The Medical & Surgical Residency Survival Guide

How to Build a Tactical Advantage for Success

McMahon, Daniel

• Publisher: tfm Publishing Ltd
• Year: 2019
• ISBN:
  9781910079683
• Topic: Médecine
• Subtopic: Théorie, pratique et référence de la médecine

Are you a medical student about to graduate from medical school, an intern or junior resident muscling through the early years of your formative residency training? If so, this book was written for you. The transition from medical school to residency training is a challenging and transformative experience; life as a resident physician is drastically different to what most experience during their clinical rotations in medical school. You will undoubtedly approach the transition with a combination of emotions including enthusiasm and eagerness but also trepidation and apprehension. This survival guide will serve to temper these emotions and transform them into a sense of confidence as you progress. The book's focused, honest, and straightforward approach addresses the unique challenges encountered in residency training and discusses a number of strategies to facilitate tactful navigation of these challenging waters. This easily digestible volume concisely outlines a combination of principles that will help you become a highly motivated, adaptable, and successful trainee. The book spurs self-reflection that can be applied to develop the strength, perseverance, and endurance to succeed when the going gets tough. Each chapter contains valuable insight that trainees can draw from regardless of specialty. By utilizing and employing the tools discussed, opportunities presented throughout the course of your residency training and beyond can be translated into successes that you will continually be able to build upon, hone, and polish throughout your career as a respected and well-rounded physician and professional.

Part I

RULES OF ENGAGEMENT— CALIBRATE YOUR BRAIN FOR SUCCESS

You can never cross the ocean until you
have the courage to lose sight of the shore.

Christopher Columbus

Chapter 1

It’s a grind — play the long game

Rome wasn’t built in a day.

There is no way around it. Medical residency and surgical training is an all-out grind. You will progress through one morning of rounding at a time, one day at a time, one night at a time, and one shift at a time. You will endure one clinic patient, one inpatient or emergency department consult, one trauma alert, one procedure, or one operation at a time. You will press on one week at a time, one month at a time, and one year at a time. You get the idea. This is an ultra-marathon not a sprint.

At times your training will seem like an indefinite apprenticeship that is rife with challenges and unforeseen obstacles along the way. The price required to complete your training is steep and will include blood, sweat, tears, and sacrifice. There are also great rewards along the way. Do not forget that. And yes, your training is a means to an end.

At times your training will seem
like an indefinite apprenticeship
that is rife with challenges
and unforeseen obstacles
along the way.

“What is the end result,” you ask?

The end result is to be a confident, competent, intelligent, capable, successful, and well-rounded physician in whatever field of medicine you strive to become board-certified.

Like medical school, residency is a grind but on an entirely different level. The level of responsibility is vastly different in internship and residency than what most experience in medical school. While you are not the attending physician of the patients you will be caring for, you are directly responsible for the day to day execution of patient care at the ground level. From inpatient to outpatient responsibilities, and everything in between, you will carry the lion’s share of direct patient contact among a large cadre of physicians in whatever institution you find yourself training.

You will order medications, laboratory studies, and radiographic studies. You will work among a wide array of different clinical services depending on your path of training. You will perform inpatient rounds, see inpatient consults, and experience a litany of outpatient clinical encounters. You will write thousands of patient notes, consultation reports, discharge summaries, and operative reports. You will chase down lab results, imaging studies, and consultation advice like a bloodhound in hot pursuit of Cool Hand Luke. You will perform procedures and operations. You will change dressings and place lines, tubes, and drains. The list goes on and on.

In addition to all of this clinical work, you will prepare for lectures, presentations, academic conferences, and board examinations. You will work in a measure of academic research and maintain some semblance of a personal life outside the grasp of the black hole that will be your training as a medical or surgical house officer. You will work eighty hours a week on average; sometimes more and sometimes less.

Get the idea? You will constitute the backbone of direct patient care throughout your residency training and all the while you will maintain your sanity and drive to tread on.

Take this seriously. Your patients and your medical team are depending on you. You would not have made it to this level, or be performing at this level, if you did not take things seriously. However, we all get tired, complacent, and burned out which at times requires us to remember this is not just a game we are slugging through.

This is real life and these are real people with real illnesses. This is real pathology and these are real traumatic injuries with patients desperately clinging to life. These are real patients who are anesthetized under hot operating room lights and lying on a cold operating table. Their lives are in your hands and there are real consequences awaiting one false move if you do not stay at the top of your game.

You must commit to the long
game. Residency is a slow burn.
Completing your training does
not magically occur overnight.

You must commit to the long game. Residency is a slow burn. Completing your training does not magically occur overnight. Seek to execute realistic goals in the short term to achieve unrealistic goals in the long term. Sometimes the realistic short-term goal is merely dragging yourself through the wee hours of a thirty-six-hour call shift as a means to bringing the unrealistic long-term goal of completing your residency training to fruition.

You must transform this seemingly insurmountable and monstrous task into many small tasks that you can more easily approach and chisel away at one swing at a time. You cannot eat an eighteen-ounce steak in one bite. It takes many small bites and it takes time. If you try to swallow a whole steak in one bite or engulf your training whole like a hungry macrophage juiced up on cytokines you will choke and asphyxiate. Confront this training process one day, one night, one shift, one patient, one consult, and one operation at a time. You must approach this behemoth in small digestible bites lest it will consume you and your sanity.

Confront this training process
one day, one night, one shift, one
patient, one consult, and one
operation at a time.

Throughout residency you must learn to live in the moment. Be the best you can be in the moment and execute to the best of your ability in that moment with intense laser-like focus. Learn to harness and utilize this focus for every clinical question thrown at you, during every patient encounter, with every history and physical you write, with every incision you make, with every suture you place and tie, and with every electrocardiogram or chest film you read.

Be the best you can be in the
moment and execute to the best
of your ability in that moment
with intense laser-like focus.

You cannot waste time constantly worrying about the end result or you will not react, act accordingly, and execute in the here and now. Do not find yourself continuously ruminating about the end result or what lies ahead. Things will take care of themselves and things will fall into place as long as you tackle what is standing right in front of you, right there in the clear and present, and keep pressing forward.

Conversely, during this lengthy training pipeline you must remind yourself of the big picture by mentally breaking things down on a very simplistic level and seeing things from a thirty-thousand-foot view rather than right up close. Take a step back and zoom out from time to time. Learn how to keep the big picture centered in view as your main focal point, rather than being distracted and confused by every last-minute detail exhaustingly vying for your attention.

If this is interpreted as doom and gloom it is not meant to be. This is meant to be realistic, honest, and authentic. Take the challenges of your training head-on. Take the bull by the horns and you will reap the rewards hand over fist from how gratifying the practice of medicine and surgery can be if you take it one step at a time and be the best you can be with each small step along the way.

Some call us crazy for willingly taking this kind of a commitment on board. Maybe we are a little crazy to endure this training but remember that the sacrifice will be worth the rewards. Your training is a noble and worthy adversary. You will succeed in becoming a soldier against pathology, pain, suffering, illness, and injury. You have a gift and a drive to achieve that most folks cannot even begin to fathom. Go out and show the world what you have got. You will reach the summit and you will become a much stronger person as you progress along the path that will ultimately lead to the culmination of your medical training.

You have a gift and a drive to
achieve that most folks cannot
even begin to fathom. Go out
and show the world what
you have got.

Chapter 2

Perseverance & endurance

Aut inveniam viam aut faciam.
~ I shall either find a way
or make one.

I have had the unique and amazing experience of working with, and deploying with, the Naval Special Warfare — Navy SEAL — community during my military service. I learned several invaluable lessons about perseverance and endurance from these elite warriors that I think are well worth taking on board. Take these lessons on board as a medical resident or surgical trainee who is battling it out day by day in the trenches of clinical warfare wielding only a stethoscope and a reflex hammer as your sole weapons of force protection. These lessons will challenge you to approach life on an entirely different level and will change your life for the better if you commit to them. These powerful nuggets of knowledge and motivation are as follows:

First:

Remove “I can’t” from your vocabulary. By simply mumbling the words “I can’t” you are accepting defeat before you ever take the first steps in executing a goal, task, or mission. Eliminate “I can’t” right out of your head space and incinerate it with impunity. Let others say “I can’t,” and thank them for it because they are opening space for you to take the world head on and exude success from every fiber and pore of your being.

Remove “I can’t” from
your vocabulary.

You are not a defeatist. You have the guts, the strength, the endurance, the courage, and the perseverance to do what it takes. Saying, “I can’t,” is really just feeling sorry for yourself because you do not think you are good enough. You have got what it takes. When you purge “I can’t” from your vocabulary, you will gain the upper ground and possess a powerful and tactical mental advantage that will allow you to posture, attack, execute, and conquer your training.

Second:

Sustain the mental attitude, “You will have to kill me before I quit.” If you have true purpose and are truly committed to doing this and doing this right, you will either do it or die trying. This may sound a little extreme when we are talking about completing medical residency or surgical training as this is not actual military combat. That is quite true. However, committing to this ethos will frame your attitude into one of perseverance and endurance that few can attest to and will ensure your success in completing residency with unrivaled performance and an outstanding attitude.

Sustain the mental attitude,
“You will have to kill me
before I quit.”

Third:

When you think you have hit a wall or that you are at the brink of complete physical exhaustion, you have only exhausted forty percent of your true capacity. If you find yourself halfway through a call night thinking you cannot possibly make it through another minute, one more call from the transfer center, one more page from the ICU or floor, one more consult from the ED, or one more emergent operation, remember the forty-percent rule. Keep digging deep. You have got what it takes. Keep grinding forward. Take a deep breath and push on; one foot in front of the other. Do you want to be an elite warrior or just some schmuck who cannot hack it?

When you think you have hit a
wall or that you are at the brink
of complete physical exhaustion,
you have only exhausted forty
percent of your true capacity.

There will be days when you think you might not be able to power through. When this occurs, you must find the motivational spark that is waiting to be lit somewhere deep in that cerebral cortex of yours. Be able to reproduce that mental spark of motivation and be able to access it readily. Is it your spouse, your children, your family, your friends, or your spiritual life? Is it money, fame, or fortune? Wha...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• FOREWORD
• ABOUT THE AUTHOR
• SPECIAL THANKS
• DEDICATION
• REVIEWS
• PART I RULES OF ENGAGEMENT — CALIBRATE YOUR BRAIN FOR SUCCESS
• Chapter 2 Perseverance & endurance
• Chapter 3 Mental strength & fortitude
• Chapter 4 Availability, affability, & ability
• Chapter 5 There is no substitute for experience
• PART II HOW TO PLAY THE GAME
• Chapter 7 Delegate
• Chapter 8 Use the chain of command
• Chapter 9 Ask for help
• Chapter 10 Avoid drama like the plague
• Chapter 11 Don’t forget the administrative minutiae
• PART III PROFESSIONALISM
• Chapter 13 Communication
• Chapter 14 Integrity & character
• Chapter 15 Check your ego at the door
• Chapter 16 Arrogance, braggadocious, & the surgical dragon
• Chapter 17 Roundsmanship
• Chapter 18 The morbidity & mortality conference
• PART IV TALKING TO PATIENTS & FAMILIES
• Chapter 20 Delivering bad news
• Chapter 21 Empathy
• PART V PROVIDER WELLNESS
• Chapter 23 Exercise
• Chapter 24 Sleep
• Chapter 25 Work hard, play hard, & better living through chemistry?
• Chapter 26 Physician burnout
• PART VI FAMILY, FRIENDS, & FINANCES
• Chapter 28 Finances
• PART VII ONGOING EDUCATION
• Chapter 30 Research
• Chapter 31 Professional organizations & societies
• PART VIII MENTOR, TEACH, & LEAD
• Chapter 33 Teach
• Chapter 34 Lead
• AFTERWORD
• Back Cover