ambition. We want to be involved, to make a difference, to save lives. In short, we want to do great things. We spend years waiting in the wings, our enthusiasm funneled into pre-med activities, o chem exams, and countless hours of studying in the first two years of medical school. Like a horse that has been held tightly in the starting gate that suddenly swings up at the sound of the starter’s bell, we spring forward with unbridled enthusiasm into third year, dirt flying. Having spent nearly a decade in prep (if you start counting in undergrad), we are eager to actually do something and start making a difference. And yet, so much of third year can be sitting around, waiting for the action, and, when the action happens, standing in the back of the room.
“Knowing yourself is the beginning of all wisdom.” – Aristotle Even at the time, I … Read more
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.
Whether your goal is education or entertainment, there is likely a medically oriented podcast out there you will enjoy. I’ve included here a sampling of the ones I found most useful or enjoyable, grouped by type. The first are geared towards the present task at hand – surviving medical school in general, clerkships in particular. The second group can help you learn more about your future specialties of interest. The last section takes a broader look at the world of medicine, tackling issues from recent scientific breakthroughs to medical ethics – those topics you feel you should be keeping up on, but who has the time? If you have other podcasts you have found helpful or insightful, please share them via the comments link at the bottom.
After obsessively checking your email every five minutes for weeks, the appearance of your first interview offer brings with it a flood of relief and excitement. All that studying, volunteering, and writing of countless secondary applications has earned you a coveted interview slot. Yet coming on the tail of such excitement is that sense of panic. What now?
I love writing but hate starting. The page is awfully white and it says, “You may have fooled some of the people some of the time but those days are over, giftless. I’m not your agent and I’m not your mommy. I’m a white piece of paper, you wanna dance with me?” And I really, really don’t.
You’ve overcome so much to make it this far. From surviving OChem and taking your MCATs to finding volunteer opportunities that demonstrate your passion for medicine, you have accomplished a great deal to get to the point of being able to fill out that AMCAS application. And yet, writing your personal statement can feel like the most painful hurdle in your path. Like Aaron Sorkin, creator of works such as The West Wing, The Social Network, and Moneyball, you just really, really don’t want to dance with that blank page. Even if you love to write and going to med school is just a temporizing measure until you publish the next great American novel, getting a handle on your personal statement can be challenging. With so much riding on 5300 characters (counting spaces!), how to get started?
“I was a little excited but mostly blorft. “Blorft” is an adjective I just made up that means ‘Completely overwhelmed but proceeding as if everything is fine and reacting to the stress with the torpor of a possum.’ I have been blorft every day for the past seven years.”
― Tina Fey, Bossypants
I believe I have spent much of medical school fairly blorft. Elevated levels of stress seem to be a universal medical student experience. Studies looking at medical students around the globe – from Pakistan and Malaysia to Greece and India – show we all struggle with elevated levels of stress1. Stress, as it is used today, was first defined in 1936 by endocrinologist Hans Selye as “the non-specific response of the body to any demand for change”2. That definition highlights the point that not all stress is bad – a certain level can actually be useful during medical school. Knowing the importance of Step I board scores was stressful, but undoubtedly drove me to study harder than I would have had I treated it as no big deal. However, sustained, elevated levels of stress can be detrimental to both mental and physical well-being. For example, stress levels have been found to be correlated with depression and anxiety amongst medical students3. The good news is that there are steps you can take to reduce and manage your stress.