Advice for New Residents - By Specialty!

Advice for New Residents – By Specialty!

By: Kamali Thompson of Saber & A Stethoscope

Congratulations new doctors! It’s the moment you’ve all been waiting for. Those two letters you’ve dedicated your whole life to earning are finally at the end of your name, but with great power comes great responsibility.

Take a look at the advice for new residents I’ve gathered from current doctors that will help you as your start your residency in the upcoming months. Skip to your specialty or check out many of the universal tips from all of the residents’ advice.

Anesthesiology

Intern year has been an interesting rollercoaster ride and despite the lows, I can honestly say I’ve had an amazing time thus far. As a new intern, life gets crazy at times but it’s very important to:

sleep when you can!
find out what activities are important to you and make them a priority
don’t stop learning

Be sure to enjoy the ride. You will meet some of the most amazing people on this journey and most importantly, you’ll be doing what you love.

– PGY 1, Pennsylvania Hospital – University of Pennsylvania

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Get enough sleep, eat well, and exercise. Make sure you do something you enjoy every week. By taking care of yourself, you will be able to take care of your patients to the best of your ability.

Respect and listen to all members of the health care team, especially the nurses. They have more clinical experience than you and can teach you things that aren’t in textbooks.

Stay organized and be on time. You will be carrying double the patient load that you carried as a medical student and 100 times the responsibility. See how your seniors go about chart reviewing and getting prepared for rounds, figure out what works for you, and stick to it.

Study a little bit every day. Read a few pages of a textbook, look up information on UpToDate, or read an article that’s related to your patient.

Intern year is overwhelming at first. Remember that everyone is on the same page, and in just a matter of weeks, you will feel much more comfortable. It’s a great year full of learning and growth.

-PGY 1, Rutgers Robert Wood Johnson Hospital

As far as advice goes for anesthesia residency: be realistic, but consistent. Don’t set lofty goals that you know you won’t achieve; it’s better to set multiple smaller ones and actually accomplish them vs having ones that you are never able to pull off. That goes for work, studying, and maintaining a personal life. Doing that eventually allows you to achieve much bigger things down the line.

UWorld for step 3 is critical for step 3; I used nothing else but their questions and online case scenarios. For anesthesia: Morgan & Mikhail is a great text for baseline knowledge to build upon for the different cases, physiology, and pharmacology you’ll be expected to know. It’s easy to digest and take notes from. The anesthesiologist’s manual for surgical procedures is also handy to learn how to run cases intraoperatively from the anesthesiologist’s perspective. That, and Pocket Anesthesia.

– PGY 1, Pennsylvania State Health- Milton S. Hershey Medical Center

Emergency Medicine

BEFRIEND THE NURSES, most of them have been there forever and know A LOT! Involve them in patient care when possible
Don’t lie!! People are gonna ask “have you ever done XYZ” it’s ok to say no but follow that up with “I want to learn so can I do it” don’t ever lie just to get a procedure. These are humans, not mannequins
LIVE YOUR LIFE! Easier said then done but don’t forget to do what makes you happy.

– PGY 1, New Jersey Medical School

Surviving the ED 101. The ED is often a fast-paced, chaotic environment and it’s easy to get overwhelmed as a new intern. Don’t be afraid to ask for help from your seniors or attendings! They remember what it was like and no one expects you to be an expert at this stage. Try to connect with at least one patient per shift. Making that connection and having the sense of gratification can help you deal with the next patient who is not as kind. Make sure you take breaks to eat, use the restroom, and take a breather. You can’t take care of your patients if you’re not taking care of your self. You will likely work a collective of long day, night, weekend, and holiday shifts. Invest in an eye mask, ear plugs, and/or blackout shades for good sleep hygiene during the day. Be sure to prioritize your days off for YOU—see friends/family, exercise, have fun with your time outside the hospital!

Emergency medicine is a team sport. Be kind, be respectful, and befriend your nurses, techs, volunteers, housekeeping staff, etc. Remember their names. Thank them at the end of your shifts together. They have often been working in the ED longer than you have been in medicine and have strong clinical knowledge, and more importantly, instinct. They will catch your baby-doctor mistakes time and time again. Trust their instincts— if they are concerned about a patient, you should be too, as they are often right. And if they’re not, thank them for being so observant and alerting you that something felt off.

Learn from wherever you can! The classic books for EM are Rosen’s and Tintinalli’s, but EM docs have been pioneering the FOAMed (Free Open Access Medical education) world so many good resources are actually blogs and podcasts. A few favorites include: EM:RAP, EMCrit, EMDocs, EMUpdates and Life in the Fast Lane. If you have an interesting case on shift, read about it! But remember that nothing can substitute for what real patients and their stories will teach you, because they don’t always follow the text-book and that renal stone may actually be an aortic dissection.

Oh, consultants. Calling consults was one of the things I was most nervous about. But remember that you are advocating and doing what is best for your patient by seeking expert opinion. My tactic has always been to be concise with the information I’m providing and to be clear with the reason for the consult/question I need answered…and to BE NICE! You will come across rude and possibly evening demeaning consultants. Try to remember that they may be just as overwhelmed as you are, you may have just woken them up, or they may be having a rough day. If all else fails, don’t be afraid to escalate the situation to your attending.

In the words of a medical school professor, remember to check your own pulse. In the ED, you will see it all. You’ll see things that will make you laugh, that will make you cry, and that will both question but then restore your faith in humanity. You’ll see things that will make you wish you never went into medicine, but in the next minute make you realize how privileged you are to be a physician. And this might all occur within one shift! That all being said, please remember how important it is to be in tune with your own mental well-being. Take a few minutes if you need to decompress after a tough case, don’t be afraid to high-five or hug your patients in celebration of good news, and always, always remember that you are a human being who has emotions. Remember that you have an entire ED family that is there for you if you need support and never be afraid to ask for it!

-PGY2, The Mount Sinai Hospital

Family Medicine

I would definitely recommend studying with a solid database like UptoDate or DynaMed along with Onlinemeded’s intern material. I also bought their intern survival guide and read it like 5x because it teaches you how to be an effective intern.

In terms of being effective as an intern I recommend ALWAYS showing up early to rotations. With that I would also say to always, always, always ask questions about things you’re unsure of. The best bit of advice I received was “if you knew everything already you wouldn’t be here, residency is your time to learn and make mistakes.”

– PGY 1, St. Louis University’s Family Medicine

First things first, family medicine residency has a lot of clichés –> embrace them because they are true.

“Cradle to grave medicine”: you will see patients from every age range and you are expected to not only know the medicine for each age range but also expected to be socially comfortable with them as well. This can cause some distress in the beginning from trying to empathize with a Vietnam vet who is dealing with after-effects of chemical warfare to trying to focus while a 8-year-old is incessantly playing with a fidget spinner. Embrace it!!! Embrace every patient and realize that you are in such a unique position to learn from all these people and as long as you stay true to yourself and consistent and never find yourself changing who you are to fit your patients then you will emerge as one of the most aware and empathic people in healthcare….or as the young kids would say…you’ll be “woke”.

“Family docs know 85% of 85% of medicine”. Again, this is cliché but it is accurate. Your head will spin so much your first year that you will feel like you have diagnosed yourself with a new version of vertigo! But again, embrace it! Turn into the spin like losing control on the ice. Understand that you are going to work on so many different services and it will be impossible to learn it all. But every patient, nurse, resident, and attending is a learning opportunity you will only be able to access in residency So go make mentors, make friends! Who cares what service you are on, just embrace the journey and find mentors along the way. All that being said, don’t let yourself get overwhelmed trying to read everyone’s journals. It is important for your sanity to do most of your outside reading on fam med journals. My personal favorite three journals are 1. Annals of family medicine. 2. Journals of the American board of family medicine 3. Family practice. Try to encourage your residency to pay for these journals.

So keep your head up, embrace everything family med has to offer and in the end you will be proud of the doctor and person you have become!

-PGY 3, Virginia Commonwealth University Health System

General Surgery

There are several classic textbooks people recommend (Sabiston, Cameron, Schwartz), but they all essentially convey the same information. Flip through a copy of each of them and see which one reads easier for you and stick with that one. Also, get a new anatomy text, preferably one with a surgical focus. Netter’s or Zollinger’s are good.
Patients are generally the same, whether they are there for a medical or surgical issue. Despite stories of “difficult patients”, which we will all encounter and are the ones you hear the most about, the majority of patients are there to be cared for. In the midst of the daily checklist of items you are going to have the accomplish, don’t forget to talk to them, even for a few minutes on rounds. Keeping them informed on what is happening and what the plan is for their care goes a long way.
Don’t forget to care for yourself!! You spend a lot of time over the next few years caring for other people, but it is mentally, physically, and emotionally demanding work. Don’t give up the things you enjoy (though you may have to do so in moderation given the time constraints) and try to pick one or two things that you can commit yourself to outside of work. It’s a nice outlet and a reminder for yourself that people and worlds exist outside of medicine and not everyone is sick!! You’ll find yourself refreshed more often than not rather than only spending time in the hospital and your home.
Enjoy yourself! This has been something you’ve worked for your whole life and all the hard work has paid off. Residency is going to fly by faster than you know so make friends, learn everything you can, and have fun!

-PGY2, Drexel University College of Medicine

Internal Medicine

Get MKSAP as early as you can to start practicing board questions. Dealing with patients will always be very variable but a good skill to develop is how to question patients of different learning levels to get a complete history. Social life is definitely possible and important for your sanity. Time management is important. If you can spread out studying to a little bit of time everyday, you retain more and have more daily time to yourself.

-PGY 2, Well Star Health

When you’re at work, take care of your patients, take care of your co-residents, take care of yourself.
Don’t be afraid to ask questions. Don’t be afraid to be wrong. Don’t be afraid to ask for help. That’s how you learn.
Take it one day at a time. Sometimes, take it one hour at a time.
Try to get a little better every week. Build on your failures and your successes, and try not to get too distracted by either.
If you don’t have a therapist, consider starting to see one. Even if everything is fine now, you will encounter difficult things, and it helps to discuss them with an objective person.
When you’re not at work, try not to be at work (even if it means staying an extra 30 minutes to finish the stuff you were going to do at home). Mental space is important.
Make the effort to do things you enjoy with the people you love. You’re going to work harder than you ever worked, and you’ll need to recharge
Actually, what is really good is to keep reading like we did in medical school: look up things that pertain to your patient (up to date, new articles, etc). When you go to journal club, actually read the article. Pay attention to popular media’s coverage of medical breakthroughs, then go back to the source articles that stuff is based on.
Do board review questions/step 3 questions. It’s hard to find time to sit down with a book, but it’s easy to go through 5-10 questions a day and review the explanations.

-PGY 2, Robert Wood Johnson Hospital

Internal Medicine & Preventive Medicine

My first patient experience in residency was diagnosing and breaking bad news that the patient had metastatic pancreatic cancer, a terminal diagnosis. The gravity helped me immediately realize the seriousness of my words and actions – I was the doctor, and this was my job – I was no longer shielded from difficult discussions by a ‘student’ label. Remember to be careful and considerate with your words and actions, just like you would with any prior job you’ve had. Good ‘customer service’ will carry you far.

-PGY 1, Kaiser Permanente Medical Center

Medicine-Pediatrics

I think as an intern, you have a tendency to always feel like you don’t know as much as your peers know. In Med-Peds specifically, it is more objective since you get half the training your categorical colleagues do. But the fact is, you know more than you think you do. Studying is hard as an intern (let’s be real, I haven’t studied in earnest since med school), but learn what you can from your patients (…and uptodate, when you’re looking up how exactly to treat them). But most importantly prioritize self-care. It can be hard when you’re working 14 hour shifts to make time do what you love to do. Schedule time to do it. Whether you like to exercise (lol) or go to concerts or go on dates or read in a hammock or sleep-make sure you’re doing it. At the end of the day, residency is a job and if you don’t care for yourself you won’t be able to care for your patients. Also, if you use Epic at your institution– find a resident you admire and steal their dot phrases.

– PGY 1, University of Chicago

Neurosurgery

The demands of neurosurgery require mental, physical and emotional strength and endurance and it will test you. Make sure to read daily, ask questions, seek solutions and opportunities, eat healthy, and find a hobby that is a stress relief and do it daily. Don’t forget about your family and friends as they will keep you grounded. Have an attitude of gratitude and never lose sight of the immense privilege of taking care of the sickest patients who are trusting you with the organ that makes them who they are. All of these things will make you the best surgeon and doctor you can be for your patients.

-PGY 1, Vanderbilt University Medical Center

Obstetrics And Gynaecology

When you first start residency, you’re gonna feel like an imposter in every sense, when you go into the OR to ordering Tylenol. But hang in there! I promise you’re a real doctor. And you’re going to learn so much and be amazing. And one day you’re gonna be like I got this and it’s gonna feel amazing. And you know my motto about life, don’t forget its just work! So make time for having fun, don’t forget your family and don’t forget to eat!! I lost so much weight my intern year. Always wear shoe covers and eye-shields. Oh and never tell the patient she’s pooping when she’s pushing.

– PGY 2, Robert Wood Johnson Hospital

Ophthalmology

My advice would be to start oculoplastics research during intern year because you apply a year earlier for that. Otherwise, I would suggest relaxing and getting as much sleep as possible. I would read the wills eye manual, and try to read bcsc aao ophthalmology books if your program provides it prior to starting pgy-2.

-PGY 2, Columbia University Medial Center

Orthopedics

Treat every consult not as a task, but as a learning opportunity
ANATOMY—Learn it.
Don’t forget about your personal health—eat well and exercise!

-PGY 2, Harvard Combined Orthopedic Residency Program

The biggest piece of advice would be to write everything down. As the intern you’re successful when your team can count on you to get things done and it’s easy to let things slip when you start getting bombarded with pages during the day (“there are only 2 types of interns… bad ones and ones who write everything down”).

For studying, Orthobullets is by far the most efficient. If your program doesn’t sign you up for the annual program, it’s worth it to sign up yourself and follow with their study schedule. Handbook of fractures/Netters are still clutch on a day-to-day basis when seeing consults. Make sure to go over the previous years OITE before October rolls around.

Regarding patient care, just try to treat everyone as if they were your own family member. In Ortho the patients we have that end up staying as inpatients tend to be on the more eccentric end of the spectrum and it can be easy to get frustrated or lose sight of the importance of equal patient care.

Schedule time for yourself. Otherwise, it’s easy to skip going to the gym or say no I don’t have time to go out this weekend, but doing almost anything outside the hospital on a regular basis helps to keep you sane. Most people will be in a new area for residency, so exploring with co-interns is an easy thing to do.

Probably generic advice that everyone will give: Everyone should just be able to adapt to their surroundings and situation and make changes as they see it since everywhere will be slightly different.

– PGY 1, University of California San Diego Health

Pediatrics

In pediatrics, the child may be the patient but in reality we are treating the entire family. Listen to them. Harriet Lane is a go to book for pediatric clinical care. It’s very thorough so use it when needed. Most importantly, learn to not take yourself too seriously and how to make the kids laugh & feel comfortable around you!

– PGY 1, New York Medical College

Stay organized! Your patient load will double (maybe triple) from what you are used to in med school… and you are now responsible for everything that has to do with that patient (notes, orders, consults, etc.). Develop a system that works for you and stick to it. Your seniors should be helping through this but make sure you help each other out during rounds. If your co intern is presenting a patient, bring a mobile computer and put in their orders and vice versa. That way, all the consults, labs, and imaging are in earlier in the day and you don’t forget anything. Make a task list for each patient and check them off as you complete them. You’re goal for the day is to have everything squared away for the night team.
Be creative, have fun and don’t be afraid to look silly…Remember that most of your patients are going to be young children. Find little tricks to get through your physical exam. If necessary, complete as much of it as possible while the patient is in the parent’s arms. Have a distracting tool, you’ll see most Peds residents have some little toy always hooked to their ID badge. Kids love it, and we love the kids… so get one. 😉
Communicate! As a team you should be running the list often as new information comes along, this way everyone’s on the same page and nothing is missed. Communicate with the nurses. It may seem annoying but if you put in an order or want something done, let the patient’s nurse know. Include them in rounds or update them after rounds. Again, try to keep everyone on the same page. There is noting worse tha different people telling families different information – it’s frustrating for all parties involved. Speaking of the families, update them often. The hospital can be a scary place, even though we see these things hundreds of times, this is likely their first, and we should be mindful of that.
Listen!!…. to nurses, parents, your attending, seniors etc. As an intern, nurses usually have the experience advantage on you, especially in the subspecialty fields (think Heme-Onc, Cardiology, NICU, etc.) and will know when a kid needs your attention. Also, lots of parents have a sixth sense for when their kid is just “not right”, and even if you don’t think it’s particularly bad, show the parents that you are taking their concerns seriously.
Be confident! But don’t be cocky. Use your upper levels for guidance, and if you’re ever unsure about something, let them know because it’s much easier for them to give you advice in that moment instead of later when all hell is breaking loose. Also, don’t be afraid to say “I don’t know”, you’ll be much safer if you accept this and look for advice from the people above you.
Finally, you’re going to work a lot of hours in your intern year, but make sure you take some time for yourself to enjoy things in your life outside of medicine. Try to keep other activities in your life and you’ll be a happier person, and probably a better resident for it.

Some Resources:

Pedialink, Harriet Lane, Journal of Pediatrics, Pediatrics in Review (PIR), https://pedclerk.uchicago.edu (great quick peds reference to have) https://www.ucsfbenioffchildrens.org/health_professionals/intensive_care_nursery_house_staff_manual/ (Great NICU resource)

-PGY 2, Cohen Children Medical Center

Psychiatry

For interns going into any field, my first word of advice is to remember to take care of yourself. Intern year tends to be one of the hardest, and a lot of that is from adjusting and transitioning to being a doctor. Don’t forget to come up for air and do things to unwind. For interns going into psychiatry I recommend at least having the reference DSM to be able to carry with you (but you should probably also invest in the complete version). Stahl’s essential psychopharmacology is also a good reference. Lastly, everything takes practice – therapy doesn’t come easy but showing that you are genuinely interested in the patients will get you where you need to be.

– PGY 2, Montefiore Medical Center

A great reference book to have as a psychiatric resident is Prescriber’s Guide: Stahl’s Essential Psychopharmacology. It combines evidence-based medicine and clinical advice on all the psychotropic medications we use daily, in an easy to use format. Essentially, a lifesaver. It’s can be hard at times to work with such a complex and difficult patient population. As a resident, it’s important that you find the activities that help ground you and allows you to cope with such stress. Personally, I love to exercise to help with the stress I encounter everyday and travel when I can to allow myself to separate from my work.

-PGY 2, Robert Wood Johnson Hospital

Radiology

You will probably be coming off an intern year where you feel very knowledgeable and competent. That’s great! But be prepared to start over completely in radiology. It’s a rough learning curve and it may be overwhelming but take it one day at a time. Exposure is key so don’t be afraid to dive into every case.

There’s a lot of books and online resources out there, lots of lists you can find online, and lots that your senior residents will tell you about. Find what works for you and stick to it.

-PGY 2, Robert Wood Johnson Hospital

Mistakes are OK.
Learn as much as you can. Residency will go by fast.
Make time to spend with family, friends, do things you enjoy.

-Attending, NYU Langone Orthopedic Hospital

Kamali Thompson is an MD/MBA student who blogs at Saber & A Stethoscope. This post first appeared on her site here. The blog shares experiences gained through medical school, business school, and as an international fencer/2020 Olympic hopeful! Give it a read and follow along on twitter (@kamali_thompson) or on Instagram (@dr.mali.malls)

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