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What to Expect as a PGY1 Resident

What to Expect as a PGY1 Resident


Residency is a time of immense personal and professional growth and learning. The transition from medical school to residency is the bridge to becoming a doctor. However, the process also comes with a lot of change, new demands, and situations which cause stress that can both grind you down and challenge you.

What is the largest learning curve new residents face?

In today’s current environment, there are significant differences between medical school and your first year of residency. As a medical student, participation is not essential to the process. You are an observer who is learning by looking in with almost no level of responsibility. However, you will be expected to move quickly from observing decisions to making them during your first year of residency. Your level of responsibility soars.

In general, you will be responsible for assessing patients on admission including taking a history, performing a physical exam, ordering diagnostic testing, and developing the differential diagnosis and treatment plan. You will be supervised, but the level of supervision may vary. Residents also order appropriate diagnostic tests and consult with other specialties as needed. Attending patient rounds and performing treatments and diagnostic procedures appropriate to your specialty are also resident responsibilities. In addition, as a resident, you will be prescribing treatment (medication), providing patient education, and writing discharge summaries. In some specialties, you will assist with surgical procedures and respond to emergencies, such as trauma pages or codes.

What are other major transitions to expect?

You will also need to learn how to work autonomously. As an intern, during your first year of residency, you are likely supervised closely by senior residents and attending physicians. As you progress through your residency, you are given more responsibility and more independence. However, as you are given more independence, you will need to understand your proficiency level and know when you can proceed and when you need to request assistance. Sometimes there won’t be an attending or senior resident standing next to you supervising, so you will need to make decisions and know when to seek out supervision. This can be very stressful and challenging for new residents to learn when you need help. Asking for “help” can be perceived as a weakness, but not requesting help appropriately is dangerous for patient care. You will need to get past the anxiety of calling in and waking up a senior resident or an attending, and understand it is never wrong to call in help when you need supervision. Attending patient rounds and performing treatments and diagnostic procedures appropriate to your specialty are also resident responsibilities. In addition, as a resident, you will be prescribing treatment, providing patient education and writing discharge summaries. In some specialties, you will assist with surgical procedures and respond to emergencies, such as trauma pages or codes.

As resident you rotate through different services. This involves navigating different rules and processes which are often dramatically different. Learning to frame shift in a nimble way can be challenging. For example, a typical intern may rotate from a surgical service to anesthesia to ER to the ICU. Each service has a different focus, perspective, supervision structure, and may even use a slightly different computer system. Additionally, attending physicians may also run their service quite differently and expect residents to adjust to their preferences which means each service has a different perspective and important process on how to provide the best patient care. Navigating through all these environments is part of the learning process. Some do better than others and it helps to be open to how that service runs best and be receptive to feedback. Often, you will rotate to another service just as you are becoming comfortable with the last.

Medical school is also a time when students are focusing on details and completeness. This dramatically changes in residency. One example of this is medical students are asked to do a complete patient history. With residency, the focus changes due to time constraints. Now you are asked to focus on documenting problems and working efficiently to determine what is necessary information and what is superfluous. Time management becomes a challenge and the art of keeping many patients straight in your mind when many of them have similar problems is a skill that must be acquired rapidly.

What can a new resident do to manage through the transition?

It is very important to seek out and receive feedback from residents and attendings. Be receptive to this feedback which is often criticism and assume good will. What I mean by that is take criticism as a gift which will help you improve your knowledge and management style. Don’t become defensive and be open to change which will help you and benefit your patients.

Please keep in mind that all graduate medical education programs have counselors that can also assist with the transition process. At our institution, we have behavioral counselors, wellness counselors, and learning specialists to assist residents and their partners with any concerns they are having with adjustment. Your program director is an excellent resource to access these services, as is the General Medical Education (GME) office. These services are confidential. I actively encourage my residents to seek these services and see this as a positive action on their part to advocate for their own wellness.

What skills do new residents need to most focus on?

New residents can struggle with communication issues throughout residency. Learning how to work in teams with other residents, attendings, and other professionals like nurses, audiologists, etc. is important to develop. Programs like ours work closely with residents on interpersonal skills and encourage direct feedback by supervisors and attendings to help increase their ability to discuss patient care with others. We also have training on gender relations and bias and guest speakers on how to improve your ability to spot bias and be inclusive of diversity among colleagues, patients, and their families. Interprofessional collaboration is the key to optimal patient care.

What advice do you have on available resources?

It is important for new residents to figure out their learning goals for the first year and work closely with their program director and fellow residents for support. Many residents use the OTO Head and Neck Surgery book by Raza Pasha which provides an outline on multiple different topics, so residents can continuously get a quick baseline and then layer additional knowledge. ENT Secrets by Melissa Scholes is another resource. It provides a broad base of otolaryngology knowledge you can access quickly. Other resources are online textbooks, using Google, and reviews from PubMed, and UpToDate. Contact your institution’s medical librarian for information about the subscriptions and resources available to you.

What can new residents expect in their work/life balance?

The transition from medical school to residency will have a dramatic change on your personal life. Residents take more calls and put in more hours a week on a consistent basis. While medical school requires a lot of time and effort, residents continually put in 60-80 hours a week. Residents deal with both book knowledge, clinical skills, professionalism, and communications. Many also are involved in research. It takes conscious effort to prioritize self-care and family time.

How do programs like yours try and help with work/life balance?

Our organization is typical of many residency programs in trying to help residents in this area. We set up social events to help residents with the critical need to develop camaraderie and a support system within the program. It is important to include residents in the interview process for new colleagues since residents who don’t bond socially with their peers do struggle. Our Otolaryngology – Head and Neck Surgery Department will have social events at restaurants or attendings’ homes throughout the year. For those married residents, we involve the spouse and family and encourage them to get involved in the department. About 50 percent of our residents are married, and we don’t want them to have to choose between their family and spending time with their colleagues.

Finally, what makes a successful first year resident?

I have met, worked with, and observed many different types of residents and those that seem to integrate best and succeed have an openness and desire to improve themselves with humility and a strong team work ethic. They adapt to new environment and situations well and focus on team work and continuous improvement. The other important characteristic is communication skills. Residents who have difficulty communicating with colleagues, patients, and families tend to struggle more than those who put people at ease.

About Tanya K. Meyer, MD
Tanya K. Meyer, MD, is the otolaryngology residency program director and a laryngologist at the University of Washington Department of Otolaryngology Head and Neck Surgery in Seattle, Washington. She is currently an associate professor. Dr. Meyer completed her Fellowship in Laryngology at the NY Center for Voice and Swallowing after her otolaryngology residency at the medical College of Wisconsin Medical Center.

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