Every resident will need help: Encourage them to ask for it

As a residency program director, I marvel each spring that learners who arrived as nervous young medical school graduates have become board-eligible family physicians in three short years. As residency graduates launch themselves into the world and a myriad of opportunities, programs welcome a new cadre of interns.

Three decades after my own residency graduation, I can only imagine the feelings of today’s newly arrived interns. They are eager to prove themselves but also saddled with a large side dish of imposter syndrome. They are certain that everyone knows more and is better organized than they are, and some fear that soon we will find out just how little they know.

I try to convey to interns during orientation that I trust them and have confidence in their capabilities. I joke, “Once again, we matched the top 12 applicants on our list.” Balancing that, I also discuss the many ways in which the program is available to help residents when they need it.

One of the major changes we made during my time at the University of Rochester’s Family Medicine Residency is the concept of using “progress committees” to address educational and behavioral issues before they reach the level of probationary concerns. The name reinforces the underlying intent: Programs want their residents to succeed, to flourish and to progress. We all work together to make that happen.

Progress committees are ad-hoc groups of two or three faculty, convened by the program director for a particular resident when it seems the trainee is struggling to address an issue. A progress committee meets with the resident on a regular basis to address the issue and formulate exercises and interventions to help resolve the problem.

This approach stands in stark contrast to a judgmental probation, a trial period in which failure results in removal from the program.

In some cases, I have been amazed how long it took for a resident’s concern to surface. Why didn’t they ask for help sooner? During the AAFP’s Residency Leadership Summit in March in Kansas City, Missouri, plenary speaker William Cutrer, MD, MEd, from the Vanderbilt University School of Medicine, suggested that many of us in academic medicine go overboard in our praise of trainees. In doing so, he said, we unintentionally define what we see as an ideal resident: one who is already self-actualized and needs only minimal help, if any at all.

How difficult must it be for a resident to ask for help after their program director has put them on a pedestal?

When I ask my patients about medication adherence, I try to normalize nonadherence. Instead of asking if they take their medication, I say, “Everyone forgets to take their medication from time to time. It’s human nature.” (When appropriate, I add, “especially when they are on as many medications as you!”) I try not to ask in a way that conveys judgment. Instead of saying that “good” patients take their medication and “bad” patients do not, I try to convey that they are somewhere on a continuum with all patients.

Following Cutrer’s inspiring RLS presentation, I am going to make it a point to tell incoming interns that ALL of them are going to need extra assistance at some point in their training. It is not true that “good” residents don’t need help and “bad” residents do.

We need residents to know that the earlier they come to us with concerns, the easier those challenges will be to address. We need them to understand that residency education is a partnership between residents and their program, and we want success for both the resident and the residency.

I need to convey that I trust my residents—not to be perfect and never need help, but to be honest with me and to let me know when they need help. Asking for help should not be seen as a sign of weakness.

From the resident perspective, as difficult as it is, they need to stifle the imposter syndrome and its irrational sequelae (of being tossed out of the program, humiliation, etc.) and be honest with themselves first, and then with the program, in asking for help.

Program directors never want to fire a resident. It is a rare occurrence, and it is always agonizing for any program director. There often are resources within a program and its faculty to help address underlying issues. Sometimes we might not immediately know the solution to a resident’s problem, and that’s OK.

At the end of my first year of medical school, I attended what is now FUTURE (formerly the National Conference of Family Medicine Residents and Medical Students). The AAFP president at the time offered a vision of a family doctor that stuck with me. He said he told his patients, “You can come to me with any problem. I might not know the answer, but I will be with you while we find the answer together.”

Our residents would benefit greatly from the same kind of grace. Ultimately, helping a resident overcome a challenge, rather than taking punitive action, benefits our programs and communities as well.

Stephen Schultz, MD, FAAFP, was the longtime program director of the University of Rochester Family Medicine Residency in Rochester, New York. On November 1, he will become the program director of Novant Health’s New Hanover Regional Medical Center, in Wilmington, North Carolina. This post is based on a session Schultz presented with current Rochester program director David Holub, MD, FAAFP, in March at the AAFP’s Residency Leadership Summit.