Tips/tricks To Succeed In Residency?

[distressedpremed]

Hey guys, 

 

Just wanted to ask the more senior residents here. 

 

What are your tips to "succeeding" in residency? What separates a good resident from a great one? How (or should) you try to do well in off-service rotations? 

 

If you're aiming to get an academic job, should your focus be on research and teaching in terms of available extracurricular activities? 

 

I know this is very specialty dependent, but I want to see what advice I can get.  

 

Thanks! 

[Mithril]

Here are my tips after almost being done my FM residency from an FM perspective.

 

1. Read around your cases. Any cases that you see in clinic or in the hospital that you don't quite know the management of, read around it. It will be cemented in your head for far longer than just reading about it in a textbook or an online resource.

 

2. Pretend you don't have a staff physician. This is what I did for most of the consults regardless if it was off-service or not. You're a resident now and being a resident means that by the time you're done you must be able to manage your own patients by yourself. That doesn't mean you can't consult other specialties, but it means consulting them yourself, coming up with the management plan and looking at the management plan from all angles (medical, social, follow-up, etc.). If you do this very early on in your residency, you'll have more confidence in yourself when you're really alone on rural rotations.

 

3. Do as many procedures as you can. It may be the only time in your career where you get to do procedures like knee arthrograms, lumbar punctures, chest tube insertions, laparoscope maneuvering, etc. It shows your staff that you're keen and enthusiastic.

 

4. Do some pre-reading before the start of a new service. Just pick up Toronto Notes or something and read through the section of the rotation you are starting before actually starting it. The same thing that you would've done in med school if you wanted to look good.

 

5. Be friendly and approachable to everyone you work with, including the nurses, pharmacists, and OTs/PTs. This should be a given but I was actually evaluated on a few rotations on how well I got along with other staff (OB and palliative were two of them).

 

6. You're gonna make mistakes and not know things. Sometimes you'll have preceptors or staff who are assholes. You'll need to learn to roll with the punches and not take it personally. The moment you let criticism from others get you down is the moment that you start losing confidence in yourself. Don't let that happen. Take criticism as a way to become even better, even if it wasn't delivered to you in the nicest way possible.

 

7. Sleep and exercise. I can't overestimate the value of having a solid stretch of uinterrupted sleep. For some rotations this will be more difficult than others, but on days where you're not on call it's far more important to get good sleep than cramming an extra 30  min or an hour of studying. You consolidate your learning much better with proper sleep. Exercise is also really important and will make you feel healthier and keep your mood up. Aim for at least 3 hours a week.

 

8. Make friends with the other residents and make friends with staff. These will probably be people you work with for a number of years. It's a good idea to foster good relationships now. Go out to events and the like. In my rural rotation I often went hiking and skiing with my staff and they actually offered me a locum position once I was done because they liked having me around.

 

One thing I liked about my residency program is that other than surgery, IM, ortho, and rads in first year, everything else was very relevant to family practice. Even then, our program tailored surgery, IM, ortho, and rads in such a way that it was still useful for family.

 

I can't comment on your academic questions. Others will have to chime in.

[LittleDaisy]

2. As a FM resident when we do off-service rotation consults for IM& surg, are we expected to review w the staff or senior resident before prescribing meds(ATB) and ask for other consultants? I guess that one thing that sucks in academic hospitals is the hierarchy and so many learners!!

You meant that we could order blood tests and imageries before review? That I already did in ER as a CC4 ☺

[ellorie]

The best advice I ever got from a staff in PGY1 was as follows: when you are on call, bring a spare pair of socks and underwear. A new pair of socks around 2 am has incredible power to make you feel less like crap. Also, dress comfy and invest in good footwear.

 

Make friends with the admin people, especially the ones in your program and your department. They talk, and good word of mouth is your friend. Do some of your own clerical stuff if and when you can. It earns you a lot of goodwill.

 

Look out for your co-residents and let them look out for you. Friends outside of medicine are important also, but the people who do residency with you are the ones who really understand the day to day suck of your life.

 

Take all your vacation, request it early, space it out over the year, and try to take it on the heaviest rotations. Like, request it as soon as you have your rotations.

[LittleDaisy]

This might be out of topic. As an Ontario residents, do we get any discounts with UPtodate?

My current subscription will be expired soon..Any discounts through PARO, UofT PGME? OMA or perhaps CMA?

[ArchEnemy]

This might be out of topic. As an Ontario residents, do we get any discounts with UPtodate?

My current subscription will be expired soon..Any discounts through PARO, UofT PGME? OMA or perhaps CMA?

 

Medical Students got UpToDate for free at UofT, but I am unsure about Residents and Staff. Worth looking into this before you pay for a subscription!

[thestar10]

Medical Students got UpToDate for free at UofT, but I am unsure about Residents and Staff. Worth looking into this before you pay for a subscription!

residents in toronto get it as well.

[A-Stark]

I agree with much of what has been said, except that Toronto Notes should become a doorstop at best after LMCC Part 1. It's not a good reference. 

 

Use things UpToDate for more "point of care" stuff. MKSAP books are helpful for IM rotations. 

[LittleDaisy]

Do you mean that we get access to Uptodate at UofT academic hospitals?

Or we get free membership subscriptions to have access to UptoDate on my Smartphone and my laptop at home? thanks for clarifications!!!

 

I do agree that Uptodate is great, will try the MKSAP books for my IM

residents in toronto get it as well.

[Mithril]

2. As a FM resident when we do off-service rotation consults for IM& surg, are we expected to review w the staff or senior resident before prescribing meds(ATB) and ask for other consultants? I guess that one thing that sucks in academic hospitals is the hierarchy and so many learners!!

You meant that we could order blood tests and imageries before review? That I already did in ER as a CC4 ☺

For meds and consulting it depends on your staff and your and their comfort level. As the rotation progresses you should be having more autonomy, but the surgeons and IM in our hospital are very laid back. Discuss with your staff first and how it's your goal to be completely autonomous.

 

I agree with much of what has been said, except that Toronto Notes should become a doorstop at best after LMCC Part 1. It's not a good reference.

 

Use things UpToDate for more "point of care" stuff. MKSAP books are helpful for IM rotations.

To be honest I've never used Toronto Notes beyond first year. We have a 220-page book on the essential things to know in family medicine, and I supplement my learning from that with UpToDate, which is messy as hell, or eMedicine which has far more streamlined information and is more organized.

[thestar10]

Do you mean that we get access to Uptodate at UofT academic hospitals?

Or we get free membership subscriptions to have access to UptoDate on my Smartphone and my laptop at home? thanks for clarifications!!!

 

I do agree that Uptodate is great, will try the MKSAP books for my IM

You get access with u of t's library. You are able to have access with the apps as long as you sign in online periodically.

[A-Stark]

2. As a FM resident when we do off-service rotation consults for IM& surg, are we expected to review w the staff or senior resident before prescribing meds(ATB) and ask for other consultants? I guess that one thing that sucks in academic hospitals is the hierarchy and so many learners!!

You meant that we could order blood tests and imageries before review? That I already did in ER as a CC4 ☺

 

 

As a senior I would expect you to use your own judgement for run-of-the-mill stuff, but you should review your plans with me, especially earlier on in first year. Definitely order stuff that's part of your planned workup!

[NLengr]

As a senior I would expect you to use your own judgement for run-of-the-mill stuff, but you should review your plans with me, especially earlier on in first year. Definitely order stuff that's part of your planned workup!

In my program all off service residents and junior on service peope reviewed consults with the appropriate senior or staff. The last thing they want is you feeding someone who needs an OR ASAP. Nobody cared if you started non surgical stuff like antibiotics or pain meds before reviewing since they don't really change management plans very often.

 

To be honest, most of the juniors and certainly all the off services weren't comfortable enough to try to manage problems on their own, even though they frequently were doing the right things.

[bentobox1234]

What makes a good PGY1 resident to clerks?  How much teaching did you guys do vs learning as a PGY1?

 

Thanks

[Mithril]

What makes a good PGY1 resident to clerks?  How much teaching did you guys do vs learning as a PGY1?

 

Thanks

I usually taught something every day if I had med students on the service. It helps both me and them.

[ellorie]

I did a bit of both - I did far more teaching as a PGY2 because I was on service and also the only resident on the team.  As a PGY1, most times on team, the senior would do most of the teaching.

 

I think what's useful is helping clerks with the mechanics of how to get stuff done in a hospital, as well as giving advice on things like CaRMS, how to book electives, how to look good on electives, things like that.  As a PGY1 you're the closest to that and so have good insights to share.

 

When I am on-service now and I have medical students that are mine, I generally try to find out their learning goals/specialty of choice so that I can pick topics that will be relevant to them.  I let them know that I want to teach them well, and that I want them to give me feedback about if my teaching style is working or what they would like to be different.  I also try to make time to sit down with them every day, even if it's only 10-15 minutes.  I have some topics that I have prepared that I can teach (mostly "approach to [bread and butter topic]" but I also teach around cases.  If I see a patient with a particular finding, I'll make time to take the medical students and show them how to do that examination.

 

I also send clerks home early when there's nothing to do, and while I do get them to help with paperwork and scut (because as a resident, you need to know how to do that stuff), if it's the end of the day and there's nothing left but scut, I'll often send them home and just tell them to pay it forward when they're residents.

 

And, if they're good clerks (which most of them are) I'll make sure to highlight the good stuff they do to staff and make sure they get credit for helping out. 

 

Just think about what you wanted from your residents when you were a clerk.  For me, I wanted time/attention, positive regard, the sense that I was valued, and teaching that was appropriate to my level and career goals.  And sometimes to go home a bit early.  So those are the things I try to give my clerks.