In my recent book collaboration, I wrote about the “July Effect” and my personal experience with that. But for you who is starting out, you can learn from my experience.
Follow these tips and you’ll be golden
1. “Trust but verify” Ronald Regan.
There is nothing worse than missing a blood culture result that leaves a patient progressing into sepsis without adequate antimicrobial coverage. Or missing an EKG finding that ends up as an STEMI. Even when you feel like you “got this”, verify one more time. It’ll save you the embarrassment and it’ll definitely save your patients life. In the beginning the work load is cumbersome and “July effect” is highly likely, so always cross check your orders and results. Follow the evidence based guidelines, refer back to them until they’re fully engrained. If you’re unsure verify before you bluff, your seniors can see through BS. Trust me, we’ve all been there!
2. You can’t “fake it till you make it” here.
Don’t ever fake patient results, don’t lie. If you didn’t do a genitourinary exam the one time when you should’ve then don’t lie about it. You weaken the link in the team once you’re labeled as unreliable by your coworkers early on residency.
3. “Be Proactive” – Dr. Romain
Be the one to do “it”. You’re on a learning curve anyways so better start now. Step up to the plate, get comfortable with difficult procedures and conditions early. Don’t shy away from challenges, they’ll make you stronger. Be open, everyone already knows you’re semi-ignorant, don’t hide it, be proactive to learn otherwise you’ll be classified as ignorant by your peers early on and that’s never good.
4. Prioritize Your Health & Wellness.
Take advantage of the gym discount, meal prep and make time to do the things you love. Life will be stressful so it’s important to have a wellness plan for yourself.
5. “Enjoy the lack of accountability ” – Dr. Hays
You will never again be surrounded by this level of support ! You have at least 2-4 people with more experience looking over your shoulder so take advantage of that to learn and take “guided” chances.
6. Request Feedback periodically
Particularly important at the beginning, midway and end of each rotation. Also very beneficial when you’re rotating through another program that’s not yours. Chances are they’re paranoid about your presence there, and you’re more likely operating outside of your element. It’s easy to think you’re performing optimally so request constructive feedback midway of each rotation so you can be better before it’s over.
7. Communicate Effectively
Collaborating with passive aggressive people is extremely challenging. You will meet many challenging personalities but talking through issues will actually help you. Always talk to your nurses before and after common patient encounters. They’ll “fill you in” on interim history and they would perform better if you share your plan with them before you leave. Ask questions during rounds and never make assumptions. Medical errors occur far too commonly due to assumptions.
8. Create a spiritual routine.
Your character will be tested, tempted & tried ten times over. You’ll be stretched beyond your wildest imagination. Creating a compass for stressful seasons will guide you through those moments. Prioritizing values such as integrity, compassion, reverence will keep your empathy from becoming apathy. Pray, meditate and find time to connect with God. It’ll keep your mind steady & in peace.
9. Your first ITE (intraining exam) will suck.
My theory of the ITE is this: your score should get better each year. This means you should indeed obtain the worse score during the first year and then the best score in your final year. That’s an indication of progress. Good doctors get better with more experience and exposure!
10. Evidence is your source.
Use all the evidence based resources to learn and defend your point. Be focused on true problems. Identify them, don’t ignore the signs. You cannot “see” what you don’t know. Read, study, research. You’ll only identify pathology that you’ve learned about. Common things happen commonly but zebras still do exist.
11. Find a mentor early on.
Don’t make decisions alone, pick someone you can relate to, who is practicing in a manner you want to practice in. Request mentor ship. Don’t assume that they know you want to be mentored. Define the relationship. Be specific, set up time to meet with them and make it productive. Mentorship can make or break your career, don’t undermine it.
This article from the NEJM goes into more detail and you should read it.