HealthFebruary 07, 2020

3 things residents should avoid

By: Kunal Sindhu, MD

Residency is an extraordinary period in a physician’s life. During this time, you will learn how to translate all of the knowledge and skills you learned in medical school into patient care. That said, residency can present enormous physical and emotional challenges to new doctors. You will work long, grueling hours in conditions of unprecedented stress.

Succeeding can mean navigating some tricky pitfalls. Here are three resident issues you may face and how to manage them.

1. Fear of making mistakes

Residency can be a scary time for new trainees. While you will work under the supervision of attending physicians, you will have far more freedom and responsibility in the care of patients than you ever had as a medical student. The impact of your decisions, both good and bad, will be much greater.

This dynamic can breed decision paralysis. You will inevitably find yourself in situations in which the next step in management is not clear. In these contexts, with so much riding on your decisions, it’s not uncommon to fear making mistakes.

This isn’t necessarily a bad thing. A healthy level of fear may help temper overly aggressive management instincts and can help ensure patient safety. At the same time, fearing mistakes to the point of indecision can prevent your patients from receiving the care they need. For example, you may fail to make critical decisions in a timely manner.

Striking the right balance is key. Having reached residency, you have already spent years stockpiling medical knowledge. If you’re sure about the next step in management, trust yourself. In these cases, try not to let a fear of making mistakes paralyze your routine decision-making process and jeopardize the care you deliver.

However, if you have any doubts about the next step in the management of a patient’s care, make sure to consult with your senior residents and/or attending physicians. If you don’t know how to proceed, it’s completely acceptable—and preferable—to ask for help. The safety of patients always comes first.

Want practical advice for your internship year? Check out The Washington Manual Internship Survival Guide!

2. Imposter syndrome

With all of the new challenges you will face in residency, there will be moments when you feel overwhelmed. In the face of such challenges, some residents may even come to persistently doubt their clinical capabilities, a phenomenon known as imposter syndrome. As defined by an article in JAMA, imposter syndrome “is a psychological term that refers to a pattern of behavior wherein people (even those with adequate external evidence of success) doubt their abilities and have a persistent fear of being exposed as a fraud.” While it disproportionately affects women and minorities, Stanford Medicine notes, anyone can develop imposter syndrome.

As with fear of making mistakes, harboring some degree of self-doubt can be a good thing. Self-doubt can stimulate intellectual curiosity, leading you to useful medical knowledge. It can also lead physicians to reach out to their colleagues for help when they’re unsure how to proceed in difficult clinical situations. Both of these things can protect your patients’ well-being.

But harboring too much self-doubt in the form of imposter syndrome can be damaging. As the JAMA article points out, imposter syndrome can have unfortunate results, including lost clinical and research opportunities. Moreover, according to a study in the International Journal of Medical Education, imposter syndrome has been linked to burnout, which has consequences for both resident physicians and their patients.

Achieving a healthy medium between too little and too much self-doubt is the best approach. As the JAMA article notes, the prevalence of imposter syndrome in American medicine is a complex systemic issue that will require profound cultural changes to remedy. However, if you find yourself constantly doubting your ability to practice medicine, there are a few strategies that you can pursue. Acknowledging your feelings and discussing them with trusted confidants can help you recognize when you’re experiencing episodes of extreme self-doubt. It will also help you reframe these negative thoughts when they arise, giving you the opportunity to build a more positive outlook. Seeking guidance from mental health professionals as needed may also prove beneficial.

3. The need to show off

While some may respond to resident issues like fear of making mistakes or imposter syndrome by shutting down, others may spring in the opposite direction, taking every opportunity to demonstrate their knowledge and abilities.

By the time you reach residency, you will have spent thousands of hours preparing to become a doctor. You should feel proud of your accomplishments, but you should also strive for modesty. You will frequently encounter patients, their families and your colleagues in emotionally charged clinical scenarios. Maintaining humility is essential to successfully navigating these stressful environments. Modesty will help you relate to others and facilitate personal growth. By gaining awareness of your weaknesses, you’ll be less likely to overlook learning opportunities.

In the interest of humility, avoid the temptation to show off. As a member of a large care team, it’s important to maintain strong relationships with your colleagues, and any perceived arrogance can alienate individuals who are essential to your clinical success. It can also turn off patients and their families, thereby jeopardizing the patient-physician relationship, as a Patient Education and Counseling paper notes.

As a resident trainee, your most important goal should be to learn how to practice medicine safely and effectively. Be prepared to work hard and try to avoid the common residency pitfalls discussed here. Most importantly, take care of yourself.

Kunal Sindhu, MD
Lippincott® Medicine
Lippincott is a leading international medical publisher of professional health information for practitioners, faculty, residents, students, and healthcare institutions with a full suite of essential medical products, from books and journals to digital solutions.
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