{Residency} Challenges, Life Lessons

[pharmingiscool]

Hey y’all.

For all those who have done a residency, what are some things you learned about yourself and how to preserve sanity during the program? I’m starting a residency soon and I just want to know how I can have a fruitful yet healthy year.

My personal goals during residency:
- have adequate sleep
- spend time with family
- prevent burn out
- make friends
- keep my life positive while learning

Really interested in knowing how y’all have handled your year and what advice you have!

Thank you

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[PharmDBro2017]

Advice: Try to impress them so they hire you afterwards, or else good luck finding a gig a year from now.

 

[DrWrong]

So, I did a residency at a large teaching hospital (Level I trauma center, Burn Center, etc.). First thing that I realized was that everyone in your residency class is probably going to be almost equivalent to you. I say this because it was a big culture shock for me to go from being the standout student with a perfect GPA and president of multiple organizations to just a resident at an organization where all of the staff had the same accomplishments.

I think all of your personal goals are NOT in line with what residency is all about. Residency is going to be about pushing yourself, honing your time management skills, developing skills to identify and work on projects, and developing confidence to practice in an independent manner. Additionally, as the above person said, it will be about networking and setting yourself up for a job.

Whatever you do, keep in mind that your preceptors are going to be the people that potential employers reach out to to find out if you're a good fit for their job. I say this because we currently have a few residents graduating who didn't perform well and are having a tough time getting jobs (maybe it's because the job market is a bit tighter, who knows).

Go into residency, bust your ass, get a job, and keep steamrolling.

 

[pharmingiscool]

So, I did a residency at a large teaching hospital (Level I trauma center, Burn Center, etc.). First thing that I realized was that everyone in your residency class is probably going to be almost equivalent to you. I say this because it was a big culture shock for me to go from being the standout student with a perfect GPA and president of multiple organizations to just a resident at an organization where all of the staff had the same accomplishments.

I think all of your personal goals are NOT in line with what residency is all about. Residency is going to be about pushing yourself, honing your time management skills, developing skills to identify and work on projects, and developing confidence to practice in an independent manner. Additionally, as the above person said, it will be about networking and setting yourself up for a job.

Whatever you do, keep in mind that your preceptors are going to be the people that potential employers reach out to to find out if you're a good fit for their job. I say this because we currently have a few residents graduating who didn't perform well and are having a tough time getting jobs (maybe it's because the job market is a bit tighter, who knows).

Go into residency, bust your ass, get a job, and keep steamrolling.

Thank you for the advice! I know my goals are reaching for the impossible, but I really want to find a way to incorporate mental health. Is there a way to balance this?

I was a stellar student in didactic studies, but realized I had so many clinical weaknesses once I got to rotations. How can a resident be a good performing pharmacist if there’s a lot to still learn? What are preceptors looking for?

 

[KidPharmD]

Hey y’all.

For all those who have done a residency, what are some things you learned about yourself and how to preserve sanity during the program? I’m starting a residency soon and I just want to know how I can have a fruitful yet healthy year.

My personal goals during residency:
- have adequate sleep
- spend time with family
- prevent burn out
- make friends
- keep my life positive while learning

Really interested in knowing how y’all have handled your year and what advice you have!

Thank you

Lets talk about your individual goals:
- have adequate sleep - This can be seriously problematic. You should be sacrificing something in residency to get the most out of it. If you are getting good sleep you might have to forgo recreational time. Get your stuff done, prepare for the next day, be ahead on all your projects, then you can sleep 7-8hrs a night.
- spend time with family - This depends a lot on what you mean by this. Do you mean parents, siblings, cousins, etc? If so, then kiss them goodbye for the year. You don't have to neglect your relationship necessarily but you might need to think hard about what else you should be doing. If you mean a spouse and children then I did this and I will tell you that you should be sacrificing sleep for them. I came home and played with my daughter, talked with my wife, and then stayed up 2 extra hours reading.
- prevent burn out - This will happen with less effort than you think. Take care of your health, decompress and debrief when you need to. If you are struggling with burn out too early in your PGY1 year then you may have picked the wrong path.
- make friends - If you have co-residents then unless you or they are antisocial or just an ass then these will be friends you have for a long time even if you aren't near them.
- keep my life positive while learning - I hope you can do this, but don't forget you are supposed to be learning more than the normal amount in your residency year. If you aren't then you really aren't getting a good value off of that small stipend you get.

 

[lord999]

Some negative advice:

1. This isn't boot camp, nor is this Hollywood. There is a line (and it's not that hard to see contrary to the heat of the moment) between educational professionalism and unprofessionalism even for destructive criticism. If some preceptor is going Hollywood Full Metal Jacket on you, you quietly remain professional, then bring it up quietly with the RPD. If that doesn't work, then HR. There is nothing wrong with criticism, but there is a right and wrong way to present it, no exceptions to either party. No one, period, may justify bad behavior on the sake of patient lives. They can discuss destructive criticism in a professional manner in a professional setting, or they need to be counseled on hostile work environment.

2. Consider this a year-long job interview for a job that isn't going to be there. What I mean by this is that you are under scrutiny the entire year. You should perform as if you were trying to impress on a job interview, but don't think or expect that there's a job waiting at the end of the line. Opportunity yes, but not necessarily employment. That said, you get the right people on your side, opportunities get made for you.

3. Try something you think you'll hate as a elective. You should confirm that you hate that activity, while working under a controlled environment to ensuring that if you have to do this hated thing, you'll be competent enough to discharge the responsibility without it possibly coming back to haunt you and while under observation. Oncology, ER, Nutrition, and Pediatrics tend to be that subject for some people. Sometimes, they might find out that it's not so bad after all.

4. Most residencies organize under tribal lines. There's all the normal stereotypes for small-group dynamics. Make sure you're not either the pariah or scapegoat in that group. I wouldn't exactly be the hero either as who doesn't like to see a hero's fall?

5. Rule #2 (behind "Do No Intentional Harm And Try Not To Intentionally Harm") of Practice Training - Always work under the assumption that "you don't know what you don't know." You're going to see things that are out of your comfort zone, don't hesitate to inform your preceptors that you need some time to think or work out the issue or defer if the problem is too acute for you to solve in a timely matter. Make it a point to work on those matters that you discover you don't know during or after hours.

 

[pharmingiscool]

Some negative advice:

1. This isn't boot camp, nor is this Hollywood. There is a line (and it's not that hard to see contrary to the heat of the moment) between educational professionalism and unprofessionalism even for destructive criticism. If some preceptor is going Hollywood Full Metal Jacket on you, you quietly remain professional, then bring it up quietly with the RPD. If that doesn't work, then HR. There is nothing wrong with criticism, but there is a right and wrong way to present it, no exceptions to either party. No one, period, may justify bad behavior on the sake of patient lives. They can discuss destructive criticism in a professional manner in a professional setting, or they need to be counseled on hostile work environment.

2. Consider this a year-long job interview for a job that isn't going to be there. What I mean by this is that you are under scrutiny the entire year. You should perform as if you were trying to impress on a job interview, but don't think or expect that there's a job waiting at the end of the line. Opportunity yes, but not necessarily employment. That said, you get the right people on your side, opportunities get made for you.

3. Try something you think you'll hate as a elective. You should confirm that you hate that activity, while working under a controlled environment to ensuring that if you have to do this hated thing, you'll be competent enough to discharge the responsibility without it possibly coming back to haunt you and while under observation. Oncology, ER, Nutrition, and Pediatrics tend to be that subject for some people. Sometimes, they might find out that it's not so bad after all.

4. Most residencies organize under tribal lines. There's all the normal stereotypes for small-group dynamics. Make sure you're not either the pariah or scapegoat in that group. I wouldn't exactly be the hero either as who doesn't like to see a hero's fall?

5. Rule #2 (behind "Do No Intentional Harm And Try Not To Intentionally Harm") of Practice Training - Always work under the assumption that "you don't know what you don't know." You're going to see things that are out of your comfort zone, don't hesitate to inform your preceptors that you need some time to think or work out the issue or defer if the problem is too acute for you to solve in a timely matter. Make it a point to work on those matters that you discover you don't know during or after hours.

Thank you! Your advice is really appreciated. I haven’t worked before so I thought number 4 was interesting. Never thought about the small group dynamic. I’ll try to stay humble and assertive, be on my best behavior so that opportunities are made for me (rather than expecting it to be handed!)

 

[spacecowgirl]

You have never worked before? God Bless. Your goals have nothing to do with residency goals. This is not a year about making your best personal you; this is about making your best professional you. There is overlap to be sure but what you listed in your post is secondary. You shouldn't kill yourself with work in the process (I don't believe in 80 hour weeks, or even >50 hour weeks, or other ridiculous asks of some sites) but like other posters have said, this is a job interview - not just for your site but for your networks and future job placement. Networks are everything if you want opportunities in this market.

Preceptors and RPDs are looking for a lot of what lord999 already stated - being in a position of a learner who doesn't know what they don't know. Being open to feedback and actively soliciting feedback but not in an an annoying constant, real-time way. They are looking for people who prioritize their work, don't get hung up on minutiae, people who can separate important details from the minutiae, people that can manage their own workload/time. Clinical info can be taught - these working skills are much harder to teach.

Check out some books or podcasts on productivity and work - Productivity Paradox, Happier, How to be Awesome at Your Job, Adulting, Quick and Dirty Tips (there are several), Work+Life...that should help you get started.

 

[spacecowgirl]

Also - July you'll be overwhelmed but excited. August, the excitement will wear off and fear will set in. By end of August-mid Sep, you'll be in full panic, what did I do to myself mode. This is expected. It passes.

 

[Sine Cura]

Low-hanging fruit for goals

 

[beautifulrobot]

Also - July you'll be overwhelmed but excited. August, the excitement will wear off and fear will set in. By end of August-mid Sep, you'll be in full panic, what did I do to myself mode. This is expected. It passes.

This. November-December can be the darkest months of residency where you don't think you'll make it / that it's worth it. This is a normal feeling that a lot of residents experience. It will also pass. Just keep going, ask for help, seek mental health care if things get really dark. There's no shame in doing so and there's no reason to go at it alone.