Rules of the Road for Residents

Most residents take to residency like fish to water. Finished with medical school and a year of internship as well, they are finally able to function as the physicians they have always wanted to be. For others, the path is not as smooth.

Some problems occur early. For example, because the choice of specialty is made in the third year of medical school, often before a student is familiar with medicine and its various specialties, a person may find himself/herself in a residency in which he/she is unhappy.

Other problems occur later in residency when a student must face written and oral Board examinations with a feeling that his/her time was not well spent. The resulting guilt, anger, and remorse can last a surprisingly long time.

I am going to make some suggestions as to how I think that radiology residents can avoid the "time not well spent" syndrome and get the most out of their residency. Let me phrase it as if we were sitting together talking.

• First, be glad that that you are in radiology. It's a great specialty with something for everyone. Those with a surgical bent can concentrate in angio/interventional, while those whose interests tend toward children and their problems may find pediatric radiology just their thing. Some enjoy being a general radiologist, thus doing a little bit of everything.

• Be happy you are where you are. There probably are better residencies elsewhere and there is always someplace worse. Every residency program has something -- and usually many things -- to recommend it. In short, try to keep a positive attitude.

• You are in a residency program for two reasons -- to learn and to work, which is also a way of learning.

• Learning is YOUR responsibility. Indeed, learning is far too important an objective to be assigned to anyone else. There are many corollaries:
  • Reading is crucial and it is never to early to begin.
    • You'd be amazed at how quickly time flies. By starting a reading program early, you will not only be better prepared for Board exams but you'll appreciate your rotations that much more. You will also feel more confident in your interpretations.

  • Reading is crucial and it is never to late to begin.
    • Don't be discouraged if you didn't begin your residency with a consistent reading program. Comes time for the Boards, no one feels they have read enough. The important point is to make a start.

  • Don't use you Attendings as a substitute for reading. There wouldn't be enough time in the day for them to tell you all you need to know.
    • On the other hand, do not hesitate to ask your Attendings questions about what you didn't understand in your reading or about some case going on in your hospital.

• Go to your conferences. When you are in practice later, you'll pay good money to hear some speaker say the same things!

• Participate in your conferences.
  • Make sure that you take your share of conference cases. The process of standing up and discussing a case not only mimics what happens during oral Boards but is actually a day-to-day re-enactment as clinicians come down with their films and expect you to say something intelligent.

  • Even if certain Attendings have a tough time distinguishing between education and humiliation, stand up and take those cases! And by all means, don't skip their conferences! While some people are insensitive, others believe that putting you on the spot provides for better training. Doesn't matter. Keep cool and discuss the case.
    • You learn more from the cases you miss than from other people's mistakes.

  • Did I remember to tell you to go to conference and discuss cases? The reason I emphasize this is that I regret not taking more conference cases while I was a resident. I think I would have learned more.

• You are also in a residency program to work.
  • Taking care of patients is job #1. It trumps conferences, meetings, going home, and everything else.

  • Be aggressive about doing procedures.
    • The more you do, the better you will be.

    • There is no such thing as having done enough procedures just as there is no such thing as having done enough reading.

    • Document the cases you do! It is a great excuse for buying a Palm Pilot to track your work.

  • You are doing yourself a favor by working hard. You're not doing your Attendings a favor by working hard.
    • One of my most eye-opening revelations came on the day of our in-service examination. The Attendings had to cover an entire an entire city hospital on their own. I smugly thought they would never finish. Guess what? They actually finished early! Amazing!

• Avoid departmental and hospital politics.
  • As long as politics do not interfere with your learning and your working, keep your blinders on.

  • If there are impediments to your fundamental functions as a resident, you must speak with your program director at once.

• Co-operate with your colleagues -- help each other out.
  • I trained at an institution in which, I felt, the chief resident took advantage of the junior residents. Co-operation among residents was minimal. People were late for their calls, left unread films for each other, and so forth. The faculty didn't want to know about anything. It was a very competitive environment as well. Boy, was it ever unpleasant!

• Don't be afraid to say, "I don't know."
  • Don't wing it. If you have a question either look it up or take it to a senior.

  • Don't hesitate to show films to your Attendings.

• Find yourself a mentor from among the Attendings.
  • If your age and personality are compatible with the notion of a mentor, find someone you can confide in and seek his/her guidance.

  • You might consider choosing as a mentor someone in the same subspecialty that you feel might enter as well. As with all choices, there are pluses and minuses to this approach. Your mentor should be someone you trust, admire professionally and personally, and one with whom you can speak freely.

• Acknowledge that being a resident is stressful -- but don't dwell on it.
  • There is a ton of material of to learn and many procedures to master. All your Attendings keep reminding you of all the texts you absolutely must read. It's enough to drive anyone bananas!

  • Learning means making mistakes and occasionally looking like a blithering idiot.

  • On call can be exhausting, and often no one seems to care.

  • Many days, nothing seems to work right.

  • Things run much less well than they should. The hospital, the Department, transport, the file room, and frankly -- you yourself -- are far from perfect.

  • What can you do?
    • First, realize that being a resident is tough -- and it is tough on everyone, whether they acknowledge it or not.

    • Don't expect perfection from yourself or others.

    • Mistakes are inevitable and are part of the process of learning. Hopefully, by reading, constant practice, and attention to detail, mistakes can be minimized.

  • Get yourself a life!
    • There is much more to life than work.

    • Have friends and outside interests.

    • Engage in regular exercise.

Can I summarize this for you?

1. Your job as a radiology resident is to learn and to work. These two functions are not separable.

2. Patients come first -- the most important lesson of medicine.

3. Take responsibility for your own eduction. Don't depend on anyone else.

4. Do as much reading as possible. Ask the seniors what they recommend and then put yourself on a reading schedule as soon as possible.

5. Attend as many conferences as possible. Volunteer to discuss cases. We each learn best from our own mistakes.

6. Do as many procedures as possible -- and document what you have done. You may be required, at some point, to provide this information!

7. Don't be afraid to say, "I don't know." Don't be afraid to ask for help.

8. Consider having an Attending as a mentor to help guide you.

9. Help each other out. Believe the Zen masters when they say that the only ones we are in competition with are ourselves.

10. Because residency can be a time of stress, it is important to have a support system in place. Friends, outside interests, and exercise are all necessary.

revised -- December, 1999
revised -- December, 2002

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