One of the best feelings medical students must have is the day they match into a residency training program. This day will end an era and starts another. During those few months before July 1st, all medical students go through this phase of mental transitioning from the medical student to the resident. This transitioning process varies in its depth and complexity depending on each student and their environment. Some take it easy as a time to relax before the hard days and nights of work. Others start to prepare by reviewing the medical information they gathered throughout studying at medical school. Some might be busy moving to the place they matched into, which can take a lot of effort and time, sometimes more than expected.
Preset expectations before July 1st are common among fresh residents, regardless of how great they were during medical school. Most new interns will have some fixed expectations that act as a safety net to their minds during this journey of medical residency. Many believe they will know everything about what to expect during residency during the famous “orientation week,” and others think they will perfect everything in that field and be experts in their practice after graduation.
There is no doubt that beginnings can be anxious, especially when it comes to being a physician, and as one might expect, a lot of challenges exist during that journey. Those challenges can be the paucity of applied clinical knowledge, how to learn the health system, where and what to study, and reality that can be quite different from what is taught in medical schools.
Residency training programs have improved dramatically during the years. Currently, they are structured in a way that is studied and approved by national committees such as the ACGME that requires certain milestones to be met in regular intervals. Those milestones govern different aspects of medical training, such as medical knowledge, professionalism, teamwork, and others. Continuous feedback, whether from attending physicians, colleagues, ancillary staff, and even patients, is being provided to maintain progression throughout those milestones. Most programs have access to various medical information resources, including electronic libraries, articles, journals, textbooks, and telemedicine broadcasts.
It is true that access to medical knowledge became easier and approachable to any learner of medicine, not even in a dedicated residency program, but certainly so for medical residents, but the question poses itself in this current era, with this endless sea of information that is updated in a very fast pace, do medical residents gain the necessary clinical knowledge to apply in their future careers?
To some, this question might seem out of context given that enrolling in an accredited residency teaching program will allow you — the junior doctor — to achieve more than its necessary to care for patients. Still, to others, this is a serious problem. It is reflected by feedback given from junior attendings (few years after residency graduation) stating that yes, they have a lot of knowledge and experience but still not comfortable as one once thought.
If one attempts to analyze this question considering the heavy workdays that in the old days had led to serious work fatigue issues and between one’s obligation to learn everything that is there to improve and become an expert, a lot of residents find themselves lost and do not know where and when to start.
It is certainly true that residency programs have prepared young physicians in much more comprehensive and detailed ways than ever before, and continuous feedback through the years led to the development of various programs and agendas that decreased work fatigue and improved clinical knowledge. Teaching programs prepare doctors to understand the medical system and blend them well with different aspects of medical care that are not confined only to diagnosis and treatment. Also, teach residents how to work within a team and be effective team members. Having said that, some hidden problems remain to be explored and managed.
Among the challenges is recognizing that reality can be somewhat, if not totally, different from medical textbooks. This recognition comes with the time of practice not directly taught. The idea that a patient does not necessarily present the same way as in Harrison’s, or that every patient can present differently with the same diagnosis.
Moreover, the response to treatment can be extremely variable that no one can accurately predict. This may be partly due to the mental set differences. A medical student mentality with all those great expectations did not switch yet to the realistic physician mentality. The mentality that operates mostly in a reactive rather than proactive way is to say a student relays a certain set of data to superiors then receives a command to apply.
Whereas physicians’ mentality is proactive when they take responsibility for the patient’s care and feel the urge to provide all the care needed. This mentality accepts different variables as the true nature of humanity, even in clinical practice. The idea that patients represent individuals with their own physiological and psychological characteristics is unique to that individual. Understanding those variabilities will allow the physician to appreciate patients’ expectations and needs. It will enable the caring provider to provide more than medicines and interventions to provide healing.
This mental transition does not happen overnight but is the true challenge each junior physician must embrace and overcome over time. Once it is achieved, it will mark the beginning of a healing physician.
Salim Yaghi is an internal medicine chief resident.
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