My partner Evan’s third year of residency completed his trajectory toward what is commonly called “burnout.” Two out of the 10 residents in his class left the program. In an already understaffed department, the remaining residents picked up the slack, taking extra call and working longer days. The general misery index among his cohort skyrocketed.
On March 11, an invitation-only meeting will determine the future of the United States Medical Licensing Exam (USMLE) Step 1 exam. The results will profoundly affect how all future American doctors are taught.
Overwhelmed and exhausted, a resident recently came to me to ask, “Can we do something about call?” Defeat and despair had taken over his psyche. He felt unable to cope with the tasks of residency, including the seemingly never-ending demands of fielding consults, pages and patient needs. He imagined that the problem could be solved by taking less overnight call.
Originally, I wasn’t going to enter the fellowship match. I had started my psychiatry residency fully intending to do the four years, then maybe a fellowship. Then, in my second year while sharing dinner with friends who had just certified lists for the general residency match, my plans to go into child and adolescent psychiatry came up.
When I took a job as a residency coordinator in graduate medical education at a local community hospital, I made myself a promise: I will not date a resident. They’re too busy, we work together, and we have nothing in common.
The recent ruminations of Drs. Katsufrakis and Chaudhry in the form of an invited commentary in Academic Medicine, entitled “Improving Residency Selection Requires Close Study and Better Understanding of Stakeholder Needs,” has garnered a significant amount of attention on Twitter. Drs. Katsufrakis and Chaudhry’s commentary was in response to a well-written and well-reasoned article by a group of medical students published in the same journal recommending the USMLE Step 1 transition from a numeric score to pass/fail.
Now that you, the reader, have become house staff, the time has come to change your mindset from one of competition to one of collaboration with your peers. The path that leads to achieving the MD or DO degree is one of often single-minded pursuit of academic victory. The competition has been fierce.
One of the trickier things to learn as a young doctor is how to navigate boundaries between patient, doctor, family and friends. Medical school teaches us that it is unethical to treat yourself or your close family due to a lack of objectivity that can affect judgement. It is fairly obvious why doing otherwise can create poor medical care due to blind spots created by subjectivity, hope, selective listening, personal agendas, and bias for a certain approach to treatment.
In 1999, the American Board of Internal Medicine and Association of Program Directors in Internal Medicine defined a “problem resident” as a “trainee who demonstrates a significant enough problem that requires intervention by someone of authority, usually the program director or chief resident.”
Medical training and practice exposes us simultaneously to the beauty and tragedy of life. As a resident, you are thrown into a strange world in which death will often sit as an unwanted companion in the room with you and your patient.
A page, an email, a text will request that you report to the program director’s office to have a conversation about a complaint against you. You are terrified, offended, maybe irritated. As you leave rounds to walk to the office, your adrenaline pumps.
One evening, overwhelmed by burnout, I drafted a letter of resignation to my program director and saved it on my computer. The next morning, I deleted the email without sending it.