how to be a great resident

[codex]

Longtime lurker.

In the spirit of the recent call for positivity & professionalism, here is a heartfelt question, mainly for those out of training. What does a great resident look like? Specifics & concrete examples appreciated.

Disclosure: I'll complain with the loudest of residents about the job market, existential threats to the field, apathetic leadership, etc. And I believe these concerns are real & significant enough to have successfully dissuaded some of my most capable friends still in med school from applying to radiation oncology. But, as a mid-level resident who is already "in it" so-to-speak, I still want to be good at what I do.

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[radbioistheworst]

Longtime lurker.

In the spirit of the recent call for positivity & professionalism, here is a heartfelt question, mainly for those out of training. What does a great resident look like? Specifics & concrete examples appreciated.

Disclosure: I'll complain with the loudest of residents about the job market, existential threats to the field, apathetic leadership, etc. And I believe these concerns are real & significant enough to have successfully dissuaded some of my most capable friends still in med school from applying to radiation oncology. But, as a mid-level resident who is already "in it" so-to-speak, I still want to be good at what I do.

Despite failing radbio I’ve got some decent job prospects (which if you read this site is remarkable in and of itself) and generally felt I’ve done pretty well so here’s my advice:

-Show up (on time) to work. Leave only after all your work is done. You don’t ever want your attending to look for you at the end of the day to follow up on something only to find out that you’re already home. If you don’t have any obligations consider staying later to study because you appear to be dedicated and passionate about your job, even if you’re using that time for things unrelated to clinic.
- Along the same lines, be available/reliable. You’ll be asked to see an extra inpatient or tend to a 430 walk-in. It might be annoying but be sure to accept these responsibilities without complaining too much. It’s very easy to tell which residents are there to work and which just got in the field because of the lifestyle.
- Be proactive with follow-up. It happens to the best of us, but it’s not a good feeling if you’re attending has to remind you to do something or if a patient slips through the cracks. If you suspect a cord compression and order a spine MRI, try to be the first one to look at the images and decide management. Don’t wait for radiology to call med onc and then wait for med onc to call you.
- Communicate accurately, frequently, and collegially with your attendings, staff, and colleagues in other specialties. I try to document everything in our EMR, even something as simple as “patient called w/ worsening esophagitis I advised him to take 5 mg oxy Q4 prn instead of Q8.” Obviously this is good for patient care but also for colleagues to see as well as a good habit to build for you when you practice on your own.
- Be cordial and easy to work with for EVERYONE, not just your attendings. You’re evaluated by your patients, front desk, nurses, therapists, etc. If just one complains about you it will probably get back to the higher-ups but on the flip side if you treat the cleaning staff with the same respect and friendliness as you would your chair, that will be noticed as well.

These might all be very common sense things but TRUST ME they’re not practiced all throughout radiation oncology. Notice I didn’t mention anything about being able to quote the colostomy free survival rate in the Sauer trial because while that’s nice to know, it’s all secondary to the above points. Though I will say when it comes to academic goals, I do think many employers do look at number of pubs (particularly 1st/2nd author manuscripts) even at private jobs because it’s tangible evidence of work ethic and passion for the field


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[deleted18755]

Longtime lurker.

In the spirit of the recent call for positivity & professionalism, here is a heartfelt question, mainly for those out of training. What does a great resident look like? Specifics & concrete examples appreciated.

Disclosure: I'll complain with the loudest of residents about the job market, existential threats to the field, apathetic leadership, etc. And I believe these concerns are real & significant enough to have successfully dissuaded some of my most capable friends still in med school from applying to radiation oncology. But, as a mid-level resident who is already "in it" so-to-speak, I still want to be good at what I do.

I’m not sure what makes a great resident anymore or how to kiss up to everybody without looking like an annoying teachers pet (do people still use that term? Maybe it’s “gunner” now) but anyway this is the most useful advice I ever received in residency that actually prepared me for practice on my own (especially important if you’re from a lower volume/diversity of cases program):

When seeing follow-ups as a senior resident don’t just try to get through the follow up clinic (scan looks good next...) but start from the patient’s consult and think about what you would have recommended then see what was actually done, if you agree move to the next step on the patient’s treatment course and repeat, but if you disagree or are confused as to why something was done or how/why things turned out a certain way try to figure it out or review with attending. This way even a simple follow-up is like a consult/full learning opportunity.

This will really make you feel confident and/or address gaps in your understanding before you are on your own, or at least did for me going from a relatively small program to thrown into a busy practice largely on my own.

 

[Chartreuse Wombat]

Longtime lurker.

In the spirit of the recent call for positivity & professionalism, here is a heartfelt question, mainly for those out of training. What does a great resident look like? Specifics & concrete examples appreciated.

Disclosure: I'll complain with the loudest of residents about the job market, existential threats to the field, apathetic leadership, etc. And I believe these concerns are real & significant enough to have successfully dissuaded some of my most capable friends still in med school from applying to radiation oncology. But, as a mid-level resident who is already "in it" so-to-speak, I still want to be good at what I do.

Program director for nearly two decades. The three most important qualities that I look for are gratitude, humility and the ability to work on a team. If you exemplify these virtues you are on your way to be great.

 

[medgator]

Despite failing radbio I’ve got some decent job prospects (which if you read this site is remarkable in and of itself) and generally felt I’ve done pretty well so here’s my advice:

-Show up (on time) to work. Leave only after all your work is done. You don’t ever want your attending to look for you at the end of the day to follow up on something only to find out that you’re already home. If you don’t have any obligations consider staying later to study because you appear to be dedicated and passionate about your job, even if you’re using that time for things unrelated to clinic.
- Along the same lines, be available/reliable. You’ll be asked to see an extra inpatient or tend to a 430 walk-in. It might be annoying but be sure to accept these responsibilities without complaining too much. It’s very easy to tell which residents are there to work and which just got in the field because of the lifestyle.
- Be proactive with follow-up. It happens to the best of us, but it’s not a good feeling if you’re attending has to remind you to do something or if a patient slips through the cracks. If you suspect a cord compression and order a spine MRI, try to be the first one to look at the images and decide management. Don’t wait for radiology to call med onc and then wait for med onc to call you.
- Communicate accurately, frequently, and collegially with your attendings, staff, and colleagues in other specialties. I try to document everything in our EMR, even something as simple as “patient called w/ worsening esophagitis I advised him to take 5 mg oxy Q4 prn instead of Q8.” Obviously this is good for patient care but also for colleagues to see as well as a good habit to build for you when you practice on your own.
- Be cordial and easy to work with for EVERYONE, not just your attendings. You’re evaluated by your patients, front desk, nurses, therapists, etc. If just one complains about you it will probably get back to the higher-ups but on the flip side if you treat the cleaning staff with the same respect and friendliness as you would your chair, that will be noticed as well.

Agreed.

These might all be very common sense things but TRUST ME they’re not practiced all throughout radiation oncology. Notice I didn’t mention anything about being able to quote the colostomy free survival rate in the Sauer trial because while that’s nice to know, it’s all secondary to the above points. Though I will say when it comes to academic goals, I do think many employers do look at number of pubs (particularly 1st/2nd author manuscripts) even at private jobs because it’s tangible evidence of work ethic and passion for the field


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Nope

 

[Neuronix]

Privare practices look at number of first author publications to reject you if you're too "academic". Such was my experience.

 

[radbioistheworst]

Privare practices look at number of first author publications to reject you if you're too "academic". Such was my experience.

I’m not out in the work force yet so listen to these guys. All I’m saying is several of the interviews I received from private groups cited my academic productivity as part of the reason they wanted to interview me, whereas former residents who weren’t as productive didn’t get as much interest. May have simply been the market at the time. Granted, I sold research on my cover letter as evidence that I could be efficient enough in the clinic to do extracurriculars and work well enough with others to initiate and complete group projects. Take it with a grain of salt I guess.


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[deleted18755]

I’m not out in the work force yet so listen to these guys. All I’m saying is several of the interviews I received from private groups cited my academic productivity as part of the reason they wanted to interview me, whereas former residents who weren’t as productive didn’t get as much interest. May have simply been the market at the time. Granted, I sold research on my cover letter as evidence that I could be efficient enough in the clinic to do extracurriculars and work well enough with others to initiate and complete group projects. Take it with a grain of salt I guess.


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Just my opinion but 1 maybe 2 first author papers would be good but more than that and I’d wonder why you are applying to private practice or how much clinical time you sacrificed for “academic productivity”

The absolute worst thing you could do is list a bunch of abstracts/posters at ASTRO without papers. We all know how easy it is to get one accepted and an abstract without a published paper = lazy and unable to commit/follow through. Multiple ASTRO abstracts with no paper is way worse than nothing at all (obvious you just threw together some garbage so you could go to the meeting).

 

[Haybrant]

You need to know your audience. Part of your job is to make the life of the attending easier. In doing so you learn to become independent and a better physician. Knowing your audience for everything is the key to success

 

[KHE88]

Though I will say when it comes to academic goals, I do think many employers do look at number of pubs (particularly 1st/2nd author manuscripts) even at private jobs because it’s tangible evidence of work ethic and passion for the field

PPs do not care one tiny bit about publications. This is a lie told to residents by programs in order to generate research productivity within the department and get attending's names on papers as senior authors. I only have a couple in low impact journals and was not asked once despite going on a large number of PP interviews. If you're interviewing at a hospital, your hiring decision will likely be made by a non-physician administrator who doesn't know or care. They look for other qualities. Namely how hard are you going to work and how good are you going to be about bringing business in.

The absolute worst thing you could do is list a bunch of abstracts/posters at ASTRO without papers. We all know how easy it is to get one accepted and an abstract without a published paper = lazy and unable to commit/follow through. Multiple ASTRO abstracts with no paper is way worse than nothing at all (obvious you just threw together some garbage so you could go to the meeting).

At my program it is mandatory for all residents to submit abstracts to every ASTRO meeting, even as PGY-5s. Trust me, I do not want to "go to the meeting." As I typically have to self-fund a large amount of it, I'd much rather use my vacation elsewhere than listen to our great leaders pontificate hot air, show pictures of their family on vacation somewhere exotic, and then patronize/bully the residents at the ARRO session. I've always found it odd that some residents get so worked up about wanting to go to ASTRO and that there is this idea out there that we voluntarily publish a bunch of nonsense patterns of care chart reviews or uninsightful educational stuff so that we can get a vacation. What an odd definition of a vacation.

 

[deleted18755]

PPs do not care one tiny bit about publications. This is a lie told to residents by programs in order to generate research productivity within the department and get attending's names on papers as senior authors. I only have a couple in low impact journals and was not asked once despite going on a large number of PP interviews. If you're interviewing at a hospital, your hiring decision will likely be made by a non-physician administrator who doesn't know or care. They look for other qualities. Namely how hard are you going to work and how good are you going to be about bringing business in.



At my program it is mandatory for all residents to submit abstracts to every ASTRO meeting, even as PGY-5s. Trust me, I do not want to "go to the meeting." As I typically have to self-fund a large amount of it, I'd much rather use my vacation elsewhere than listen to our great leaders pontificate hot air, show pictures of their family on vacation somewhere exotic, and then patronize/bully the residents at the ARRO session. I've always found it odd that some residents get so worked up about wanting to go to ASTRO and that there is this idea out there that we voluntarily publish a bunch of nonsense patterns of care chart reviews or uninsightful educational stuff so that we can get a vacation. What an odd definition of a vacation.

Damn I didn’t know this ... not that long ago if you had an abstract accepted at ASTRO the department gave you those days off (extra vacation) and paid for everything (there also used to be crazy industry sponsored parties every night). I’d be lying if I said I didn’t throw together more than one garbage retrospective review just to go to the meeting and once a SEER analysis I started literally 24 hours before the deadline. Department paid airfare and hotel, I visited family in Philly and only went showed up to the convention center to hop on the bus to the industry events.

Those were the days...

 

[KHE88]

Some programs are definitely better than others. I'm aware of programs where there is no limit and residents are just given a credit card and told to put everything on it. But at some programs the reimbursement is pathetic to non-existent and you are expected to share a room with other residents at a budget motel well outside of town and transportation is not covered. I'm clearly a little bitter about the whole thing. I've spent literally thousands out of pocket throughout residency to go to ASTRO meetings to "present" posters nobody cares about. I've paid for poster printing out of my own pocket. And it's a double edged sword because while not submitting anything to astro is basically forbidden, at the same time you get a lot of comments about the residents going to party at astro from faculty who stay behind and are annoyed there are no residents in clinic. Also the swanky vendor parties at private country clubs appear to be a thing of the past. They still exist, but you have to pay for them now and there are only a certain number of invitations that fill up immediately.

Then there's content issue and the dog-and-pony show the conference has become. I have no intentions of returning anytime soon after residency.

ASTRO expectations and reimbursement are definitely something for med students to ask about and consider.

 

[Fpg1245]

Been to both ACRO and ASTRO in the last 3 years. I have to say was pretty underwhelmed by the showing both on the actual content side and on the vendor side. Thankfully I was reimbursed no problem but my god it was disappointing. Also was not too impressed by the personalities either...but I won’t get into specifics there. I think at this point I’m gonna see how long I can go without making it to these meetings before people start asking questions.

 

[thecarbonionangle]

These conferences are disgusting displays of self promotion,brown-nosing, insecurity, clickishness, arrogance, the absolute worst stuff.

What makes a “good resident”? Be ready to put your head down so much it hurts and when you look up and are pissed on, thank the master for the rain. Abuse, explotation and apathy are generalized in the field. A “good” resident is one who is abused and taken advantaged of for four years, puts out a bunch of bs research enabling the attendings, etc. At the end of day you will have no jobs, opportunities and nodody will care to help you get a job. You were a good resident tho, pat your back!

 

[evilbooyaa]

Yeesh a bit over the top here, folks. I don't think residency is all ****storms and disasters. Please keep the discussion on topic - Further discussion of the job market in THIS thread will not be tolerated as it is off-topic to the OP's question. There are enough other threads where the job market is a valid discussion point.

I think the concept of self-paying for ASTRO every year is outrageous, FWIW. I think if you're presenting research at ASTRO should be paid for. Maybe not smaller conferences, but definitely ASTRO. These are important things that medical students should ask the residents at their interviews about.

I do agree that having a poster at ASTRO, in the long-run for job prospects, is worthless if you're not turning it into a paper. There is a glut of useless research that ends up as posters at ASTRO, but ideally you should be at least turning them into papers.

I agree with radbioistheworst, wombat, and medgator. I certainly think clinical competence is extremely important as well. It's differing levels of responsibility, obviously, dependent on how far in residency you are. For example, as a chief resident, IMO, you should be able to run a service in a safe manner without harming patients with minimal input from the attending. You should be doing contours that would be reasonable if your attending doesn't look at them. I know that there are services where the attending doesn't know how to do contours or planning anymore because they have 24/7 resident coverage, and that's certainly disappointing to see. Some rotations are very hand-holding, others are residents essentially running the service (regardless of experience level) with simply a sign-off from the attending. If you're experiencing a lot of that as an early resident (PGY-2 or PGY-3), I think a discussion with the PD and/or PC about the rotation schedule is not unreasonable. Depends on the culture of your program - if your program is very 'my way or the highway' then you don't have a lot of recourse besides the ACGME survey, blasting the program publically (and if you want to do it anonymously feel free to PM me), and being honest with incoming medical students.

Other forums have threads on specific residency programs - if people are really negative (or positive) about their experiences at a specific residency program and are willing to do any sort of write up about it while remaining anonymity, I encourage you to PM me and I will be happy to post it on the forum - the whisperings of MS-4s in the google spreadsheet is valuable to them, but it would be much better for incoming medical students to hear real resident stories.

 

[radbioistheworst]

Yeesh a bit over the top here, folks. I don't think residency is all ****storms and disasters. Please keep the discussion on topic - Further discussion of the job market in THIS thread will not be tolerated as it is off-topic to the OP's question. There are enough other threads where the job market is a valid discussion point.

I think the concept of self-paying for ASTRO every year is outrageous, FWIW. I think if you're presenting research at ASTRO should be paid for. Maybe not smaller conferences, but definitely ASTRO. These are important things that medical students should ask the residents at their interviews about.

I do agree that having a poster at ASTRO, in the long-run for job prospects, is worthless if you're not turning it into a paper. There is a glut of useless research that ends up as posters at ASTRO, but ideally you should be at least turning them into papers.

I agree with radbioistheworst, wombat, and medgator. I certainly think clinical competence is extremely important as well. It's differing levels of responsibility, obviously, dependent on how far in residency you are. For example, as a chief resident, IMO, you should be able to run a service in a safe manner without harming patients with minimal input from the attending. You should be doing contours that would be reasonable if your attending doesn't look at them. I know that there are services where the attending doesn't know how to do contours or planning anymore because they have 24/7 resident coverage, and that's certainly disappointing to see. Some rotations are very hand-holding, others are residents essentially running the service (regardless of experience level) with simply a sign-off from the attending. If you're experiencing a lot of that as an early resident (PGY-2 or PGY-3), I think a discussion with the PD and/or PC about the rotation schedule is not unreasonable. Depends on the culture of your program - if your program is very 'my way or the highway' then you don't have a lot of recourse besides the ACGME survey, blasting the program publically (and if you want to do it anonymously feel free to PM me), and being honest with incoming medical students.

Other forums have threads on specific residency programs - if people are really negative (or positive) about their experiences at a specific residency program and are willing to do any sort of write up about it while remaining anonymity, I encourage you to PM me and I will be happy to post it on the forum - the whisperings of MS-4s in the google spreadsheet is valuable to them, but it would be much better for incoming medical students to hear real resident stories.

I mean, what exactly about “put your head down so much it hurts and when you look up and get pissed on thank the master for the rain” do you find to be over the top?


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[thecarbonionangle]

I mean, what exactly about “put your head down so much it hurts and when you look up and get pissed on thank the master for the rain” do you find to be over the top?


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You may disagree, that's fine. Some people have different experiences. My general experience is that I have had to take a lot with a smile and I'm just expected to put my head down. I know others in similar situations. I know the truth hurts some people.

 

[Mr RADical]

Additional piece of advice: sometimes doing all the scut actually improves learning opportunities.

When I was in residency streamlining the attending's day by making sure things were taken care of improved my ability to independently practice and often times lead to more teaching/discussion of the cases because we weren't behind trying to catch up. The truth of most rad onc residencies is that the resident is not needed to carry a service at many programs. A lot of work we did wasn't glamorous, but it allowed us to be ready for the moments where we really learned.

 

[smith2009]

Additional piece of advice: sometimes doing all the scut actually improves learning opportunities.

When I was in residency streamlining the attending's day by making sure things were taken care of improved my ability to independently practice and often times lead to more teaching/discussion of the cases because we weren't behind trying to catch up. The truth of most rad onc residencies is that the resident is not needed to carry a service at many programs. A lot of work we did wasn't glamorous, but it allowed us to be ready for the moments where we really learned.

This is hilarious.

How to be a good resident?
Do all the scut.

SMH...what a sad field indeed.

 

[Neuronix]

Additional piece of advice: sometimes doing all the scut actually improves learning opportunities.

When I was in residency streamlining the attending's day by making sure things were taken care of improved my ability to independently practice and often times lead to more teaching/discussion of the cases because we weren't behind trying to catch up. The truth of most rad onc residencies is that the resident is not needed to carry a service at many programs. A lot of work we did wasn't glamorous, but it allowed us to be ready for the moments where we really learned.

I have to agree with this to some extent. I'm impressed that smith and I responded at the same time. I'll start with a caveat to address smith, some scut is useless--filling out paperwork for example. But, a lot of things that seem like scut turn out not to be in the long run, and some things that aren't educational lead to other things that are.

This is where I disagree with Chartreuse Wombat though they are much more senior than myself.

I believe in the "Three As" for academics as much as private. There's no difference between academics and private anymore anyway (just kidding, sort of).

What are the three As? Affability, availability, and ability. "gratitude, humility and the ability to work on a team" are just restating affability three times in my opinion. I have worked with some very pleasant people who are not particularly available or able. They do well in this world--better pay than me and work less than me. So hey, who is winning in the end? Me personally, I appreciate someone who works very hard, is always up for more learning, and wants to be the best they can possibly be. If they're not the most affable, I personally don't care. That's just me though. We all like people who are most like ourselves and that's how I am.

Now that I'm in practice I see lots of situations where the resident could learn more if they were around more, saw more patients, and read more. I can't store in my brain all the minor (and sometimes major) decisions I make during the day that I think they need to know. I can't teach them all this stuff at the end of the day at 7 PM when I'm done clinic and my brain is fried or remember it the next day.

Still, there's a huge emphasis on lifestyle among residents, so I really try not to push. Some residents clearly want to be with me to learn as much as they possibly can and accept some amount of scut and long hours as inevitable. Some residents clearly want to work 8 AM - 5 PM (or less) as much as possible (this is not just where I am now, I've seen this elsewhere as well).

But, you won't get this feedback from me. Resident evaluations of me are extremely meaningful--if my evaluations aren't glowing I won't be promoted and can even be fired. I have received bad evaluations for giving too much feedback and keeping people too late. I'm personally and professionally quite wounded by this. Personally, I'm wounded because I work 60+ hours a week as an attending. I'm on vacation and doing plenty of work right now. I hold myself to a higher standard than I hold anyone, especially my residents, and I beat myself up for mistakes. I would never expect a resident to do something I wouldn't do or wouldn't have done/expected as a resident myself.

Meanwhile, my evaluations of residents are meaningless as long as they don't want to stay on as faculty where I work and it's not something terrible. Even residents with serious issues will probably still graduate residency with no evidence of that. So I'm not going to push anyone. It really is on you to be the best you can be.

In the end, my advice is to focus on the three As. Sure, be friendly, smile, try to have positive interactions with everyone at all times. I recommend being available as much as possible when the attending is present and working, see as much as possible with them, do as much as possible with them, and push off the notes, contouring, and other stuff till the off hours. Hopefully your attendings are the type who want to teach, know a lot, can refer you to the right papers, won't be threatened or annoyed by lots of questions, and will review everything with you (contours, plans, setups, films, etc etc etc). This is what I strive to be, but it's a two way street.

If you want to know specifically what to read or whatever, let me know. The reality is that as long as you pass your boards, affability will still probably the most important thing for you and your future. This is lamentable to me, but I'm a rare bird.

 

[deleted18755]

This is hilarious.

How to be a good resident?
Do all the scut.

SMH...what a sad field indeed.

I really think it depends on the attending. When I was a resident, there were more than a few attendings who genuinely loved to teach and were very good at it (as neuro above appears to be), but there was just so much time in the day, so a seemingly fair trade was that I did some of this "scut work" for them so there was more time for them to teach me.

It seems like the balance has shifted and now there is a lot of resident scut with nothing in return, or worse yet, attendings who simply cannot function without a resident. It really wasn't that long ago that most attendings weren't "covered" and just went about their day and actually were more efficient without having to take the time to stop and teach and sometimes had a resident and actually ended up working more hours. I have been out of academics for awhile but there seem to be at least a few departments were every single attending is "covered" by a resident (sometimes one resident "split" between two attendings) as if the attending literally cannot do his job without a resident (or at least without complaining to the chair, who then finds a way to get him "covered" by a resident).

I've heard of more than a few departments where the attendings goes out of his way to schedule a vacation to match the resident's as if he literally cannot make it a week without a resident!?!

 

[seper]

That is a common sentiment, but some residencies, like mine, were actually pretty good in providing common oncologic situations to learn from.

Rad Onc residency is complete and utter bull****. I learned far more in my first year as an attending than I learned in all of residency combined. Rad Onc residents are there to 1) Write notes so the attendings don't have to 2) Write more notes so the dosimetrists don't have to 3) Write more notes so the physicists don't have to and 4) Memorize complete useless nonsense about p values in 30 year old clinical trials, signal transduction pathways in flies that are irradiated that may or may not correspond to what is doing on in humans, and atomic bomb survivor data because, why not? Actually learning how to take care of patients doesn't happen until you are on your own and can put that **** behind you. My advice for residency is to just be a giant suck up, cause then you get good recs, and can get a job you want.

 

[Gfunk6]

I agree that in most every program there is one fantastic teacher. Someone who protects their resident from scut, takes the time to do formal didactics, engages their resident in constructive pimping, and gives their resident leeway to make independent decisions before intervening. I remember having one attending who met all these criteria - rotating on his service was always in demand among the resident group.

Unfortunately, I feel that many academic departments do not incentivize this type of model teaching and view it as just "doing your job."

 

[evilbooyaa]

In an ideal world, academic programs would look at which attendings residents are clamoring to work with and reward them appropriately. In an ideal world. In the real world, we'll just expand residencies until every single attending, regardless of how good or bad a teacher, just because they're an assistant/associate/full professor of radiation oncology, has 24/7 resident coverage.

I believe that programs that are really, really bad in terms of resident mistreatment and non-education should be outed, but that's probably because I know I'd never put my program on that list.

 

[RadOncDoc21]

In an ideal world, academic programs would look at which attendings residents are clamoring to work with and reward them appropriately. In an ideal world. In the real world, we'll just expand residencies until every single attending, regardless of how good or bad a teacher, just because they're an assistant/associate/full professor of radiation oncology, has 24/7 resident coverage.

I believe that programs that are really, really bad in terms of resident mistreatment and non-education should be outed, but that's probably because I know I'd never put my program on that list.

I basically worked as a scribe for four years and taught myself how to be a radiation oncologist.

 

[evilbooyaa]

And the really sad thing is it doesn't need to be this way. I know this from experience from myself or from my friends in different specialties. My friend who did her peds residency at a community hospital loved it, she said she learned so much. I was also interested in anesthesia and so in med school did some rotations in that, and they had EXCELLENT didactic series, and their attendings TAUGHT and didn't just pimp in the OR. Rad Onc just has issues with its culture and issues with how its residency programs are designed, again IMHO.

Again, I think extrapolating your experience to every residency program isn't realistic. I wouldn't explain my residency experience as at all similar to yours. As usual, I believe we hear from the vocal minority in regards to many issues on this forum. As always, I offer 100% anonymous 'outing' of programs, even for people who have graduated. I do wish those with strong opinions would be willing to offer their insights on specific programs at least when they're a few years out. I've come to accept that will likely never happen.

 

[SBRTreble]

As always, I offer 100% anonymous 'outing' of programs, even for people who have graduated. I do wish those with strong opinions would be willing to offer their insights on specific programs at least when they're a few years out. I've come to accept that will likely never happen.

Or I imagine people will feel more comfortable doing so once they are not so worried about the job market. Agree, that's unfortunate.

 

[RickyScott]

I have also personally seen the opposite, programs that bend over backwards for their residents, who still find issues to complain about and for the rare "bad apple" are not willing to take any kind of remedial action.

 

[deleted18755]

I also had some great teachers and overall pleasant recollections of my residency experience. I'm totally speculating here but I bet two things have really changed over the past 15-20 years:

1. A physician who has been in private practice for 20-25+ years and never even pretended to care about academics or teaching (or maybe even went into private practice specifically because he hates teaching) has his practice acquired by an academic center and suddenly becomes a "clinical instructor" with full resident coverage/teaching responsibilities (depending on the perspective) and has no interest and/or experience and/or teaching skills.

2. A whole cohort of medical students who went into radiation oncology specifically for lifestyle and now are working harder than they thought they would in residency, realizing the job market isn't as awesome as they were told it was 10-12 years ago, and now are bitter, regretful, complaining too much about everything.

As an aside, I'm not sure if anybody on this forum is old enough to answer but a question just popped in my mind: radiation oncology has always been a "lifestyle" specialty (at least with regards to hours, call, no inpatient, etc) but if that was the case why was it so noncompetitive as a residency choice and ultimately career as recently as the 1980's or even 1990's? Was the salary really low back then or was the lack of technology just not appealing (or did people not care so much about life/work hours and balance back then)?

 

[evilbooyaa]

As an aside, I'm not sure if anybody on this forum is old enough to answer but a question just popped in my mind: radiation oncology has always been a "lifestyle" specialty (at least with regards to hours, call, no inpatient, etc) but if that was the case why was it so noncompetitive as a residency choice and ultimately career as recently as the 1980's or even 1990's? Was the salary really low back then or was the lack of technology just not appealing (or did people not care so much about life/work hours and balance back then)?

Personally, if I had to train in an era of 2D (not even talking about the Co-60 era) where the toxicities seemed to be more common than the cure (except for early stage breast) I probably wouldn't have gone into the field. The old school med oncs who talk about the horrible evils of radiation are basing it on treatment from 20-30+ years ago.

Based on what I've heard, lifestyle was less of a decision 40 years ago, and being a general doctor (IM, General Surgeon) was associated with a lot of pride and respect. Also, all doctors made more for doing less that long ago, so any salary differences weren't as big of a deal.

 

[RickyScott]

I also had some great teachers and overall pleasant recollections of my residency experience. I'm totally speculating here but I bet two things have really changed over the past 15-20 years:

1. A physician who has been in private practice for 20-25+ years and never even pretended to care about academics or teaching (or maybe even went into private practice specifically because he hates teaching) has his practice acquired by an academic center and suddenly becomes a "clinical instructor" with full resident coverage/teaching responsibilities (depending on the perspective) and has no interest and/or experience and/or teaching skills.

2. A whole cohort of medical students who went into radiation oncology specifically for lifestyle and now are working harder than they thought they would in residency, realizing the job market isn't as awesome as they were told it was 10-12 years ago, and now are bitter, regretful, complaining too much about everything.

As an aside, I'm not sure if anybody on this forum is old enough to answer but a question just popped in my mind: radiation oncology has always been a "lifestyle" specialty (at least with regards to hours, call, no inpatient, etc) but if that was the case why was it so noncompetitive as a residency choice and ultimately career as recently as the 1980's or even 1990's? Was the salary really low back then or was the lack of technology just not appealing (or did people not care so much about life/work hours and balance back then)?

I applied to residency in the late 90s and was in one of the first competitive classes. Previously there had been somewhat of a lack of interest because job market had been terrible and a lot of programs shut down. Programs were so happy just to see an American grad (I felt like a celebrity), and a lot were not even in the match. Programs like Moffitt,Pitt, Dallas, Vanderbelt, Rutgers, Colorado had not opened. When I applied, starting salaries were around 150-170. When I graduated they were around 220- 250, and have not really changed since.
Cancer has become more "prominent" and the field has more visibility due to marketing. I went to a top 10 med school, and most my classmates had never heard of MD Anderson at the time. There were no billboards for cyberknife etc, no satellites etc. A lot of really good programs had sh--- technology, as there was no push for the latest and greatest. Once the revenue from IMRT started coming in, everything changed.

In terms of lifestyle, jobs, salaries, and scores/grades to get into this field, it is understandable if there is presently some "buyers remorse." . I can tell you the hours for the most part were much less back then. So much of my residency was spent babysitting attendings on coffee/lunch breaks, before leaving at 3-4, unless you were doing something with brachy. I learned so much in residency, partly because I would read radonc texts and papers out of shear boredom. (Internet was not that interesting at the time)

 

[seper]

Job market used to be really terrible in 90's. That's why the duration of training was changed to 4 years then.

I also had some great teachers and overall pleasant recollections of my residency experience. I'm totally speculating here but I bet two things have really changed over the past 15-20 years:

1. A physician who has been in private practice for 20-25+ years and never even pretended to care about academics or teaching (or maybe even went into private practice specifically because he hates teaching) has his practice acquired by an academic center and suddenly becomes a "clinical instructor" with full resident coverage/teaching responsibilities (depending on the perspective) and has no interest and/or experience and/or teaching skills.

2. A whole cohort of medical students who went into radiation oncology specifically for lifestyle and now are working harder than they thought they would in residency, realizing the job market isn't as awesome as they were told it was 10-12 years ago, and now are bitter, regretful, complaining too much about everything.

As an aside, I'm not sure if anybody on this forum is old enough to answer but a question just popped in my mind: radiation oncology has always been a "lifestyle" specialty (at least with regards to hours, call, no inpatient, etc) but if that was the case why was it so noncompetitive as a residency choice and ultimately career as recently as the 1980's or even 1990's? Was the salary really low back then or was the lack of technology just not appealing (or did people not care so much about life/work hours and balance back then)?

 

[scarbrtj]

Always good advice. Usually handed out to the surgery interns (which I was one), but applicable to all residents.

 

[bobloblaw]

Longtime lurker.

In the spirit of the recent call for positivity & professionalism, here is a heartfelt question, mainly for those out of training. What does a great resident look like? Specifics & concrete examples appreciated.

Disclosure: I'll complain with the loudest of residents about the job market, existential threats to the field, apathetic leadership, etc. And I believe these concerns are real & significant enough to have successfully dissuaded some of my most capable friends still in med school from applying to radiation oncology. But, as a mid-level resident who is already "in it" so-to-speak, I still want to be good at what I do.

This is not so much "what a great resident looks like" but what I hope are helpful suggestions to get the most out of your residency experience:


Develop good relationships with the therapists / dosimetrists / physicists / nurses / schedulers in your department. This will make your day to day life easier and will also be good training for when you are running a practice with your own staff. No matter how good you are, you can't run a successful clinic unless you are able to lead a well functioning staff.

At the start of each rotation, ask for a meeting with your faculty member to talk about the rotation - what the learning goals and expectations are (both yours and his/hers). It is helpful if you think ahead of time about skills that you want to develop on the rotation (contouring, plan evaluation, disease management, etc) so you can talk about plans to achieve these goals. This should be a 2 way conversation that both of you prepare for. If your program does not already do this, ask to schedule a mid-rotation feedback session so that you have time to redirect if either (a) you are not getting what you need to learn from the rotation (b) your faculty member has concerns about your performance. It is much better to discuss these things partway through rather than to find out there were unresolved problems at the end of the rotation. Also, you should have a feedback session at the end of your rotation.

Read and prepare for clinic ahead of time.

Develop a system for keeping organized in clinic.

Develop good communication skills with referring physicians (this means sending out emails or picking up the phone). It takes extra effort, but it is good for patient care and these communication skills will come in handy when you are trying to build a referral base for your own practice.

Identify mentors (could be among your faculty, but it doesn’t have to be) who you can ask for career advice along the way. Also, pay it forward by mentoring others (visiting med students, junior residents, etc).

Don't wait until your last year to start building a network to help when you are looking for a job. This could include getting to know the practicing radiation oncologists in the area that you want to work in (if you have specific constraints of where you want/need to work), talking to recent graduates of your program (to find out how they negotiated the job search, boards, etc), or joining committees in ASTRO or other professional organizations, etc.

WRT scut - sometimes it is soul-draining, but sometimes it can be educational. We all do it.