As the new year dawns, resident physicians reach the midway point in their training year. Having survived the steep learning curve in their transition to graduate medical education, the second half of the training calendar is when things often start to click for first-year residents.
Heather Kowalski, MD, is associate program director of an orthopaedic surgery residency at University of Iowa (UI) Health Care, which is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
As interns begin the second half of their year, Dr. Kowalski offered advice on how they can thrive as they take on more responsibility.
Find areas for growth
Many programs hold formal, semiannual evaluations that give residents valuable insight into their strengths and weaknesses.
At UI Health Care, midyear reviews are structured around an individualized learning plan that residents fill out prior to their meeting with a program director. The document contains prompts such as “What areas have you or your faculty identified as topics where your medical knowledge could use improvement?”
Midyear reviews are “a really great opportunity for interns to get some insight into how they've been doing compared to what we expect and what we usually see halfway through intern year,” Dr. Kowalski said.
“Most residents are self-reflective and are able identify areas that they feel they're not quite at the same spot as their classmates are. But there are times there are things they may not have noticed.”
After midyear reviews, interns are encouraged to create SMART goals. These are goals that are specific, measurable, attainable, relevant and time-bound. Setting such goals can help them make further progress in areas such as surgical skills or medical knowledge.
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Find your confidence sweet spot
Confidence is a tricky balance for first-year residents.
“You don’t want to be overly confident so that you make mistakes,” Dr. Kowalski warned, “but you also don’t want to be so unself-assured that you’re asking a million questions. Knowing that you’re doing the right thing is the only way that you gain confidence.”
To build confidence and understand that you are taking the right steps for growth, Dr. Kowalski advised interns to seek regular feedback from senior residents and faculty members.
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Improve efficiency
Interns are expected to move quicker and more efficiently as the year goes on. Prioritization of your patient panel is key to accomplishing that.
“We expect them to learn what consults need to be seen first or need to be seen expeditiously, versus what consult can wait another 30 minutes because it's not that urgent,” Dr. Kowalski said. “Learning how to prioritize is a critically important step of their intern year that will help them for the rest of their lives.”
Communicate cohesively
Newer residents can be brash in interactions with members of the care team, often without realizing it.
“That can be a blind spot for a lot of trainees,” Dr. Kowalski said. “Once that’s brought to their attention… their interactions with other services and their faculty can be significantly improved.”
Another communication must: keeping your supervising residents in the loop.
“That’s the type of thing that might be mentioned in a learning plan,” Dr. Kowalski said. “We might say something like we would like to have less reporting of your lack of communication from your senior residents over the course of the next two months and if we continue to have reports from your senior resident of lack of communication, we will bring it to your attention.”
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Embrace new autonomy
Generally, interns are going to see an increase in responsibility as the year goes on. For orthopaedic surgery interns at UI Health Care, that can often mean handling night call as the only physician at the hospital while a third-year resident is on call from home.
Even with such newfound independence, Dr. Kowalski said it’s important to know what you don’t know.
“If you're being cavalier and trying to make all the decisions on your own and assuming that you know everything, that's when you get yourself into trouble,” Dr. Kowalski said. “But when we have a junior resident who knows when to ask for help, the senior level or the midlevel residents are usually more comfortable letting them kind of run the show.”
