HealthJune 22, 2020

What to expect as a second-year resident

By: Ajibike Lapite

The transition from intern to second-year resident comes with more autonomy but also new challenges. Here's what to expect when you're no longer an intern.

You did it! You made it through your first year of residency, and, believe it or not, you are soon going to be a second-year resident.

Everyone talks about the significance of the transition from medical student to resident, yet few discuss the transition from first- to second-year resident. Surviving intern year is something to celebrate, and many of you are eager to have that senior resident status. Many of you are also probably anxious about what this transition will mean for your responsibilities.

Here, we'll explore what to expect as a second-year resident — but this discussion comes with the caveat that during a pandemic, residents are expected to be more flexible. Your second year may be a bit different from what you anticipated, given the circumstances.

Expect a double dose of autonomy

I'll be honest: At the end of my intern year, I resented my senior residents. I deplored their “pimp” questions on rounds, and I rarely wanted their help (though I was grateful to have it when I needed it). I was envious of the senior residents who scampered off to their call rooms after rounds, but I also abhorred the seniors who hovered. Now as a senior resident, I have newfound perspective. It's hard to strike the balance between absentee senior and helicopter resident. Still, I understand the plight of internship.

What your second year of residency looks like will depend on your specialty. For those who had a transitional year, your second year of residency will be your first foray into the specialty you love. It may to some degree feel like a new intern year, and so you may not feel like you have (or even want) a significant increase in autonomy.

For others, you'll have less oversight (whether you want it or not) when you're a senior resident. That autonomy isn't as pronounced in nonsurgical subspecialties as in surgical specialties, which is likely due to specialty culture. Because of this, the autonomy shift for surgical residents may be more profound than for nonsurgical residents. This autonomy allows you to exercise the knowledge you acquired as a first-year resident and allows you to practice independent decision-making.

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A boost in clinical complexity

One of my favorite co-residents said hopefully at the end of intern year, “At least we will never feel as dumb next year as we do now.” But we'd underestimated the shift in the nature of rotations for second year.

Residency programs are intentional about which rotations are sorted into each year, so the patients on your services after intern year likely have more complex needs and have higher acuity compared to your prior patients. Use what you learned intern year but recognize that you need to keep building your knowledge base.

Lean into a new role

As a senior resident, you have the opportunity to practice the skills you'll need as an attending: teaching and supervising. It's challenging to supervise first-year residents since you're in the process of learning yourself, but it's such an important opportunity. As a senior, you're not inundated by calls from the nurses or required to change all the orders or complete the documentation. This allows you to take the time to think about the big picture for the panel of patients on your team, which your busy first-year resident will not have time to do.

Life as a second-year resident is different from your first year. You know the hospital system, you understand the electronic medical record and you've started to develop your style of medicine. This year will give you opportunities to show what you've learned and help guide the first-year residents, who will value your tutelage, expertise and support. But some parts of being a senior resident can be challenging, including increased clinical complexity and responsibility. Despite these newfound challenges, senior resident status is rewarding and infinitely better than internship.

Ajibike Lapite
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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