Medical Residency The first months of medical residency are the most stressful, residents say
By Jason Schultz
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n 2012, approximately 25,000 firstyear residents were matched to a residency program in the United States, out of almost 40,000 applicants. The University of Rochester Medical Center at Strong hospital each year welcomes dozens of first-years, or interns, to a variety of medical disciplines. A recent visit to the hospital shed light on the duties and challenges faced by newly-minted M.D.s. One of the newest members of the Strong medical resident staff is Lauren Loss, an intern in the neurology program. Loss says a usual day for her begins around 5:45 a.m., when she signs out patients from the overnight shift interns, ensuring the care of her patients is transferred properly. Then it is off to the lab to check on her patient’s medical tests from the day before. After checking the charts and taking notes, Loss makes her rounds, spending time with up to eight patients to whom she is assigned. Around 9 a.m., Loss and the other residents in her group meet with Don Gullickson III, the attending physician overseeing their team. Along with Gullickson, the group does its rounds in the emergency room, meeting with several patients to give care and offer a teaching opportunity to residents. During rounds, one resident reviews the patient’s chart, along with any new information and changes in condition. Gullickson next asks questions of the residents to help them determine the best course of action in caring for each patient. One patient visited that morning was Margaret Murphy, who was recovering from a serious heart infection. The residents were checking up on her condition and tending to some sideeffects following her health problem. Murphy said she was feeling much better, though she complained of some swelling in her legs. “You guys are all awesome,” Murphy said. “You are all doing a fantastic
job with your care. The teamwork is amazing here. You are the reason I am back to where I am today.” This hands-on interaction is vital, Loss said, to developing interpersonal skills. “Having a good bedside manner is very important; if you have a bad rapport with patients, they won’t want to work with you in managing their healthcare issues,” she said. “People want to be proactive with their own care, as a physician you have to nurture that desire.” Hands-on training also fosters confidence for interns, said third-year resident Amy Becker, who manages her younger cohorts. Becker explains the first few months of residency are the most stressful for interns. “It takes three or four months to get your footing,” Becker says, adding that as she advanced in her residency,
Attending hysician Don Gullickson III, left, and resident Amy Becker. the article to personal work experithe workload and demands of the job ences, and discussed common probbecame more manageable. lems such as communication with the Finding confidence, Loss added, patient, family and outside healthcare was an important step in becoming an providers, proper education on posteffective resident. discharge treatment, and simple things, “The biggest challenge is learning such as ensuring a patient’s prescripto feel confident making decisions,” tion is filled out before they leave the she said. “After years of learning and hospital. reading about medicine, it is a big Marc Berliant, Strong’s chief of change when you actually start the general medicine and director of the practice of medicine and caring for resident-faculty practice at Strong, was patients.” present at this meeting to direct the Becker said interns are responsible discussion. Berliant said his role is to for providing primary care to patients oversee the education ambulatory (outand reviewing documentation on their condition. In the second and third year, patient) care to Strong’s residents, who follow a panel of patients over a period residents take on supervisory roles for of time learn to how outpatient care new interns, and manage multiple patients in the team’s care. Depending on differs from their morning rounds. “The biggest difference in inpatient their specialty, residents either continue vs. outpatient care is that in the hospiwith up to four years in a residency tal, you are treating patients with acute program or begin a fellowship. Becker conditions very briefly, with the goal said she will begin her geriatrics felof getting them out of the hospital and lowship next year. back home,” Berliant said. “With outAfter their morning rounds, patient care, the goal is on longitudinal another group of residents met with care, which requires much more folsenior physicians to address different low-up, coordination with healthcare aspects of providing care. This day’s providers and communication with the session involved reviewing an article Third-year resident Nick Paivanas speaks on the problems patients face once they patients and their families.” To foster teamwork, Berliant elicduring a review of a medical article. “That are discharged, and developing best practices at Strong to improve post-dis- ited input from nurses and pharmacists first year is terrifying; people are calling present at the meeting to give their percharge care. you ‘doctor,’ and looking to you to know spective on improving post-discharge Residents related information from what to do,” he said. treatment. Sitting in on this discussion was Nicholas Paivanas, a third-year resident and Georgetown med school graduate. Originally from Fairfax, Va., Paivanas was drawn to Strong for its excellent cardiology program, and the opportunity to be with his wife, who is in the obstetrics and gynecology program. Paivanas said he is excited to complete his third year in the program, as he will begin the next three years of his cardiology concentration, and also assume the duties of chief resident. With three years under his belt, Paivanas was able to give perspective on how he has grown as a doctor. “That first year is terrifying; people are calling you ‘doctor,’ and looking to you to know what to do,” he said. “But by the end of that year, you start to get comfortable and gain confidence. In the second year, you start to supervise interns, and I liked that transition, because it gives you a better overview of how the hospital is run and the third year gives you time to focus on electives and branch out to private clinics Medical student residents, from left, Lauren Loss, Jaclyn Burch, Laura Mekher, Sabrina MacDuff and Amy Becker prepare for morning that focus on your specialty.” rounds at Strong Memorial Hospital
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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013