Residency is unquestionably difficult. Up to this point, individuals in training have thrived in their academic coursework, navigated the workplace during gap years or other early career endeavors, and practiced “doctoring” as medical students. Residents hold (and get paid for!) a single job; in reality, they juggle myriad responsibilities, all while operating under high pressure and moving at breakneck speed.
Some of the diverse roles that residents fill include that of a clinician, a surgeon, an academician, and a professional. This article reviews some of the truths about residency related to these various functions.
The Clinician: What Happens at the Bedside … or Slit Lamp
As a resident, you will spend more time in clinic and see more patients than you likely ever expected. During this time, it is crucial to learn how to conduct an examination, formulate a plan, counsel and treat patients—and do so efficiently. You should strive to meet patients at their level and, whether actively or passively, aim to absorb habits from colleagues to refine a bedside manner of your own.
The Surgeon: What Happens Before and During Surgery
The outcome of any surgery is contingent on preparation. Assuming you are well fed and well rested when you arrive (a large assumption in itself), have you visualized the end goal of the procedure and the steps required to reach that goal? What are the potential pitfalls of each step? What patient-specific factors make the case unique or challenging? Equally as important, how will you react when things do not go according to plan?
In my fledgling career, I have found that the mental aspects of surgery sometimes require a different skill set than that of the clinician. When a surgery does not go as planned, it is important to compartmentalize. The time for conversation and kindness will come. But, in that moment, you must focus yourself at the microscope on the eye with the problem. This can be jarring. It is helpful to be conscious of the situation, stay vulnerable, and debrief with your attendings, fellows, and senior residents when the time is right. You are not alone in the experience.
The AAO’s Experts InSight podcast has an episode titled “Surgical Anxiety and Performance in Ophthalmology,” featuring Jay Sridhar, MD; Anne Wishna, MD; and Royce Chen, MD. In this episode, the surgeons discuss approaches to learning and performing surgery, and they acknowledge the anxiety of this process and the need to find balance to optimize outcomes. It is full of memorable quotes and worth a listen.
The Academician: What Happens Outside “Work Hours”
Doctors go through rigorous training to become experts in their field. Patients come to them—to you—because of the weight of your opinions. They assume that you are well read, so you have a duty to build the requisite fund of knowledge if you care to do your job properly. As a resident, practically speaking, this means reading, completing review questions, attending didactic lessons, and synthesizing all information. It can also mean delving deeper into a specific area of interest through research. You may benefit from taking time to pay attention to the things that you find stimulating; what piques your interest and raises new questions? What skills do you bring to the table that make you an able and willing investigator?
The Professional: What Happens All the Time (ie, Your Identity)
Just about every resident will check the basic boxes for competency in comfortable conditions. You have been thoroughly vetted during an intense application and selection process. But doctoring is a difficult job. Many people rely on you, and you will be judged by how you respond when conditions are uncomfortable. The good news is that you have some control: You decide your professional identity and how others feel in your presence. Show up on time or, better yet, early—and always be kind.
A Final Note on Professional Identity, Self-Worth, and the “Struggle”
You will not be a cookie-cutter applicant, resident, or fully practicing doctor. You come from a unique place, have unique talents, and will boast unique achievements. That is perfectly OK as long as you uphold the basic roles required.
Your training is not an obstacle to be overcome. It is a necessary process that shapes and strengthens you, so let it! Ride the ups and downs, be a sponge, and process your well-being through it all. Lean on support systems as much as you need.
