AprogramDirector : PGY1-PGY2

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In a PM you told me that the transition from PGY1 to PGY2 is a very difficult one.

What makes the transition so tough, or what is so special about it? What does a resident need to know so that they can make the transition successfully? I know for me, knowing this is putting the cart before the horse - but when the time comes I may either not remember to ask or have anyone to ask.

Also - what type of program do you direct?

 

[NotAProgDirector]

I run a university IM program.

The PGY-1 to PGY-2 transition is the hardest. Most people assume you know nothing when you start as a PGY-1, so anything more than nothing that you know is bonus material. Hence, although most students are worried about the beginning of PGY-1, from a PD/academic standpoint it's not the real breakpoint. Yes, some people fail out of internship early -- more commonly due to a psychiatric decompensation rather than a clinical skills problem.

The real problem is this: PGY-1 teaches you to be a reporter -- to collect information, examine patients, take histories, write discharge summaries, etc. You can be a really good intern doing all these things perfectly. Then, PGY-2 comes along and the rules change. Now it's all about making clinical decisions, determining what's most likely / most deadly, supervising someone else, etc. Theoretically, we should have a system that for the first 4 months you are a pure PGY-1, then 4 months of increased responsibility, and then the last 3-4 months where you are practicing being a PGY-2 with supervision. But, our systems don't really handle that well.

We try -- for example, I encourage the PGY-2/3's to let the PGY-1 run the teams for the last few months, etc. But still, that first time where you are the "most senior" person in house, making decisions, can be terrifying.

But, of course, I'm still not telling you the truth. The most difficult transition is not the MS IV to PGY-1 nor the PGY-1 to PGY-2. It's PGY-3 to practice. You laugh. Just wait. It's horrifying.

Except for the salary bump, that's nice.

 

[LanceArmstrong]

how about the private practice to retirement transition...?

or the retirement to death transition?

😱

 

[LADoc00]

Aprogdirector...whats with all scary avatars? First a sith, now this?

Are there not so subliminal messages involved here??

 

[RxnMan]

...Are there not so subliminal messages involved here??

Sith -> tyrants
Scorpius -> into control...games
aProgDirector -> ???

 

[NotAProgDirector]

Just fulfilling my destiny.

 

[chocomorsel]

Aprogdirector...whats with all scary avatars? First a sith, now this?

Are there not so subliminal messages involved here??

So funny, I was gonna say the same thing. His avatars a quite frightening. WTH? Thanks for all the wonderful advice though.

 

[McGillGrad]

So funny, I was gonna say the same thing. His avatars a quite frightening. WTH? Thanks for all the wonderful advice though.

ying and yang

 

[LADoc00]

Just fulfilling my destiny.

So when it you explain your residency program has a 80% success rate, its more like an 80% survival rate. The rest are eaten..I get it now.

 

[NotAProgDirector]

So when it you explain your residency program has a 80% success rate, its more like an 80% survival rate. The rest are eaten..I get it now.

I am insulted. My program has a 100% success rate. I always succeed and I'm the only one who counts.