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Wednesday Jun 12, 2019

We Made It Through Residency. Here's How You Can, Too

Editor's note: As a new class of family medicine interns begins orientation and prepares for the start of a new academic year, third-year University of Texas Southwestern Family and Community Medicine resident Astrud Villareal, M.D., D.I.M.P.H. -- with help from her faculty mentors -- compiled the following tips for future family physicians.

[helpful tips on blackboard]

Your Why, Your Resources and Your Mentors

Recall the hours you spent critiquing your residency personal statement. Perhaps you sent a draft to an English major friend who reminded you to change your verbs to a more active form. You spent time and energy perfecting it because what you were saying -- why you chose family medicine -- mattered. Hold on to that why. Hold on to that personal statement. Our personal whys give meaning and purpose to what we do.

Residency is a rough road. There will be moments when you will need to refresh your memory about the reasons you stepped onto it. When those moments appear, remind yourself of your why.

While you are on this road, remember that residency is demanding, time consuming and sometimes frustrating for everyone. Rules change from rotation to rotation. Just when you feel comfortable in one area, you switch.

One way to help ease the struggle is to know your resources. Do not limit resources to items like The Washington Manual of Medical Therapeutics or VisualDx (though both are great). Remember that people -- fellow residents, residents from other programs, faculty, behavioral health teams, social workers, pharmacists and more -- are also valuable resources. Spend time with a senior resident and learn how they maximized learning opportunities without sacrificing their hobbies and well-being.

As you begin residency, equip yourself with the right tools from the start and hold onto ones you find along the way. It can be exhausting, but it is rewarding.

Finding mentors is an important part of equipping yourself. If you had to think about it, I'm sure it would not take long to identify a mentor who already helped you during your journey to family medicine. As you transition from student to resident, it's important to find another mentor who can help you navigate your new role.

Mentors have built wisdom from a culmination of personal experiences, challenges and learning opportunities. Yes, they are able to point out areas that need improvement, but they are also your biggest cheerleaders, and as a resident (who might already be critical of yourself to begin with) you should have cheerleaders.

As I near residency graduation, I reflect on the importance of having mentors who challenged me in various ways, especially to establish boundaries -- reminders that while residency is an important part of my life, it is not the only part.

-- Astrud Villareal, M.D., D.I.M.P.H., PGY-3, chief resident, University of Texas Southwestern Family and Community Medicine Residency

Hobbies, Reflection and Help

Remember what you wrote on the "hobbies and interests" section of your application to residency? As a faculty member reading residency applications, I often ask interviewees about these and truly enjoy speaking to applicants whose eyes brighten when I ask about an unusual hobby. Seeing an applicant's passion for something nonmedical reassures me they will be able to handle the rigors of residency.

As a resident, when a harsh attending's words or a frustrating patient experience made me question my abilities as a physician (or worse yet, my worth as a person), turning to outside hobbies reminded me of all the talents and skills I have, and prevented a single rotation experience from influencing how I view myself.

Furthermore, I realized that attempting to fill every waking moment with studying or focusing on medicine actually tipped me in the direction of burnout. But when I gave my brain, heart and spirit a break from resident duties, I came back to work refreshed, came back to studying with more focus and came back to resident life with renewed zeal for family medicine. Though it may seem counter-intuitive, maintaining interests outside of medicine protects against burnout, augments physician performance and makes it easy to create human connections with patients.

It also helps to reflect on what it means to be a physician. As an applicant, I enjoyed the residency interview trail because many of the questions required me to think deeply and articulate how my experiences in medical school had fostered my growth as a physician and a person. Then residency began -- and with the often-overwhelming pace and volume of work, it was easy to get lost in daily routines without stepping back to reflect on the gravity of what we do daily as physicians. These moments can affect each of us profoundly, sometimes leaving lasting impressions -- or wounds -- that we may not readily notice.

Formal venues like support groups or Balint groups in residency are opportunities to safely discuss such experiences with peers and mentors, but I have found other strategies equally helpful. Opening up to a close friend or family member, regardless of whether they are in the medical field, has often helped me get frustrations off my chest or allowed me to share a proud moment. Sharing stories with those outside medicine has reminded me of the sanctity, privilege and burden inherent in being a physician that can be forgotten when one is immersed in work all the time.

Regarding those burdens, it's helpful to consider a tradition from my residency where each resident shared a three-minute "about me" presentation. This included answering the question, "When I am stressed, you can help me by …" It forced me to really think about how I react to stressful situations and how I interact with others during times of stress. Because of the variety in our responses to stress, those around us may not understand how to help us in these moments.

The value of telling others how to help is that it allows us to be proactive and intentional about recognizing our own stress management methods and communicating these to our colleagues. The end results are a better understanding of ourselves and a tailored approach to how we can best support each other.

-- Turya Nair, M.D., associate program director and assistant professor, UT Southwestern Family and Community Medicine Residency

Relationships, Acceptance and Boundaries

My first tip is a two-for-the-price-of-one. First, the training process affects not only residents, but also their friends, family and significant others. Stressful work environments can create imbalance, distance and conflict at home.

It's important to stay cognizant of how the stresses of residency can spill over to close relationships, and how you usually share them. Telling friends and family about the daily and structural elements of residency -- including choices, stresses, constraints and cultural rules -- can help them feel informed and better able to support you during this learning process. It can be hard to remember that although you're embedded in the training process so intensely, people outside of it really have no idea how it works. Being transparent with loved ones can help decrease negative spillover effects and promote closeness.

Second, residents should not be responsible for ameliorating everything that threatens physician wellness, and self-care alone will not be enough to thrive. Close relationships can be key to promoting resilience, so maintain connections with others -- even if how you connect is a little different because of residency work schedules. Let people know if you're struggling, invite them to support you and let them in when they offer.

With all these challenges, try to remember what is in your power to change and what isn't. I regularly use a secular version of the Serenity Prayer to help calibrate my actions and reactions in medicine: "I aim for the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference." I even teach it to patients.

If you're facing a frustration, can you do something about it? Do you have the necessary agency, power, resources and support to help make a change? And if not, can you mindfully accept what is, rather than hitting your head against a wall or repeatedly throwing yourself under the bus in attempts to save the system?

Keep these boundaries in mind -- and others. Boundaries define who you are, what you're responsible for, and how you want to exist within your training program and workplace. Setting boundaries includes giving yourself permission to say "no" to new tasks.

If "no" is too challenging, start with, "I'll take some time to think about that." Then reflect in private and return with either, "yes" or "I've decided I don't currently have enough time to devote to this task in order to do it well." You might also be able to suggest others who could take on the task in question.

Know what your limits are and respect them. Residency and health care systems will always ask for more of you, and that doesn't change when you graduate. Use the many opportunities during residency to practice defining your boundaries, what you can take on and your professional identity. This will make it easier to do so in the future.

-- Sarah Woods, Ph.D., L.M.F.T., director of behavioral health and assistant professor, UT Southwestern Family and Community Medicine Residency

Astrud Villareal, M.D., D.I.M.P.H., is a board-certified family medicine physician finishing her last year of residency at UT Southwestern Family and Community Medicine. She will be joining the residency faculty and will focus on curriculum development, global health and population health. You can follow her on Twitter @rechargeability.(twitter.com)  

Posted at 10:30AM Jun 12, 2019 by Astrud Villareal, M.D., D.I.M.P.H.

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