Allow me to propose a new holiday – July 1st is now Medical New Year’s Day. Yes, it’s true that many training programs start before July 1st with orientation – or even clinical work as is the case where I work, but nevertheless, July is a time for new beginnings, whether for new interns, fellows or medical students. With this changing of the guard comes new roles, responsibilities and anxieties. Think back to your first day as an intern – what were you worried about? What were you hoping would happen? Did you want somebody to take you by the hand? Or did you want to be challenged out of the gate?
It is true that anxiety thrives in the future tense, where things are unknown. Many clinicians in new roles are afraid of being unprepared or left out on an island. The first exposure to a new program or rotation can go a long way in helping to ease the fears inherent in the transition process. Many trainees are exceptionally sensitive in the first days (even hours) of a new rotation experience. This discovery phase is filled with a lot of unanswered questions, many of them non-clinical (where’s the restroom?) The emotional – rather than the rational – centers of the brain are most stimulated at these times. It can be more difficult to weigh mixed information, thus small missteps or setbacks can leave the resident jaded, lost, frustrated and less likely to be open to learning in the future. The sooner that we as educators reward new trainees for their curiosity and drive, and guide them through the discovery phase, the faster they will acclimate to these jarring new clinical environs.
So, please don’t be jaded. Take your time and make sure that you answer questions and offer help in a non-judgmental manner. Don’t presume that a new trainee knows the answers just because they don’t ask. Maybe they feel like they are supposed to know how to manage asthma perfectly from day one. Remind them that it’s OK if they don’t – but reward them if they do.
Be patient. Understand that things may take longer and that there is a learning curve to more than just the nuts and bolts of medicine. July can be a frustrating time for many folks – patients and families included.
Remember the magic of discovery and diagnosis! I still fondly recall my first day as a “real doctor” more than 11 years ago. I was assigned to the Private Practice rotation and was paired with a Primary Care Physician who had been in practice for 20 years. The first patient we saw together had testicular pain. After doing my H&P and presenting my differential diagnosis we ventured into the room together. It was then that he pointed out the “blu-dot sign” pathognomonic for torsion of the appendix testis (or appendix epididymis). After educating the family he went on to tell me that I probably won’t see it again until 5-6 years later. And wouldn’t you know it, I saw my next case as an Emergency Medicine fellow – nearly 6 years to that very day – this time with a brand new intern. Sounds hackneyed and contrived? Ask some of your colleagues and many will share similar anecdotes.
The joy of learning something new – and then nailing the diagnosis – is something that I now mostly experience thorough interactions with my residents and fellows. You can be that impactful someone who leads an intern towards a diagnosis and then helps them make it by providing teaching and encouragement. During the discovery phase of early residency remember that what is familiar to you is new to them. Rediscover the “magic of medicine” through the eyes of someone who has not “seen it all” and, in turn rediscover for yourself why you signed up for this job in the first place.
Happy New Year!
