Nontrads in Residency

[QofQuimica]

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I'm now at the end of my first month of residency. Not sure if it's made me stronger, but it hasn't killed me yet, at any rate. I thought maybe I (and any of the other residents who would like to contribute) could post some about our experiences.

For me, there have been a lot of surprises, some good and some not so much.

This program is really intense to the point that it can be completely overwhelming at times, but it's a supportive culture. I really like our program coordinator. My classmates are a good group too; I'm the only nontrad, but we get along well. I already have a nickname. (Don't even ask. ) The chiefs have been supportive too, and even the consultants and nurses have been patient with me, albeit a little exasperated by my cluelessness at times. No one has yelled at me, even when I probably deserved it. They take work hour rules seriously, and I think we probably fill out about as many evals here as we had to do at my med school. (It has already come to be annoying to many of us.)

One of the biggest difficulties has been wrestling with learning the system itself. How do you call a consult? Can you get a social worker to help with something at 8 PM on a Friday night? Where do you find the chart if it's not on the nurse's desk or in the patient's room? That chart issue is probably my biggest source of angst right now. We're in the midst of transitioning the electronic medical record, and there are about half a dozen different programs with their own userIDs, PWs, and nuances to learn. Plus, some parts of the charts are still paper. In September, the next phase of the transition will occur, and we'll have to go through this whole thing again. We rotate at a couple of satellite hospitals as well, and they have their own EMRs and systems. I'll be going to one of them in August. Sigh.

We were warned ahead of time about running afoul of nurses, that they would try to test us and bust our chops. But on the whole, I've gotten along very well with the nurses. Of course, there are always a few disgruntled people in any group, but the couple I've come across don't get along well with anybody. Two things I've done that I think make a huge difference are learning the staff's names (and telling them mine), and asking them how they need me to do something I'm not sure how to do (like, write an order properly) so that I save both of us time and aggravation. I have found that the nurses are very willing to make suggestions and give me input. Considering that some of them have been at the hospital since around the time I was born, they know a heck of a lot about how to get things done quickly and efficiently.

That strategy doesn't always work though. On days when I leave the hospital late at night, I have been calling security for an escort to my car. Not that I feel unsafe, but I just don't want to walk across a deserted parking lot by myself. This has not won me any friends among the police, two of whom tried to dissuade me from using the service because they felt the campus was so safe. I was uncomfortable enough after the second time that I asked my program manager for advice on how to resolve this. It turned into a whole thing where I wound up talking to the police chief, and wow, there was all kinds of awkwardness when the same officer who tried to talk me out of calling the night before came to pick me up the following night. 🙁

 

[curt656]

Great post Q! Congratulations on starting your residency!! It sounds like you are settling in well! Don't let those cops bully you into a situation where you do not feel safe. There is no such thing as complete safety in today's world. What you are asking is not unreasonable at all. In fact, any gentleman should be happy to escort a lady to her car.

 

[FiremedicMike]

I'm sorry your experience with the PD has been poor, please try to remember that they are human, and just like nurses there are good ones and bad ones, and sometimes they have bad days.

I'm certain from your demeanor in posts here that you were totally respectful and kind, I just don't want you to discount the entire campus PD, or even this particular officer (yet) because of your experience thus far.

As always, I love reading your posts, remind me what specialty you matched again?

 

[NTF]

I've spent so many years looking up to you, that it's a bit difficult to envision you as "clueless".

 

[QofQuimica]

I've spent so many years looking up to you, that it's a bit difficult to envision you as "clueless".

Oh, I assure you that I am as clueless as any other intern, and probably more than many. Everyone has to have that first day. As I said, most people are understanding, but some of the old-timers among the staff definitely take July in stride better than others do.

Mike, I felt very bad about how far things went. I told the police chief that I absolutely was *not* filing a complaint and did not want the officer to get in trouble. But he said he was glad I had told him, because if it was happening to me, it was probably happening to other people. This is definitely the case; other women I have told this story to have said they had the same experience. Still, upsetting the police is not the best foot to start on, especially when I need their help on a regular basis....

 

[n3xa]

I already have a nickname. (Don't even ask. )

That strategy doesn't always work though. On days when I leave the hospital late at night, I have been calling security for an escort to my car. Not that I feel unsafe, but I just don't want to walk across a deserted parking lot by myself. This has not won me any friends among the police, two of whom tried to dissuade me from using the service because they felt the campus was so safe. I was uncomfortable enough after the second time that I asked my program manager for advice on how to resolve this. It turned into a whole thing where I wound up talking to the police chief, and wow, there was all kinds of awkwardness when the same officer who tried to talk me out of calling the night before came to pick me up the following night. 🙁

Mama Q? 😉 I KEEEEED!

That's unfortunate about the security escort. I used those on a regular basis in my undergrad days and depending on the area I would certainly use it if it's offered. Better to be safe and have the police annoyed than having something happen to you, though.

 

[Law2Doc]

...I have found that the nurses are very willing to make suggestions and give me input. Considering that some of them have been at the hospital since around the time I was born, they know a heck of a lot about how to get things done quickly and efficiently....

Be very careful accepting as a given the wisdom of nurses. I know a couple of residents who got in pretty hot water listening to nurses "helpful advice" as to how much pain medication/sedation to give a patient, choice of drugs etc. A lot of nurses have a single goal, to have an easy shift. The "snowed" patient never presses the call button. So I've seen nurses suggest, and even bully green interns into giving a whopping dose of ativan, morphine etc for a given patient, and later seen the attending hopping mad when the patient took an extra few days before they were even alert enough to extubate. You need to be nice to nurses because they can really hurt you by calling you for every little thing. (eg. "Mr Smith is NPO, but is asking for a glass of water, can you come up and talk to him?"). And you definitely need them as your eyes and ears on the wards to let you know when a patient is "not right", even if they can't provide more useful info than that. This is the most critical function of most nurses -- they have seen enough patients crash and burn to know when it's fast approaching. But you walk a very dangerous line if you take the approach that their many years of experience ever supersedes your medical education. That's true on a lot of the TV shows (Nurse Jackie, etc), but I've rarely seen it play out that way in real life.

FWIW, The best way to make nice with the nurses is to bring unhealthy food to the wards. A box of munchkins now and then and you are a superstar.

As for residency generally, you have to pretty much resolve that this is the primary thing going on in your life, and your ability to have balance has to do with how well you balance things around this obligation. It is more like military conscription than a job, because rarely are you going to be in a situation where you have minimal control over your schedule, be expected to work nights and weekends and sleep in the day one week, and the reverse the next. With mixes of overnight calls and nightfloat schemes, you will soon realize that you are in the hospital at least a little time every single day for most of the year. (ie when you work 5 days in a row, then an overnight from day 6, then leave in the morning on day 7, and come back to start the next week on day 8, you really have been in the hospital every single day, even though you have met the "one day off in seven" rule. This makes the time fly by because it feels like one long day sometimes. It goes very quickly for you, although probably not as fast for those around you -- it's kind of like being in a time bubble. And then as you get further into residency, you start realizing that it's going to be your $%# on the line in a short time, and you have a ton to learn. So you start stressing that you haven't and arent' doing enough in terms of reading, procedures and whatnot. And start feeling that it's flying by too fast, and you aren't getting everything you need out of it. As such, it's not a good career path if you are neurotic.

 

[Trismegistus4]

Fancy meeting you here, Q.

I'm not the only nontrad in my program--we have that which psychiatry is famous for, a refugee from a surgical field 😀--and we do get along well. I do notice the difference between me and my straight-shooter classmates in that I've had a life outside of medicine, though. I just moved into a house with 4 other guys, none of whom are in medicine or health care, and when I told one of my classmates about this, she said "that's SO great," because when I go home I can talk about things that have nothing to do with what's going on in the hospital. I hadn't thought anything of it, but I then realized that most of them have been living with fellow med students for the past 4 years and some are now living with fellow residents. I take for granted that taste of a life outside of medicine which is like a breath of fresh air for most of them.

 

[QofQuimica]

Hey, Tri, good to hear from you, and I'm glad residency is going well so far. Concerning living situations, I'm living by myself, and what *I* like is coming home and not having to talk to anyone about anything. 😛

 

[ShyRem]

On the other side of intern year here. I am astounded by how much I have learned. Truly, I never knew how much I was learning until the new intern class started.

I have survived intern year. Thrived even. I am stronger, faster, smarter, more humble, more confident. More tired. A weekend off seems like an eternity now, where before it went by too quickly. An evening where I can spend time cooking with my family is heavenly and feels like a vacation.

I have thanked nurses, complimented them, argued with them, stonewalled them, worked beside them, gotten dirty with them. I am not too proud to help turn a patient, lift a patient, whatever needs to be done if I have a moment. I have taught them, and they have taught me. There is a great deal of respect on both sides, but that respect is earned, not demanded.

Intern year. It goes by so fast. The transition to second year I think is much harder. I'm expected to... know stuff. 😱 I'm expected to be the one to catch those mistakes my interns make. I'm expected to not manage my 5 patients in the unit, I'm expected to know all 20 and help my four interns manage their 5 each.

 

[QofQuimica]

Now over 1/3 of the way through intern year and approaching the halfway point soon. It's kind of funny how the days are so long while the weeks just fly by. I'll be meeting with my PD for my six month review soon, and I'm making plans to take Step 3 of the USMLE. Once I do that, I can apply for my full license, and then oh boy, all of you denizens of this state better watch out!

Looking back at everything I wrote last time, here are the updates.

Program: I still like my program and appreciate being in a supportive and resident-friendly culture, especially when I read posts on SDN by residents whose programs are indifferent or even hostile to them. I wish the chief would be more thoughtful about how the schedule is made up (like not scheduling me to work overnight the night before my vacation starts where I'd be post-call on my first day of vacation 🙄). But we're starting residency interviews now, and I honestly feel like I can recommend this program highly. I'm looking forward to talking with applicants about it. One of the fourth years from my med school is interviewing next week, and it will be fun to see her. Also, I still suck as a doctor, but at least I suck in new and different ways than how I used to suck. In other words, I'm actually learning something and improving. I'm also not afraid to write an order for Tylenol without checking with someone first any more.

Hospital: I've gotten to know my way around the hospital better, including residents from consulting services, and that helps smooth things over as far as getting things done. I go out of my way to introduce myself and get their names too. I also finally mastered the various EMRs, just in time for them to roll out another one next month. 🙄 again. But these things can't be helped. It's JCAHO's doing, not the hospital's choice. And it's a lot worse for the crusty old-time attendings who are uncomfortable with computers as it is. At least I'm used to using an EMR. I wish we had the same EMR that my med school hospital used though. I didn't realize how awesome it was until I didn't have it.

Nurses: I've become quite friendly with several of the nurses by this point. They share their junk food with me, and you know that's a good sign! Last week, one of them clean-and-jerked me just to prove that he could, and I swore I'd believe anything he said from now on if he'd just put me down so that I could pick up all the stuff that had spilled out of my coat pockets all over the floor. Fortunately my pen light didn't get busted, and neither did my head when he dropped me! But all kidding aside, the trial period of feeling the interns out is over now that the nurses are getting to know us and accept us. As one of them put it, we're "their" residents, and sometimes I see them giving the off-service interns grief at the same time that they're watching our backs. I don't get involved with the off-service intern/nurse pissing matches, but I do try to smooth things over for the med students as long as they're not tools. But if they disrespect the nurses, then they deserve what they get.

Police: As for the campus police, I now have a buddy on the night shift. He likes to hang out in radiology and chat with the techs, so I just go there when I'm ready to leave and he drives me to my car. If he's not there, the techs page him to come get me.

 

[wobit]

I stumbled across this thread today and I'd like to offer my own nontrad intern year thoughts, even though I haven't been keeping up with this group I hope it's helpful.

I'm mid 30's with a preschooler and a toddler, a spouse that works full time, and I'm in a field that's 75% men (Emergency Medicine). I am in the midst of a tough ICU rotation so if anything I've got a grumpier than normal outlook right now, and I'm still feeling really happy. Residency is so much more fulfilling and less uncertain feeling than medical school. It's crazy hard work but I love it.

Ways that my experience seems harder than my younger peers:
1) My kids are firmly diurnal and when I need to flex my sleeping schedule they can make that difficult. I have to have explicit plans ahead of time to get protected sleeping time when I'm on overnights and it's hard on my husband.
2) I miss a lot of the spontaneous fun that the younger interns have going on, about once a month they've done something like a local brewery night or poker and are arranging to have a Thanksgiving dinner amongst themselves, and I just don't see enough of my kids to go out and do adult fun things very often, nor can I deprive the grandparents of the kids for Thanksgiving Dinner. I am still routinely invited, they're very welcoming about it and understanding of my obligations, but I wish I could go more often and bond with my classmates.
3) My body aches. My knees and low back, because I no longer have time to exercise and my body's 5-10 years older than anyone else's but I'm doing the same standing, stooping, and stair climbing.
4) It is out and out impossible to get any reading done at home. If the kids aren't climbing on me I'm doing laundry or trying to pull out the clothes they've outgrown and find the next size up, or digging puzzle pieces out of the couch. Reading has to be done at the hospital during slow times or I stay after a shift if I'm really behind.

Ways in which it might be better to be older:
1) My family buffers me from the melodrama. It's hard to get too overwhelmed by some jerk coworker who had a bad cup of coffee and took it out on me, because I have other things to think about when I'm at home.
2) I think my work experience previously - just having worked for pay instead of always being a student - helps me. We are learners but we are also employees.
3) Having more life experiences (kids) seems to help me relate to patients more easily and has certainly made some of the knowledge base easier to understand. And sometimes the younger doctors aren't taken as seriously by the patients, that doesn't happen to me.

In general, excellent daycare is crucial to peace of mind. We pay nearly 3 times our rent in childcare because we found a really amazing Regio Emilia style early childhood education center attached to the Early Childhood Education department of a nationally known University, and I'm happy to pay the premium price because I feel content and relaxed with their staff.

My PD and our coordinator have been awesome, there's pictures of my kids up in the program offices, and they are understanding of my needs. I am a little anxious about interview season coming up, as a program we historically have a strong showing from the residents at the interview dinners and I want to hold up my part but evenings are hard. We'll see.

Thinking back, I truly believe that my non-trad age and my family contributed to my Match effort. The program that is right for me saw them as pluses.