July: A New Year in Medical Education, A Program Director’s Musings

Photo credit: © Nevit Dilmen [CC-BY-SA-3.0 or GFDL], via Wikimedia Commons

January no longer signals the beginning of a new year for me. And not even September, with the hint of crispness in the air, the promise of waves of panoramic color across the landscape, and the scent of new books and lunch boxes, can fill me with the anticipation of a brand new year. As a medical educator, July has come to signify the beginning of a new year: new interns, new residents, new fellows and new attendings. One of my colleagues said to me recently that the majority of doctors retire at the end of June, before the beginning of a new academic year. That makes sense to me.

The goodbyes that spanned months to our now departed residents are abruptly over. Their places are robustly filled with the eagerness and competence of residents ready to take on their role of supervisor, ally, and teacher to the new interns who are filled with anticipation and the ripeness of finally becoming physicians. I tell the interns at orientation that no words can adequately prepare them for what’s to come. I liken the experience to being a parent for the first time. Though much advice is dispensed, budding parents reject much of it, and typically they think they’re prepared for life-altering circumstances. And immediately after the baby is born, you see their hollowed out eyes, the recalcitrant fatigue, and the moments of triumph when they’ve managed to hit upon what makes the baby stop crying. All the baby furniture they bought, the black and white toys because those are the only colors babies can perceive, the safety gadgets, all of these are security blanket measures only – nothing to do with what is really required for the job of parenting. It is difficult, and yet their lives have taken on a new fullness and meaning.

It’s like that for interns. Nothing can prepare them for what’s truly to come. We try. We tell them that their lives will never truly be their own again. That their lives will belong to their patients as they learn accountability. We tell them that their personal lives and actions, personal and work-related, must reflect a deeply ingrained sense of professionalism because you never know when you’re going to run into a patient. That they must get enough sleep when they’re off duty. That the duty hour restrictions were devised with the purpose of promoting patient safety and quality, and that fatigued and sleep deprived doctors are not able to provide the best of care. That they are supposed to use that time off for sleeping, reading and honing their fund of medical knowledge, and taking care of themselves so that they could be their best selves for patients.

Their pockets are bursting with stethoscopes, tuning forks, manuals, iPad minis, to-do lists, patient sign-out sheets, and yes, these are useful aids, but only symbols that hint at being good doctors. The most important work will be reading voraciously, knowing when to get help, being present with patients and learning what it means to be an integral member of the team. Submit to the process is what I always tell the new interns. Fighting it won’t help. Sometimes I think that present day residents have it worse than we did, the dinosaurs, – they’re expected to do the same amount of work in less time. Electronic medical records (EMRs) while developed to augment patient safety and quality and render the record legible have in many senses complicated the work-flow, and have not left enough time for us to spend meaningful time engaged in patient care. Those of us who’ve been doing this for a while know that the only way to combat physician burn-out is to spend meaningful time with the patients and each other.

The enormity of what is expected can be overwhelming and must be managed.

And yet, the practice of medicine offers the opportunity to help someone each day, to offer comfort, to interact with colleagues using our best selves to determine the best courses for our patients and when we’re really feeling lofty, the future of medicine. The interns are an integral part of the front line of medicine – they see all that’s beautiful about medicine and all that doesn’t, quite simply, work. To them I say, Submit. Sleep. Read. Eat. Exercise. Have fun whenever possible. Realize that you’re up to the task. You will survive. This year will pass. And when it does, an eternity will have elapsed. Then I will see you as residents, confident in what you’ve learned, managing patients and your lives, your eyes gazing upon the future and varied paths you will take, and I will be bursting with pride and joy at your growth.

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