How To Be A Senior Resident

As I walked into my first continuity clinic of PGY-3 year today, I did not see the familiar face of my former co-resident and friend who ushered me through my first resident clinic of intern year. He is now thriving in his new role as a clinic attending for his hometown institution. In his place, I saw the unfamiliar-yet-familiar, eager, and fresh face of a July intern who had never met my old friend. I introduced myself and then proceeded to tell her all about my old friend who used to sit in her chair and how he taught me everything he knew. I joked that I would now be her portal to his knowledge. And then told her how to log-in to EPIC. The first step in her medical training.

After seeing my last clinic patient, I quietly experienced a calming satisfaction that maybe the new intern would one day tell the intern who takes my seat about how I helped her that day. I contrasted my current disposition to the fluster of emotions that overwhelmed me last July as a rising senior: trepidation for the ED page to admit my first patient, excitement to manage a team, and anxiety about the heightened responsibility to dictate patient care. It was then that I realized -- You know what? Everything went fine. Sure, my interns and I experienced plenty of bumps in the road. But mostly, I think my teams and I thrived. We had a lot of fun and I think I taught my team members a thing or two. A few tips I learned as a new senior resident have now become the foundation of my third year. What did I learn about senioring? Well, I learned that there is much more entailed than simply making patient care decisions. I am excited to share a few tips on how to be an effective senior resident.

Visibility
One of the first things I noticed as a senior was my increased visibility around the hospital. People know you now. Your opinions about patient management carry significant weight with attendings. During rapid responses and code blues, you are the decision-maker. Nurses might even know your name. Fellow physicians begin to see you more as a colleague and less the bumbling intern they met last July. The greater visibility will bolster your confidence. Make sure to pay forward this new-found self-esteem to your interns and medical students. Use this opportunity to role model professional behaviors, compliment their work, and give them guidance to ensure their proper maturation.

Composure and Time
During rapid-response situations, keep your composure and remember that you have TIME. Your body language and overall demeanor set the tone for the nurses, ancillary staff, your team, and most importantly, the patient. Contemplate your decisions systematically. What has changed? What are the patient’s vitals? What labs or imaging do I need? Should this patient go to the ICU? Stick to the basics and don’t let others hasten your deliberation. Your resolution period may take some time, especially in the beginning, but a thorough investigation is more likely to produce a desirable outcome. If you make a mistake (you surely will), humble yourself to your errors by treating them as learning opportunities. You will encounter a similar scenario again but have your previous experience to guide you to the optimal conclusion. And don’t forget, you have other senior residents around to provide advice.

Education
Always carve out time from wards to attend lectures, grand rounds, morning report, and afternoon school sessions. Encourage your team members to do the same and remind them that we are all here to learn. These times afford a welcome reprieve from clinical duties and opportunities for camaraderie and scholarship with your peers. Find your niche. Second year provides more space for scholarship than your intern year. With this extra time develop a passion project and seek out others who share your interest. Don’t pass up on a chance to present your patient’s case at noon conference or to give a lecture to medical students. As an upper level, your commitment to academic inquiry sets the barometer for not only your team but the residency program as a whole. Collegiality in research, quality improvement, or other educational endeavors will add value to your time as an upper level resident.

Opportunity
Residency is stressful and busy but will reward you for your dedication.  Say yes to opportunities as they arise. Attend all the local and national conferences so that you can show off your hard work while also learning from leaders in Medicine. I’ve had the chance to attend several already. I’ve even been lucky enough to travel to Belize for a medical mission trip on behalf of my residency program. Literally all I had to do was respond to an email. The point is that opportunities in some form or another are there for you as an upper level resident. The key to unlocking them is simple: show up to work and engage with the educational framework of your residency program. You will get out of your residency career what you put into it and by simply saying yes when opportunity knocks.

Parting Words
I encourage all the new upper level residents to immerse yourself into your residency training. Stay poised and calm and always remember that you have TIME to make most pivotal patient decisions. Don’t forget to pay forward the good will shown to you by your former upper levels by taking time to build up your interns and medical students. And also remember to thank those who have helped you along the way. I’d like to thank my former seniors, chiefs, and current attendings for their mentorship. I especially want to thank Rachna Rawal, my former senior (and Chief!), for her exemplary leadership and help with this article. And finally, carpe diem. We only do this residency thing once and it goes by fast. Before you know it, you will be a third year resident, reminiscing on your PGY-2 year and imparting wisdom to new upper level residents.