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How to transition from a medical student to resident
Kelsey F Angell, MD, MPAS
They say the hours are long but the years are short. I had a hard time believing that until now. As I prepare to start PGY3 year, internship seems so long ago and yet like just yesterday. I wish I had an amazing insightful key to mastering intern year, but I don’t. I do believe you can make it a positive and rewarding experience if you try.
I had the pleasure of doing two intern years, starting as a categorical internal medicine intern before switching to general surgery. I was lucky to have wonderful chiefs and mentors that gave me insight, advice, and support along the transition. I strongly urge you to look for these people; your focus will be elsewhere, but finding someone you can go to when you’re struggling or unsure of your direction is critical.
I’m a huge proponent of exercise and taking time for yourself. It’s hard to do but you have to be capable of recharging and caring for yourself in order to take good care of others. Find a way to decompress outside the hospital. Reach out to those who helped you get here and don’t forget them along the way; they’re going to be the people there at the end of the day. They may not understand what you’re going through but they’ll try; give them credit. Make friends with your co-interns; you’re going to spend a lot of time together and they’ll understand your life and the good, bad and amazing parts of your day. Help them out when they’re struggling and they’ll do the same for you. Being able to share the experience with them is priceless.
It can be a tough road and a challenging year; you’ll suddenly be a real doctor and sometimes pushed to your limits. You’ll be tired and frustrated and do a lot of work that seems thankless. You’ll struggle to find time to read or study outside of work. Find one resource and try to read a little every day or do a few board prep questions. Attend journal club and pay attention at M&M conferences; you’ll learn so much from the discussion. Take a few minutes to get to know your patients; connecting with them makes it all worth it. Get out of the hospital and do something fun once in a while. See some sunlight. Get a decent meal. Smile. Plan a vacation. You will come out of intern year amazed at what you are capable of, what you’ve learned and how you’ve grown. Keep your head up and take a deep breath when things feel overwhelming. In the end, remember, you can do anything for a year. It just keeps getting better after that.
Kelsey Angell is a 3rd year general surgery resident at University Hospitals, Cleveland Medical Center. She completed medical school at Rush Medical College in Chicago and spent a year as a categorical internal medicine resident at UCSF before finding her fit in general surgery. Her career aspirations include becoming an academic surgeon and surgical educator, with subspecialty interests in surgical critical care, trauma and acute care surgery.
Here are some great additional sources for our newest future surgeons:
- Former AWS President Amalia Cochran’s 2015 compilation of advice to interns.
- Mary Brandt’s popular blog Wellness Rounds.
- Follow the twitter feed at #DearIntern for the latest intern advice.
Navigating Through Troubled Waters
Aileen Larson, OMS4
As a child, I knew when it was a rough day on the water. My body would tense with each loud crash of a wave hitting the side of the sailboat or a gust of wind that would splash cold seawater on my face. My father loves to sail and I would join him on many adventures. Watching him sail, I was always amazed by how he would adjust the mainsail depending on how the wind changed. The sail would catch, the boom would sway and the vessel would lean to either the port (left) or the starboard (right) side as we picked up more speed. No matter what troubled the sails that day, his reactions were methodical and kept us on course.
I am a fourth year medical student now and counting the weeks to graduation. I have had many conversations about depression, suicide and burnout in medical students and practicing physicians over the past four years. According to the American Foundation for Suicide Prevention (AFSP), “an estimated 300 physicians die by suicide in the U.S. per year.” This number is about twice the size of my medical school graduating class. The AFSP also states that “the suicide rate among male physicians is 1.41 times higher than the general male population and among female physicians the relative risk is 2.27 times greater than the general female population.” It is so important to dive deeper and find the root of this mental health crisis in our profession. We should also start thinking about ways to prevent this sickness from surfacing in our lives and affecting our careers.
From many hours on the water, I learned that the art of sailing is more than mastering the vocabulary or keeping the boat afloat—it is about surviving troubled waters. There were six things I was taught while accompanying my father on his sailboat.
- Know the sailor | My father would always stress the importance of knowing his sailing capabilities and limitations. As a medical student, I had many clinical opportunities that helped me discover my abilities and emotional limitations when caring for patients. To be mindful of the learning process and occasionally to do some “soul-searching” is something my father was trying to demonstrate when sailing. We, as physicians, improve the lives of our patients and in order to do so, it is imperative that we first learn about ourselves before we become the practicing healers.
- Releasing tension in the sails | Upon a change in wind direction, my father would adjust the sails. Many times he would relax one line in order to tighten another. Throughout my medical education, it was important for me to have hobbies and activities outside of medicine, and even more so when I felt overwhelmed or stressed. Whether that was reading a new novel, running a trail, or practicing my breathing in yoga; I always appreciated this time away from medicine. The hardest part was preventing myself from feeling guilty or viewing this break as a distraction. I would remind myself that I was simply releasing tension and that the yoga studio, the running trail or my new book was a haven that allowed me to reconnect and feel rejuvenated again.
- Making sure a lifeline is within arm’s reach | While on a boat, unwary passengers can find themselves quickly overboard. In the beginning, I had a hard time communicating with people about all the new stresses that are part of medical school. This changed when I found surgeon mentors; they became my coaches, my role models and living proof that if they can do it, so could I. It was also important for me to reach out beyond those in medicine, to family, friends and others I could confide in. These people in my life were a source of strength and reaching out to them for support was a critical lesson in survival.
- Keeping one eye on the horizon | Sailors believe that looking towards the horizon helps steady the boat. In medicine, this horizon is how we impact the overall health of our community. This broader perspective makes even the most mundane daily tasks seem significant. As I was told on many of my clinical rotations, if we can teach one patient, they may teach their family and in turn, an entire community may be better off. Thinking of not only one patient, but also society as a whole, may help us persist through our toughest of days.
- The ripple effect | The waves that were around us would change shape, direction and speed as they bounced off the boat. Each wave crashing into another would impact the next one’s path. Medicine has physicians with incredible expertise in mentoring, guiding and directing one’s career. The profession was built on apprenticeship (especially in surgery) and the humanity within medicine was taught by observation. Students and physicians should continue to be observant and pick up on the subtle cues of their colleagues in mental distress. In doing so, we may not only help the individual but also, in leading by example, help others without knowing it.
- And never be afraid to get wet | After a day of sailing, our faces were red and windblown, our hair was crunchy from the salty sea air, and our clothes were drenched from the seawater. In our profession, sadness, suffering and death are inevitable. As physicians, we can do our best to comfort the heartbroken patient, relieve pain and suffering, and provide life saving measures of care. We should be taught to process these stressful and traumatic events in our minds and not lose our compassion and sympathy for our patients.
I start my surgical training on July 1st and, during these next five years, I hope to understand the balance between caring deeply for a patient that I have lost and the sweet relief of taking a break from it all to go sailing with my father. Either way, at the end of the day, whether it’s tears or a stormy day, I would rather feel that salty water run down my cheek then not feel anything at all.
Aileen Larson is a fourth year osteopathic medical student at Pacific Northwest University in Yakima, WA. She recently matched at the Detroit Medical Center/Children’s Hospital of Michigan and begins her residency training in otolaryngology and facial plastic surgery in July. She is on the Student Osteopathic Surgical Association National Board and on the Association of Women Surgeons National Medical Student Committee. In her free time, she likes to practice hot yoga, run, read and spend time with her husband and her two dogs.
How-To Negotiate Your Worth
As a fourth-year medical student slated to begin residency in a few months, I cannot say that I have ever had to negotiate my salary as a practicing physician (yet!). However, there are ways that current and aspiring female surgeons must negotiate their clinical, academic and personal worth, at various stages in one’s training and beyond, both in terms of salary in addition to being considered for leadership positions, promotions and competitive funding.
Self-worth can encompass many facets: our clinical expertise in the operating room, our excellent rapport with patients, our academic productivity, our leadership and extracurricular engagements (such as being a part of AWS!) and our personal strengths as individuals that make us great doctors, co-workers, researchers and friends.
Unfortunately, women are Less Likely to Engage in Self-promotion for reasons including fear of appearing arrogant, lack of belief in the significance our abilities/achievements, or the thought that our achievements are already known to our audience or that they speak for themselves (a dangerous assumption!)
Here are some concrete ways to advocate for ourselves in the workplace without selling ourselves short, and how to convince others of our worth when we feel that we are not being given appropriate pay/credit/respect (in other words, negotiate!):
- Know how much you are worth. On an attending level, this could take the form of knowing monetarily how much your male counterparts in your practice are making. Citing numbers provides a concrete starting point for the discussion, AND, when coupled with evidence that your male counterparts are making this amount, it poses an important question: Why am I, at the same level of training and clinical/academic productivity, not making the same amount?
- Know your strengths. We all have resumes, but there are times when we must verbally advertise our strengths in order to get recognized. This is hard to do when we, despite having wonderful resumes, cannot easily describe our strengths. We must Own and Know our Unique Strengths, in order to effectively advocate our worth for clinical, academic and leadership settings.
- Be seen, be heard, be proud. In order for our worth to be known and appropriately recognized (through salary, promotion or elected positions), we must be sure to be Seen and Heard: in meetings, in the operating room, in research settings. This involves knowing our strength and worth (see above) as well as being verbal and engaged in our work settings. Check out books like Feminist Fight Club or Lean-In for wonderful tips on being effectively vocal and visible in the workplace.
- Sponsor other women. This final (and my favorite) tip is one that we are all capable of practicing, no matter what our level: promote and sponsor one another. Whether in a meeting, the classroom or in the operating room, we are all capable of helping other women realize and own their worth. Sponsorship is the concept that more senior faculty/leaders help promote, encourage and showcase the talents of rising junior women in the workplace. It can be Critical for Women’s Success in the Workplace and we should all engage in it: what goes around comes around!
Self-promotion and negotiating one’s worth is an art. We must be cognizant of common pitfalls during this process and How to Avoid Them. Ultimately, we can do even more than describe or negotiate our worth: we can own our worth.
Mohini Dasari is a fourth year medical student at the University of Pittsburgh School of Medicine. She is currently applying to general surgery residency programs, with career interests in global health, trauma and burns. She is the Mid-Atlantic Representative on the Association of Women Surgeons National Medical Student Committee. In her free time, she enjoys working out, writing, trying new restaurants, and spending time outside.
How to Eat Healthy at Home with Minimal Efforts
As a medical student, I like many of my classmates, put so much effort into studying that many things were ranked as “less important” and thus not worthy of my time. Nutrition definitely fell into that category for me. I am a self-proclaimed awesome baker, but ask me to cook dinner and I’ll probably fail. In attempting to eat healthy on a student budget of both money and time, my only saving grace was my husband’s culinary gifts and his enjoyment of cooking. When I am left to fend for myself, it truly becomes a struggle to maintain a healthy diet while meeting my budget and time constraints. Because of my unfamiliarity with the subject matter, I went to a professional to help answer this question. Brett McCurdy; RD, LD sat down with me to help debunk how to eat healthy at home with minimal effort.
The best way to eat healthy at home begins in the grocery store. Making weekly trips with a preformed list that includes plenty of fruits and vegetables (get a different color or variety every week), whole grains like pasta and breads, and protein including both lean meat (chicken and pork) but also beans and lentils. By stocking your pantry with healthy options you can avoid the pitfall of eating bad snacks just because that’s all you have stocked. The Harvard Plate method is strikingly similar to the MyPlate that we so often encourage our diabetic patients to use. Brett tells me that it’s more about proportion size and frequency when it comes to eating healthy than simply what you chose to eat. The Harvard plate method requires ½ plate of vegetables (plus or minus fruit), ¼ portion of protein (about the size of your fist) and ¼ portion of whole grain starches with plenty of “the good F word”, fiber. Once you have your ingredients and blue print, he recommends to start building your meal around your vegetables first. Frozen is just as nutritious as fresh and feel free to grab those steamers from the frozen section, but beware of packages that add that extra cheese sauce.
Now that we have the ingredients and building blocks, lets talk about minimal effort. Unfortunately, there is no healthy meal plan that requires zero effort, but there are multiple ways to minimize it. Meal preps that you do over the weekend can go a long way with just a few hours of work. A quick and easy chicken meal can be as effortless as a rotisserie chicken that you skin and shred and don’t forget about the fish! Grilling your meats or veggies is a quick task and provides one of the healthiest preparations for most meats. You can also prepare multiple servings to allow options for leftovers. If you’re vegetarian, you can always swap out the meat with lots of beans, tofu or lentils. Even canned food can be healthy when you grab the low sodium options. Crock-pot meals can also be prepared. Assembling the meal the evening before with a lean protein, heart-healthy grain and frozen vegetables can allow for a balanced meal to cook while you’re working through the day. So when you’re stressing out about how to eat healthy with almost no time, remember healthy ingredients and proportions are key. Allowing the occasional “cheat” day is okay too as long as it doesn’t turn into a “cheat week” or more! Allowing some of our favorite foods into our diets on a semi-rare basis can be viewed as healthy in a whole different sense of the word.
Grace DeHoff is a third year medical student at Pacific Northwest University. She is interested in pursuing a career in Neurosurgery and currently lives in Boise, ID with her husband one-year-old and son. In her free time she enjoys running and has completed multiple half marathons
DRESS LIKE THERE IS NO TOMORROW
“Tomorrow is promised to no one,” a quote I hear quite often. Live for today, for it is a gift, that’s why today is called “present. “But with all the challenges and blessings that are part of the life of a woman in medicine, it can cause us to prioritize to a point where we stop doing the simple things such as dressing our best. I’m sure everyone has heard the saying “dress for success” and what you wear is a reflection of how you feel inside and what you wear can influence other’s perceptions of you. Of course there are the opinions that clothes aren’t the end-all-be-all and that it doesn’t matter what you wear but it’s the confidence you exude. But what if I were to tell you that both opinions have validity? As I was writing this article I came across some pretty interesting stories about the power of clothes. There is a concept called “enclothed cognition” (Adam & Galinsky) in which it is said that clothes can affect how you process your thoughts, how you exude your confidence, how you perform in tasks and how others react to you. It’s not just the wearing of the clothes, but the actual symbols they represent.
“Dress for success” isn’t just a rally cry to get us up-coming doctors to be to conform to a certain image of what a successful physician should look like, it’s actually advice to inspire us ladies to dress for how we would like to be TODAY. At my institution, our professors stress the importance of maintaining a balanced life no matter how crazy medical school can become and dressing your best is a part of the process. Wearing different kinds of clothes can actually influence your level of performance, attitude, and mood for the day. Using myself as an example, I love wearing sweat pants, but when I’m always wearing them, it feels like I’m here to do business with the couch and not with my school work. But when I take the time in the morning to pick out something that lets people know I am here to succeed, to learn, to conquer the beast we call medical school, I become super productive and even dare to be confident that doing well on a test is a possibility.When I dress well, it makes me feel as though I’m taking care of myself and it shows. Wearing something that symbolizes who you would like to be is like a first step to becoming who you want to be. Wear what brings out the wonderful you on the inside and don’t be afraid to show it (within reason of course). Whether that’s a pencil skirt, or a nice pair of jeans, wear something that symbolizes your commitment to your goal. And please don’t forget the awesome accessories, my favorite being a SMILE. So what will you wear today to dress for success?
Adam, J., & Galinsky, A. D. (2012). Enclothed cognition. Journal of Experimental Social Psychology, 48(4), july, 918-925.
Lisa Coleman is a second year medical student at The Ohio State College of Medicine. For her, becoming a doctor has been THE life-long dream and the road to medical school had been a long and trying one, but is very happy and blessed to have this opportunity. Before coming back to Ohio, she spent a couple of years in the Big Apple aka New York City, where she attended grad school, contributed to research to improve doctor-patient interactions, and had lots of fun, met wonderful people, and ate lots of great food. She’s inspired to become a doctor that heals patients with more than just her scalpel and hopes to contribute to improve the lives of others. Her current surgical interests include trauma but believes the skies are limitless and wants to explore every field before committing to one.