Contributing authors: Alice Lin, MD (2nd year resident, Case Western Reserve) and Dan Knoch, MD (2nd year resident, University of Wisconsin)

“What I Wish I’d Known Then” is a series of reflective articles that will enable young ophthalmologist and senior residents and fellows to provide valuable insights to their younger colleagues engaged in the training experience.  This article focuses on the “First Year of Residency.”

Overwhelmed, short of time, sleep and knowledge – reoccurring themes for today’s first year residents.  Due to the established teaching regimen in medical school, where very little time is spent on ophthalmic subject matter, most med students are forced to take a leap of faith when deciding to pursue ophthalmology.  So naturally, when the first year of one’s residency begins, self-assured feelings and youthful exuberance are replaced with warranted thoughts of inadequacy and unpreparedness.  “To put it bluntly, it’s ok to feel stupid,” states Dr. Alice Lin, a second year resident at Case Western Reserve, “medical school doesn’t teach much about ophthalmology.  Coming into residency, you feel like you should know so much more.”

So, what do successful residents do to overcome this first year fact of life?  First, be prepared for those feelings and mentally strategize how to proactively handle them.  “I made it a priority to ask the attendings what their expectations of me were,” said Dan Knoch, MD and second year resident at the University of Wisconsin in Madison.  “It’s also a good idea to ask the attendings how they learned the information, they have some great insight and should know a variety of tactics they’ve seen employed by other residents over the years.”

Taking full advantage of exchanges with the attendings is a good way to start the year.  Share your motivation, what excites you and what you hope to learn from the attendings, this is sure to establish the groundwork for solid working relationships.

Listening and watching attendings and senior residents is also critical in leveling the learning curve.  Dr. Lin reported that having sharp listening skills and taking thorough notes helped tremendously.  “Break procedures down and do them step by step.  Don’t worry so much about speed – that comes later.”  Another helpful mind set, according to Dr. Lin, is to, “Act one level above yourself (mimic the second year residents) and you will achieve greater competency more quickly.”

Not all first year residents are aware of resources available to them on topics from fellowships to new procedure methodology.  Stated Dr. Knoch, “It’s never too early to begin thinking about and preparing for life after residency.”  CareerPhysician offers a variety of resources for residents at all stages of training.  “I didn’t even know, what I didn’t know!”  reported Knoch.  Stay abreast of what the pharmaceutical representatives are planning as they routinely offer educational programs with guest speakers on a variety of subjects.

Outside of the hospital, check into taking a short term externship.  Many community physicians are more than willing to offer shadowing programs, which can offer multiple benefits.  Not only will you get a better understanding for day-to-day life in private practice but also you’ll be networking with possible future benefits.

Dr. Lin’s Clinical Resource Picks
–    Audio Digest on CD
–    Ophthalmic Hyperguide – Access presentations, tutorials and online lectures, free registration.
–    New York Eye and Ear – on line board review, free download.
–    Wills Eye Manual

The first year in residency is bound to challenge you in many unexpected ways.  It’s important to maintain or develop a healthy balance between work and your life outside of work.  Dr. Knoch cautions first years to not forget to balance the heavy call schedule with the home life.  “When I had a particularly difficult day, I worked hard to arrive home happy.  Taking time with my family helped put things in perspective, so even when I was tired, I made a point to do something fun with my wife and kids when I got home.”  Also, calling on family or close friends to help out occasionally is a good idea.  “It may sound overused,” says Dr. Knoch, “ but taking your spouse out for date night is necessary for a healthy relationship.”  Little niceties can, and do, go a long way.

“Reflecting on my first year, I think it’s important to ground yourself and get ready for your career.  I realized that I was participating in a marathon.  The medical school sprint mentality had to go,” stated Dr. Lin.  Being proactive and learning how to circumvent negative situations is key to a successful first year in residency and beyond.  Employing solid time management and organization skills hot link to Time Management article here will help alleviate some stress.  Some helpful hints are listed below:
–    Be a list maker
–    Bring a clinical book to read while you’re on call or waiting for appointments or meetings
–    Study with friends/colleagues to incorporate social time while improving your knowledge level
–    Utilize audio CD’s (Audio Digest is a good resource) while driving or traveling on weekends or for holidays

Whether you are in your first week of residency or at the end of the first year, challenges will come your way in many different forms.  By paying close attention to those around you and leaning from them, utilizing resources available to you and working efficiently, you will increase your likelihood of coming through the experience as a smarter and savvier physician.

What I Wish I’d Known Then – 1st Year Tips
•    Ask the attendings what they expect from you during orientation or during your first meeting with them.
•    Allow yourself six months to get comfortable with the basics of ophthalmology (don’t feel badly for not knowing more than you do at the beginning of residency).
•    Be a list maker and be as organized as possible.
•    Bring short study aids or books to read while on call
•    Schedule ½ day a week of “down time”
•    Ask the attendings and third year residents questions and pay close attention to what they say and do.
•    Focus on breaking procedures down into manageable tasks and learn the processes well.  Speed comes secondarily.