How Did That Happen?: How to try to be a good resident

This is the first edition of “How Did That Happen?”stethoscopes1

The first topic in question given the droves of people freaking out about starting residency (and in my opinion, justifiably so) is how to try to be a good resident.

Clarification… Good does not equal perfect.  Perfect is not real.

I feel like most people want to be good residents. I sure do. And from time to time I have been told I am a good resident. And from time to time I work with good residents.

How the heck does that happen? What actually makes a good resident? Do you have to be the freaky genius kid who gets straight As all through med school and doesn’t sleep and doesn’t have a social life? I sure hope not, then 99% of us will never be a good resident. Ever. A textbook answer would be to refer you to the freaking CanMeds flower, but if you went through med school in this country, you have the sucker memorized.

So, here is what worked for me and/or for other people who have been told at one time or another that they might be a good resident or who worked with someone who was probably a good resident. Clearly, this is not a be-all end-all list and there are some details for different specialties that may vary.

  • Go in to things knowing you (and no one in this world) is a perfect resident.
  • Sometimes, no matter what you do, bad stuff still happens.  People still die, preceptors still won’t love you and that evaluation won’t be outstanding.  Life goes on.  You just have to keep trying.
  • Show up. I mean really show up. Go to work leave only when your work is legitimately done. Attend teaching and meetings and participate where necessary.
  • Be on time. Just because doctors are famous for being late and you magically (somehow) have that title in front of your name does not mean you should take up being late. People notice and appreciate when you don’t make them wait.
  • Be enthusiastic. I get that people don’t all have ridiculously high baselines. But, try to feign interest in what you are learning, even if it is a rotation that makes you want to gouge your eyes out with small needles.
  • Read. Read a lot. Learn about the main topics and objectives you have for a rotation even if it is something you don’t care about. You’ll remember that stuff when it comes time to prep for exams and it stops you from looking like an idiot.
  • Know how your specialty relates to the one you are currently working with (if you are off service).
  • If some asks you a question and you don’t know, say you don’t know. Then, look it up because odds are they will ask you again and if you don’t know that time, they will be less than impressed.
  • Know your patients, but also, know your team. Nothing is more annoying than when someone doesn’t know who is following who, where a team member is or what time to round.
  • Teach. It is as simple as showing someone where to find something in a chart or explaining the rationale for a test to as complex as preparing a lecture. Not everyone is good at or wants to teach, but everyone has to do their part. Remember what it was like to be a med student or more junior resident and help a person out.
  • Look things up. Don’t accept what someone wrote in one note as fact. Check images yourself, cross check medications with the patient or bottles or pharmacy. Confirm timelines with old records. Just because someone else wrote it down doesn’t mean it is true.
  • When you don’t know, ask or look it up and share with others. But don’t ask just for the sake of drawing attention to what you know… That is annoying.
  • Be nice. Seems simple, but some people struggle with it. Respect everyone, answer pages and questions and really listen to the nurses and patient service workers. Same goes with patients and families. Even the crazies need someone to be nice to them from time to time.
  • Care. Not the same as being nice, but in the spectrum.
  • Be organized. This is tough for some people. Keep track of meetings, projects and paperwork whatever way works best.
  • Volunteer for stuff. I’m not saying do everything because that will kill you, but offer to teach or do presentations or look up some articles.
  • Write good notes and try to be legible. Nobody is asking for perfection, but if you can read it and it contains enough detail that the on-call person can figure out what is really going on, then it is good.
  • Give hand-over. I can’t believe how many people are terrible at this. I think it is because we don’t really learn it in med school. If you have someone who is sick or who has potential to need something specific overnight or is just plain complicated, tell the on-call person who it is, what is going on and what you think they should do. Same goes for telling the day people if something crazy went down at night.
  • Help out others. They’ll help you in return.
  • Seek feedback. This terrifies me because I don’t want to hear bad things, but the only way to be better is to know what is wrong. Some people won’t tell you unless you ask.
  • Many of the above can be summed up with this phrase, “take initiative.” If something needs to be done do it or make sure there is someone who will.
  • Don’t get too cynical.
  • Don’t disappear. Seems simple. Some people have a gift for this.
  • Don’t go rogue and start making out of your scope of practice decisions and doing crazy procedures without staff (aka don’t pull a Grey’s Anatomy or House, MD).
  • Don’t become a hermit. Friends and family are good. They keep you “normal” and happy.
  • Don’t give up things like sleep or food for extended periods of time. I’m not saying it won’t happen, but if you have a choice, please choose these. They make people function better and keep people from being shangry (that is my new made-up abbreviation for sleepy hungry angry, something I am at about 8am after every in-house call shift).

What are your “how to try to be a good resident” tips?

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18 thoughts on “How Did That Happen?: How to try to be a good resident

  1. I was in residency (oh so long ago) we knew who the bad residents were. Never think you can get away with no one noticing. These are good guidelines not only for residency but also for actual practice after.

    • I am uncomfortable with the good resident / bad resident distinction. Nobody has come this far who is completely phony. People develop faster than others. Some interns are ready to be attendings; others take time. It just takes some of us longer than others, to work all the stupid out. Do not despair.

      • “The surest way to corrupt a youth is to instruct him to hold in higher esteem those who think alike than those who think differently.” Nietzsche, The Dawn, Sec. 297. (That was on the quote page for Nietzsche.)
        That’s the difference between a “good resident” and a “bad resident,” IMHO. Medicine is not an ice-cream cone – you don’t lick your way to the top.

      • Good point. The working out of the stupid does take some people longer than others. Although, I will argue that some people should have had some of the stupid out before they got as far as they have.
        It is a good argument for competency based medical education. Instead of just being an apprentice for so much time and hoping we all come out the other end as competent practitioners, as is the current model, it might be better to let people develop (with some milestones in mind) at their own pace and work on weaknesses as they go and grow.

    • Good point. The people who are questionable are often quite obviously questionable.
      And yes, I do suppose these are things that basically apply to all of medicine and life too.

  2. When all else fails, ask the patient. You are human.
    Ignore the gossip, as this is a habit of idle and evil minds.
    Dwell not overmuch on the petty and transcendent. They cannot stop the clock, and much of this will pass into memories.
    “He who fights with monsters should look to it that he himself does not become a monster. And when you gaze long into an abyss the abyss also gazes into you.” Friedrich Nietzsche

  3. I agree with Victo above. It’s been (shudder) almost 10 years since I completed residency and I wish I had had the opportunity to read this list back then. The thought of “going rogue” never, EVER, crossed my mind, lol!

    • Ha ha! I can’t imagine “going rogue” like that either.
      In the reverse, I struggle to realize that one day I will be able to say it was 10 years since I completed residency. I feel like I will be a resident forever. I’m sure everyone feels that.

  4. Amazing tips, and some great reminders for me on how to act as a clerk. Thank you!! Also, I feel like it’s so important not to get caught up in the hospital gossip/politics and partake in the negativity that can surround you sometimes. Attitude is everything.

    • “Deception, flattering, lying, deluding, talking behind the back, putting up a false front, living in borrowed splendor, wearing a mask, hiding behind convention, playing a role for others and for oneself — in short, a continuous fluttering around the solitary flame of vanity — is so much the rule and the law among men that there is almost nothing which is less comprehensible than how an honest and pure drive for truth could have arisen among them.
      They are deeply immersed in illusions and in dream images; their eyes merely glide over the surface of things and see “forms.”
      Their senses nowhere lead to truth; on the contrary, they are content to receive stimuli and, as it were, to engage in a groping game on the backs of things.”
      Friedrich Nietzsche – On Truth and Lies in a Nonmoral Sense. Amazingly, he never went to medical school or did a residency.

    • These definitely double as good clerk tips.
      I love your note about not getting caught up in the negativity/gossip that goes on. It can really suck the life out of you and get you into trouble. Attitude is everything indeed.

    • Residency. Humans can make it through. So can you. There’s no way to “psych yourself up to get ready to jump off the diving board.” Just jump! And share your experience with others after you come back to the surface. Share what’s happening here. When all else fails, trust your patient.

      • Wise words.
        Someone once told me that the best way to do something is to show up, that is half the battle. It is true.

    • Good luck when you start! It is scary, but like Steve said, just jump. You got this far, you will do fine. Enjoy the down time while you have it.

  5. Pingback: How Did That Happen?: How to survive rotations you hate | At least we made it this far...

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