What It Takes To Be A Senior Resident

By Melissa Sparrow

One late afternoon during a retreat at Nourse Farm, a rambling farmhouse on an inlet of the Eastern Shore of the Chesapeake Bay, my colleagues and I began to hatch a list of do’s and don’t’s for senior residents. We were about to become senior residents ourselves—the third and final year of our general pediatrics training—and we felt both anxious and excited about our new role.

One of the important aspects of being a senior resident, at least at Johns Hopkins, is the close interaction you have with interns. Throughout the entire year we would work by interns’ sides and watch them develop into responsible and deeply committed physicians.

To construct our list we solicited ideas from the intern class behind us. We also benefited from our own memories. What did our senior residents do that helped us when we were interns? What might they have done?

I remembered Gail Addelstone, one of my senior residents, an auburn-haired live wire with a penchant for bringing delicious phyllo-wrapped leftovers to share on call nights. When we started our first call night together in February, we sat down together to take sign-out from departing residents. She looked me in the eyes and asked, "How do you want to work tonight? Do you want to be totally independent and page me with questions, or do you want to stick together?"            

Gail’s questions to me throughout the month went on probing the level of interaction I wanted with her. My changing answers reminded me of what protean creatures we residents are. As we develop, we require frequent negotiation and clarification by our mentors of their demands and expectations.

Here’s a list of pooled suggestions for senior residents everywhere, as well as a few of my own thoughts:

1. Don’t talk all the time. Save your words for when they are truly important and necessary. (Even when you are teaching—ask questions.)
   
   
2. Don’t repeat work. It makes the intern feel useless.
   
   
3. Do give positive feedback, specific examples, not vague praise.
   
   
4. Be private with criticism. Interns are already their own harshest judges.
   
   
5. There’s already a lot of stress in a hospital. There’s no need to take it out on interns, or any member of the house staff for that matter. They don’t have the psychological pillow of sleep to soften the blows.
   
   
6. Make sure interns eat. Let them nap, even if there’s only a half an hour of down time in the day.
   
   
7. Remember the interns who have children. They don’t need special treatment, just recognition of the added demands on their lives.
   
   
8. Recognize when an intern is on the verge of tears.
   
   
9. When assisting, don’t ask, "How can I help?" Just find what needs to be done, and do it. Interns always feel guilty and as if they’re supposed to say, "No, I don’t need help," when, in fact, they do.
   
   
10. Laugh when ridiculous things happen.
    
    
11. Get mad occasionally and let the energy of madness allow you to do something useful.
    
    
12. Invoke change.
    
    
13. When nurses ask questions, always respect them.
    
    
14. Break tacit rules sometimes if it’s in a patient’s best interest.
    
    
15. Stand up for each other.
    
    
16. Avoid gossip. It leaves your mouth tasting sandy.
    
    
17. If you’re in a really bad mood, let people know. Say, "I’m in a really bad mood," so others will be prepared.
    
    
18. Keep good wine and brie in the refrigerator at home.
    
    
19. Leave white coats far away from delivery rooms.
    
    
20. If you’re on birth control pills, take them every day.
    
    
21. Continue to ask why University Health Service doesn’t offer Depo Provera.
    
    
22. Know paper scrubs are available in the Emergency Department if
    someone throws up on you.
    
    
23. Motrin is available on multiple floors.
    
    
24. Know that if house staff go home with a code pager, you can always borrow a substitute from the ground floor paging office.
    
    
25. Have lunch occasionally by the Phipps goldfish pond.
    
    
26. Meditating in call rooms, even for 10 minutes, helps.
    
    
27. Set up rules at the beginning of each rotation/service month. Introduce change kindly.
    
    
28. When you feel like you may explode with anger and say something nasty, ask for someone’s help. Say, "I’m losing it."
    
    
29. Smile. Not always, just sometimes.
    
    
30. If you are feeling like you are stupid and everyone else is smart, know that you need a vacation.
    
    
31. If you are feeling like you are smart and everyone else is stupid, know that you need a vacation.
    
    
32. Remember that doctors and medicine are not the center of the world.
    
    
33. Remember your center.
    
    
34. Arrogance is toxic.
    
    
35. Humility opens doors.