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The 4 Biggest Challenges of Medical Residency

The challenges of medical residency can be daunting. Here’s a look at four of the toughest — and how to conquer them.

The period of time between Match Day and the start of residency is fraught with equal parts anxiety and excitement. The start of residency marks the fruition of years of hard work — long nights at the library until it closed, many seven-hour standardized examinations and demonstrated effort and commitment in clinical spaces. You should be proud of yourself: You earned this wild time of immense educational and personal growth. However, you’re anxious for good reason, because the transition from medical school to residency is a significant one.

Here, I’ll share the four major challenges of medical residency and ways to keep the transition smooth.

1. The Learning Curve

One of the most ego-crushing challenges of medical residency is the learning curve. “Steep” is an understatement. The shift from medical student to resident includes a shift in expectations for both your knowledge and your competency.

During residency, new clinical circumstances push you to use what you have learned, but these very same circumstances can highlight areas of clinical gap — the areas you have yet to learn. The chasm between what you know and what you don’t know can seem as though it’s ever-expanding, even as you learn more each day.

In medical school, your textbook was your instructor, but in residency, your patients are your teachers. Their disease processes and clinical course guide our future management when we approach patients with similar pathology later on in our career. Now, instead of reading textbooks, we desperately search UpToDate, since the nuances of clinical medicine — which is the beauty of medicine — mean that there is always something to learn.

How to Conquer the Residency Learning Curve

  1. Attend and make the most of the residency-sponsored educational opportunities. Lectures that are provided when you’re at work are a quick way to review concepts, and you’re already in the right headspace to learn.
  2. Remember that your engagement with primary literature to answer patient-specific questions is academic and a step toward narrowing the learning curve.
  3. Ask questions on rounds and from your upper-levels. The best teachers, aside from our patients, are those with more clinical experience.
  4. Teach others. One of the best ways to recognize how much you’ve learned is to work with your medical students and teach them. It’s these moments that make you realize how far you’ve come.

2. The Topsy-Turvy Schedule

Few would envy the schedule of a resident. It’s truly one of the most frustrating challenges of medical residency. Most residents spend 60- to 80-hour work weeks in the clinical setting, and on various rotations, you could be asked to work during the daytime, overnight or a mix of both, even in the same week — not to mention 28-hour calls, with multiple calls during the week. The standard of time off is approximately four days a month. This ever-changing schedule with little downtime complicates any attempts to cultivate work-life balance and undercuts sleep quantity and quality.

How to Adjust to the Residency Schedule

  1. Sleep when you can, inside and outside of the hospital. Well-rested residents are sharper and more capable.
  2. Have flexible expectations about what your life will look like outside the hospital, given your schedule. Yoga class on Mondays at 8 p.m. won’t work when you have 28-hour shifts or you’ve transitioned to night float. Create multiple templates of your life outside of hospital, one for when you work during the daytime, another for nights and third for when you have a call-based schedule.
  3. Leave your work at work. If possible, finish your documentation in the hospital or at clinic.

For more tips on surviving residency, check out the Washington Manual.

3. The Culture of Residency

The culture of medical training is one in which residents have little agency and bear the brunt of the inequities of the system. The weight of student debt as well as a modest salary and little means to advocate for improved quality of life are all challenges during this period of time.

How to Adjust to the Culture of Residency

  1. Remember your “Why medicine?” at times when you feel hopeless. It’s important to return to your personal statement when you doubt whether residency is worthwhile.
  2. If it’s where your heart lies, join residency committees to enact change. Otherwise, remember to advocate for yourself and your education.
  3. Remember your value. Although the system isn’t structured in a way that’s particularly affirming of residents, that system cannot exist without us. Remember that you are integral to the success of your institution.
  4. Don’t lose yourself in the process. When you feel powerless, remember that when you’re in a position of power, you’ll never let your trainees experience what you’ve experienced.

4. The Nature of Medicine

Residency is structured in such a way that we come face to face with some of the illest patients. They’re a vulnerable population with variable outcomes, and so we encounter poor patient outcomes, death included, at a frequency that far exceeds that of medical school.

We take these outcomes personally, and we grieve for the patients we lose. This is the nature of medicine itself. Not all patients will recover — some patients will be discharged with a new baseline, and some patients will pass on, surrounded by residents, nurses, ancillary staff and their families. This is by far the hardest part of the job.

How to Approach Poor Outcomes as a Resident

  1. Remember that we learn from all outcomes, good and bad.
  2. Remind yourself that you did your absolute best for your patient.
  3. Decompress as much as you are able with your colleagues or with your support system outside of the hospital.

Many of the challenges of medical residency will be new to you; they’ll require adjustments after you leave medical school. It’s important to remember that you’ve been prepared to handle this next stage of training. You can do this!

Ajibike Lapite

Ajibike Lapite

Ajibike is a Philadelphia based second year categorical pediatrics resident. She has a passion for narrative medicine, advocacy (specifically refugee health and access to care), and medical journalism. She shares advice on how to approach medical school in her series "How to Survive Medical School" on her blog Stilettos + Stethoscopes.

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