transitioning: PGY1 vs MS1

[rkaz]

Advertisement - Members don't see this ad

I'm just wondering how the difficulty of transitioning to medical school compares to the difficulty of transitioning to life as a resident. Are the first 2 years of residency more difficult compared to the first 2 years of medical school? As an MS4, life is presently as smooth as silk pie. I come home in the evenings around 6:30pm, and then I wonder "Hmm... should I be studying or something?" as I really have nothing to do. I also have weekends off. (I've passed all of my step 2 boards, so I don't have to worry about that anymore either.) Maybe I need to go out of my apartment and socialize more, rather than typing on SDN. I even ask my attendings to assign me some reading, as I'm afraid I'll forget all of my general medicine before starting residency... and they are like "Nah, you are an MS4, just take it easy and enjoy yourself." Some have even said "You're going into psychiatry. Don't bother yourself with all of this" as though going into psychiatry means I don't have to know anything else.... which is odd.

This year I only have 2 school exams, in addition to the two level 2 board exams I already completed this year. Compare this to MS1/2 in which we had over a 100 exams within that 2 year period. For me, MS1 and MS2 were absolutely brutal, and I felt like I was being ambushed and beaten over the head by a mob squad. In MS1, I felt like a lot of people were struggling with depression or adjustment disorder (though few publicly admitted it), and you'd never really know unless something severe happened (like one woman I knew who committed suicide as an MS1). I remember chatting with two other MS2 students in the past, and both admitted privately to me that they used to cry themselves to sleep as MS1s as they thought they'd never be able to make it through in the first few months of school. Ms2 seemed to be better for most people as they had gotten used to the beatings and the depression subsided, but it terms of intensity I think it was worse than MS1 (at least at my school), as I remember having 4 exams in one week as an MS 2, not including exam weeks. During exam weeks, I remember people stinking for not having showered for several days, and showing up to exams disheveled in their pajamas. I'm so relieved to have made it through medical school thus far, and into my final 6 months of school.

How jarring is the transition to residency? Do most PGY1s have a serious adjustment disorder for the first several months, and cry themselves to sleep every night? I know psychiatry a relatively lower-stress field. However, we also have inpatient internal medicine months as a PGY1 which I know are more intense months. I'd appreciate any honest and forthcoming feedback, or you can also PM me as well. I just want a perspective since I'll be (hopefully) making that transition myself. Thanks!

 

[digitlnoize]

Harder then MS4. Easier then MS3. Way easier than MS1. I found intern year only much better than I thought it would be. Without the nights and weekends it'd be perfect. With them, I'm glad it's over, but it was easily bearable. I managed to study, see my family. Watch every movie I wanted too, and finish a few video games in my free time.

 

[splik]

if people are crying themselves to sleep it is usually because of their own life struggles (relationships, family etc) in addition to residency rather than the struggles of residency, though occasionally residents will cry if castigated or they feel humiliated (which should be a rare occurrence). It can be hard moving to a new place, especially if it wasn't your first choice, and you didn't expect to match there. in those instances yes people do cry themselves to sleep every night, but then adapt and grow to love where they are. it can be hard not knowing any one, but hopefully you will get to make friends quickly and establish a support network. you will feel completely incompetent your first month (if you don't something is wrong) but will rapidly socialize into residency and your role as a doctor (which i think comes as a shock to people when all of a sudden people are asking you 'so what's the plan?' and you have no one else to turn to).

it really isn't anything like MS1/2 which i personally hated. no cramming your head with useless stuff, no having to do stuff when you finished work except chill out and sleep. i would encourage you to read during residency, there is a big difference between residents who read and those who don't. and if you aren't washing someone will have words with you! being smelly is one of the few things you can get fired for!

 

[rkaz]

Harder then MS4. Easier then MS3. Way easier than MS1.

REALLY? That's awesome to know. 😎 I read on another sub-forum (perhaps the 'general residency forum', if I'm not mistaken) in which someone had written that PGY1 was worse than MS1/MS2. Reading that gave me a little bit of a freak out, as I know how rough MS1/2 was. Maybe that person was an IM or surgery resident, who knows? I was hoping things aren't as bad in psychiatry.

 

[rkaz]

The following is the stuff I'm a bit nervous about, in regards to starting residency.... being yelled at/humiliated, feeling all alone in a new place (though it would probably be good for me in terms of personal growth), and being unsure if I'm making a correct medical decision or not with no one else there to ask.

though occasionally residents will cry if castigated or they feel humiliated (which should be a rare occurrence).

It can be hard moving to a new place, especially if it wasn't your first choice, and you didn't expect to match there.

you will feel completely incompetent your first month (if you don't something is wrong) but will rapidly socialize into residency and your role as a doctor (which i think comes as a shock to people when all of a sudden people are asking you 'so what's the plan?' and you have no one else to turn to).

 

[splik]

im exaggerating a bit. as a PGY-1 you are technically always supposed to be supervised so you should be able to ask your attending or possibly a senior resident if you are unsure of something. but my point is you will feel the pressure of having to make decisions for the first time. but yes you should feel incompetent when you start, because, well you are though will probably know more than you give yourself credit for. it can be overwhelming.

ritual humiliations should be rare/non-existent in psychiatry and often reflects an individual's own insecurities. i have never been yelled at but i have friends who have experienced this and found it upsetting when it was in front of nursing staff. people have their bad days (in this case the attending apologized) and do things that aren't okay. when on medicine, i had a hem/onc fellow have a go at me in front of everyone and say "I know you're just a psych resident..." I was mad as hell, everyone felt very uncomfortable, she was chewed out by her attending, and everyone knew she wasn't very good and i hadn't done anything wrong.

at most places psychiatrists are very supportive and you will spend far too much time processing any negative encounter with anyone. there are three major periods of socialization in your intern year, and these transitions and turning points are where you actually learn the most. They are: your first month of medicine/psychiatry, your first month of intern year, and you first experience of nightfloat. later on in residency seeing your first therapy patient in outpatient clinic is a major transition that can be very stressful and a great learning experience.

 

[DJspreadsheet]

Intern year is much easier than M1/2 for oceans of reasons. Easier than M3 because a) it's far less awkward, less memorizey, less assignmentey, less Daniel-son'y, and b) you don't have all this uncertainty about boards and evals, and matching looming in your future. MS4 is obviously two separate things. Pre-match sucks because of interviews and that goddawful anticipation. Post-match is nirvana for a short period (provided you're happy with your match). Academically, once boards are over, 4th year is nice because you don't give a **** anymore.

Intern year is a hard adjustment. Knowledge-wise it isn't so bad. No one really expects you to know anything anyway. The big misconception is that as an intern "people's live will depend on me". That's nonsense. You're always supervised in some fashion or another. No one's getting a chest tube because **I** say so. Nor would I ever have to make that decision. There is the inital awkward "I don't know how to do anything" phase when you're learning the system, and learning that you're now called doctor. Those first couple months are like the 'cracked-voice pimply kid with the ginger jew-fro serving you popcorn' phase of your development as a resident/physician. They can be uncomfortable. But you get used to the system, used to what's expected of you, and just feeling less green, and being treated with gradually more respect as you get to know people.

Now, at 6 months into residency, the most persistent feeling I have is of never having any time-off. I feel like I'm always working, always shifting from different schedules. Off-service rotations can have you shifting weird schedules. Most days off are recovery days. Taking care of bills, maybe summoning the vigor to go shopping. But otherwise, just decompressing.

So the hard part of internship is the following:
Phase A: feel awkward
Phase B: feel tired / "slave-like"

 

[digitlnoize]

The following is the stuff I'm a bit nervous about, in regards to starting residency.... being yelled at/humiliated, feeling all alone in a new place (though it would probably be good for me in terms of personal growth), and being unsure if I'm making a correct medical decision or not with no one else there to ask.

Never had anyone yell at me or anyone I know. Maybe some of this is institutional. More common in the northeast, I've heard. Do residency in the south or Midwest. Full of nice people. As far as medical decisions, consult your uppers and UpToDate. Never would have survived without the internet. Sheesh.

 

[notdeadyet]

Never had anyone yell at me or anyone I know. Maybe some of this is institutional. More common in the northeast, I've heard. Do residency in the south or Midwest. Full of nice people. As far as medical decisions, consult your uppers and UpToDate.

Agree with this wholeheartedly. Most of the decent psych programs will not tolerate attendings yelling at residents. This violates professionalism policies most places have, and that many take seriously.

Psych has very few actual emergencies, so you will almost always have access to run thoughts, ideas, and plans by people who know more than you. And if you're at a decent program, most residents and attendings like to teach. Keep in mind that in interest of patient care and diversity, most programs start training you from scratch.

 

[whopper]

Aside from attendings, some nurses abuse residents. They can't do this as much as attendings but they can do damage. E.g. I knew of nurses intentionally calling resident at 3AM when it could've been handled at 11AM, call residents for cases they weren't supposed to handle, or intentionally misdirect them. IMHO you'll likely get more of this in a NYC/NJ/Philadelphia/inner city residency because people there tend to be more cynical and unempathic.

While doing PES here in Ohio, I was frankly shocked how much the nurses here aren't hazing the residents and students compared to what I've seen in NJ. It's almost non-existent.

 

[digitlnoize]

Aside from attendings, some nurses abuse residents. They can't do this as much as attendings but they can do damage. E.g. I knew of nurses intentionally calling resident at 3AM when it could've been handled at 11AM, call residents for cases they weren't supposed to handle, or intentionally misdirect them. IMHO you'll likely get more of this in a NYC/NJ/Philadelphia/inner city residency because people there tend to be more cynical and unempathic.

While doing PES here in Ohio, I was frankly shocked how much the nurses here aren't hazing the residents and students compared to what I've seen in NJ. It's almost non-existent.

I experienced a little bit of nurse annoyances, but nothing absurd. Usually they just didn't realize it was a problem. Like, they'd call me at 3am to fix some order discrepancy (remove an old order for IV flushes after transfer to psych from ICU for example, pt no longer has an IV to flush...housekeeping that could be done in the am). They often wouldn't realize that I was asleep, and would assume that I stayed up all night on night float, as some of my classmates did and others did not. With time, they learned who to call for menial tasks and who to let sleep.

I never got "hazed" though. We (and most hospitals now) have a system to report abuses. There's an easy button on our computer desktop to click and report mistakes (anything really) and its not for the purpose of discipline, but to fix problems.