The shift from a junior to a senior resident


For physicians, residency is the most critical time for growth in clinical and surgical skills, professionalism, and medical knowledge. Your residency training — for better or worse — shapes your future career as a physician. Your surgical technique, clinical decision making, and bedside manner are all, to some degree, a reflection of where you trained.

Interestingly enough, there are only two residency years with formal titles — the intern and chief resident years. These titled years represent the bookends of residency that accordingly reflect the expectations of your medical knowledge and skills. Although they are no doubt landmark years in any residency program, there is another important period between them that is often overlooked, one that I think is more crucial in the development of a physician than any other: the transition from a junior resident to a senior resident.

The shift from a junior to a senior resident represents major graduation in responsibility, accountability, and actions and, with it, a deeper understanding of medicine.

As a junior resident, especially an intern, everything is new.

I remember walking into my first shift in my intern year. Even after all those years of school and being anointed as a doctor, I quickly realized that I still didn’t know how to really be one. “Can you order a KUB?” asked my senior resident. “Sure,” I said, as I Googled, “What is a KUB?”

Even early on, the one thing I was sure of was that junior residents were to be on the front lines, gathering evidence and data to help more seasoned doctors make the decisions. This experience helped in more ways than one: for me, it added to my own knowledge and understanding, setting me up to become a better doctor. For my patients and team members, having this data collected and compiled helped our teams create and execute patient plans.

During most of intern year, there was not much decision making done on my part, but because everything was so new and there was so much about just being a doctor to still figure out, I was OK with that. Even though I wasn’t directly making decisions on my patients, I knew that I was adding value to the team through my work. I found myself constantly referring back to my more senior residents, fellows, and attendings for guidance.

As time progressed, I found those conversations the most valuable: they were teaching me how to take the information I collected and interpret it into something comprehensible, something that could be used to make a plan that would improve a patient’s outcome. Slowly but surely, I was making accurate assessments and proposing plans of my own, but I always had my more senior residents as my safety net.

The years as a junior resident proved difficult but satisfying, and as I progressed through each rotation, I felt more confident as a physician.

Although I had obtained enough skill and knowledge to comfortably manage most patients, the biggest takeaway from my years as a junior resident was the insight into how much medicine I still really did not know. With the eventual end of residency finally, within my comprehension, I started to feel the pressure to learn as much as possible — my time as a senior resident had officially begun!

As a senior resident, I noticed my mentality and approach shifting again. At first, I was excited to be free (finally!) of writing so many notes and placing all the orders. But those tasks were replaced with other, more managerial ones like patient surgical screening and scheduling, and clinic troubleshooting.

The good news, though, was that since I was no longer doing junior resident level work, I was afforded the opportunity to use that time for self-reflection and learning.

I focused on filling in the gaps that I noticed in my progress as a physician; I could fine-tune my skills, my knowledge, and my time management.

Under supervision, I was afforded more opportunities in robotic surgery, and I was participating in operations that required more complex and refined techniques. I was no longer performing the basics but helping to teach them to the junior residents below me.

I was provided with graduated autonomy by my attendings and, with it, came the weight of responsibility for the decisions I made. The autonomy also made me aware of the bigger picture — that my practice and my junior’s actions reflected my management and leadership skills. I was no longer accountable for just myself, but also for every other member of my team. Their successes and failures became my successes and failures; it was imperative I created a team culture of openness, efficiency, and accountability if we were to succeed.

This critical shift — from gathering to guiding, from assisting to administering, routine to refinement and from dependence to independence — marks the true success of any residency. Only now as a more senior resident, do I appreciate just how much progress I, along with my co-residents, made in the short four years of my training. So, while most of the movies, books, and articles focus on intern and chief years, these are all missing out on this most significant phase of physician growth.

As physicians, we all have or will go through this development phase, and only with the support and involvement of our fellow residents and attendings will trainees get the most out of it.

Justin Dubin is a urology resident.

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