How To Survive the First Year of Medical Residency

While you may have to be the best and brightest in medical school to nab an otolaryngology residency, intelligence alone won’t get a physician through the grueling, sleep-deprived years of residency. Being competitive may propel a medical school student forward, but competing with fellow residents will probably have the opposite effect.

Here’s how otolaryngologists survive—and yes, thrive—during what some have described as the most exhausting, fun, and intense years of their career and, perhaps, of their lives.

Be a team player. Medical school students spend a lot of time alone, studying and absorbing knowledge. As a resident, however, applying that knowledge means transitioning to working well with colleagues. “Healthcare now is very much about teamwork with other doctors, [as well as] nursing and ancillary staff,” said Jeffrey M. Bumpous, MD, J. Samuel Bumgardner Endowed Professor in and chief of the division of otolaryngology at the University of Louisville School of Medicine in Kentucky. Dr. Bumpous advises first-year residents to channel those competitive urges into competing with themselves to know as much as possible.

Be social. Being a team player also means being social and saying yes to things like holiday gatherings with other residents and hospital staff, playing on a resident kickball, basketball, or soccer team, or even just taking a walk outside the hospital with another resident to get a change of scenery. “Going through residency can be like working in the trenches sometimes,” said Mas Takashima, MD, director of the Sinus Center at Baylor College of Medicine in Houston, and a co-author of a study on resident efficiency (Laryngoscope. 2015;125:594–598; see “Do EHRs Really Save Residents’ Time?” left). “Some of my closest friends are people I worked with as an intern. It’s another layer of support. You’re there to help each other along this amazing journey, and the rewards are phenomenal.”

Be humble. Arrogance is not a friend to the first-year resident. “The best residents come in a little humble,” said Mark Wax, MD, professor of otolaryngology-head and neck surgery at Oregon Health and Science University (OHSU) in Portland, Oregon. “You’ve got to work with everybody.”

Joseph McClellan, MD, a third-year resident at OHSU, has noticed that residents who come in thinking they know everything and have it all figured out are the ones who struggle the most. “These people can get a reputation that follows them through their residency. It can get in the way in terms of having useful discussions about patient care, because others may find you unapproachable,” he added. While some may talk about how difficult it is to get along with peers in this first-year environment, Dr. McClellan said there’s no magic to it. “It’s just kind of the basic stuff you learned when you were 6 years old,” he said. “Be nice to everyone and find the people you want to be like and try to emulate their behavior.”

Be organized. One of the most important traits for first-year residents is organizational ability. “If you’re good at time management and [are] well organized, it enables you to be more productive and get out earlier to spend time with your family,” said Dr. Takashima. “Those who are organized clearly shine, partly because they’re on top of things and well prepared for cases.” What’s the clearest path to organization? At Baylor, first-year residents are assigned to mentors, and teachings focus on efficiencies. These may include logistics such as getting scans to the operating room in advance of surgery.

Ask for help. Whether it’s not fully grasping a particular procedure or protocol or struggling with a personal problem, it’s best to get help sooner rather than later. First years can and should talk to a trusted chief resident, program director, or faculty member if difficulties arise. “Don’t feel you have to overcome everything by yourself,” said Dr. Bumpous. “Get advice. Take constructive criticism. When you ask, ‘How do I do this better?’ be a good listener and accept people’s advice. The people who isolate themselves and don’t engage others in trying to stay on the best path are the most vulnerable to getting into a chronic problem or more serious trouble.”

Put the patient first (and do it with compassion). Physicians burn out when they lose touch with their own humanity. “Remember that you’re part of the human condition,” Dr. Bumpous said. “The person on the other end of your otoscope or scalpel is a human being—a mom, a dad, a sister, or a brother. Don’t let yourself become too removed from that.” Dr. Bumpous suggested residents learn at least one little thing about each patient as an important way to let patients know they are cared for. What do they do? Where are they from? What do they like to do? “That goes a long way toward helping people heal,” he added.

Relax before residency begins. If possible, future residents should spend any time off after med school enjoying life, whether that means relaxing with family or traveling. “It’s my personal belief that when [residents] start there is ample opportunity for them to learn what they need to learn and acquire the skill set they will need,” said Dr. Wax. “Trying to start reading or shadowing before residency is not going to really help them in the long run. Doing more things to prepare may put them ahead a month or two, but by the middle or end of the first year, everyone is at the same place, no matter what they did.”

Communicate with loved ones. Expectations are everything, so it’s important for a first-year resident to communicate with family members from the start about what an 80-hour workweek is going to look like. “Constant communication is paramount,” said Michael Yim, MD, a fifth-year resident at Baylor College of Medicine in Houston, “especially during the first few months, as everyone has to adjust to the change in daily lifestyle and overall routines. It is easy for loved ones to feel neglected during residency, so it is important to be cognizant of this fact and to be proactive about showing your commitment to them.”

Stay positive. Exhausted, swamped by paperwork, or overwhelmed by very sick patients, residents can find it difficult to remember that there’s a light at the end of the tunnel. “It’s easy to lose yourself in the daily grind of residency,” said Dr. Yim. “When that happens, just take a step back and remind yourself that you are now part of the best medical specialty around, and all the hard work is truly worth it in the end.”

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Renee Bacher is a freelance medical writer based in Louisiana.