Migrating to Residency

A new anesthesiologist, Dr. Kristin Forner, recently wrote an article about stepping off into the abyss of practice after residency. As I read, I contemplate the abyss of residency after medical school. I appreciate here perspective from a center of fear, and moving toward more and more comfort and calm. I've moved those stages through school to now. Being surrounded by really smart people will humble one into fear of what you don't know.

Her points and challenges:

It's important to "embrace the breath-stealing terror that comes with knowing you are it." Now that's not a reality for residents starting out, but there is no turning back into the comfort of student rotations where, one preceptor told me, "we don't depend on you for anything except to show up." There is a certain fear that comes with increasing responsibility and I see it just over the horizon. It's different than operating as a dependent anything.

She relates that we should "doubt decisions you never doubted, and invent questions you never had".  It seems that the more I learn, the more I know, the more I question. It seems to be grounded in "the more I know, the more I don't know" phenomenon. I seem to ask questions now that I've never asked before, and likely I should have.

Forner instructs the reader to "go back to the basics". This seems to be a haunting task given the enormity of the core of basic sciences that contributes to what we do every day. It seems that many around me attempt to make the practice of medicine more complicated, or more likely, they are inspired to do so by laws, rules, guidelines, directives, legal decisions, risk, liability and on, and on, and on. There seems to be a fine balance between practice that honors the basics and the addition of complexity that has become the practice of medicine.

While there is the tendency to go it alone, Dr. F encourages asking for help. It's so fortunate that the source of help has really expanded and I'm grateful for learning how to use them. There is so much information on my smart-phone, on my Kindle Fire, on my laptop in the online world...there is no reason not to check, ask, and test theory with database information of experts. I've become a devotee of "Up to Date" and other sources of quality information. I think I've matured a bit from my Wiki-medical-school approach to "asking for help".

Much of what we do depends on others. Medicine is a team sport, whether you want to be on the same team or not with the person you stand with. It is extremely important to "understand the value of knowing the people with whom you work".  Much of what we end up doing in practice is dependent on the actions or inaction of others. I've seen that time and time again as a PA. I'm sure it'll be more clear and important as a resident.  It's important to regularly identify those you can depend on to assist you when you need it most. Those reliable sources of guidance, direction, support and lead can make or break your practice.

As in life, medical practice is based on discernment and knowing what you know when you know it. She points out that it's possible that you may "actually know more than some of your older, more experienced colleagues". Being old may limit application of that perspective in my case, but I'm hopeful. I know I won't stand back "out of quiet respect" but I hope I recognize what I do know, and what I don't know. That speaks to "trusting instincts and listening to them". But then, that inspires great fear at times too.

Her last point speaks to "wanting to teach." This is easy for me. I believe that (as one supervisor once told me) I shouldn't "die with knowledge not passed on" to others coming behind me.  For me too, teaching is a learning tool and I need to get ready for a few more exams before this process is all over. I have much to teach and much more to learn.  And even in the fear, it's exhilarating to be moving forward into the abyss.

 

 

 

Thanks to Dr. F, I have more rappelling gear to get out and use.