Surviving Residency – How Surviving Residency – How You Can Help (from one You Can Help (from one Resident’s Perspective)Resident’s Perspective)

Samuel HughesSamuel Hughes

Portland, ORPortland, OR

May 20, 2011May 20, 2011

The Nature of the ProblemThe Nature of the Problem

ResidentResident EmployeeEmployee TraineeTrainee SiblingSibling

The Nature of the ProblemThe Nature of the Problem

Co-ordinatorCo-ordinator HR personHR person EnforcerEnforcer Surrogate parentSurrogate parent

Residents’ ConcernsResidents’ Concerns Clinical careClinical care

Patient carePatient care ICU proceduresICU procedures OR techniquesOR techniques Outpatient Outpatient

evaluationevaluation Research effortResearch effort

Techniques, etc.Techniques, etc. Academic Academic

requirementsrequirements WritingWriting

Personal lifePersonal life ““Three D’s”Three D’s”

Real World ConcernsReal World Concerns

Clinical Clinical documentationdocumentation

Maintenance of Maintenance of certificationcertification

Board certificationBoard certification

How Residents See How Residents See ThemselvesThemselves CapableCapable

““I can do brain (and I can do brain (and spine) surgery!”spine) surgery!”

EfficientEfficient ““Have you seen our Have you seen our

inpatient census?”inpatient census?” EffectiveEffective

““Nobody dies Nobody dies unless I say so!”unless I say so!”

EliteElite ““After all, aren’t After all, aren’t

only 7-21 of us?”only 7-21 of us?”

How Residents Seem to How Residents Seem to OthersOthers

SluggishSluggish ““Seriously, how long Seriously, how long

does it take to reply to does it take to reply to an email?”an email?”

SlovenlySlovenly ““Is it that hard to fill Is it that hard to fill

out one little form out one little form completely and turn it completely and turn it in?”in?”

SketchySketchy ““Do you do nothing Do you do nothing

you say you will?”you say you will?” Socially inappropriateSocially inappropriate

““Have you never had a Have you never had a job before?”job before?”

Surviving ResidencySurviving Residency Clinical dutiesClinical duties

OR OR ICUICU WardWard ClinicClinic

Medico-legal Medico-legal documentationdocumentation DictationDictation CertificationCertification

Personal lifePersonal life Three D’sThree D’s

Barriers to SurvivalBarriers to Survival

ACGMEACGME Case logCase log HoursHours

AANS/CNS/etc.AANS/CNS/etc. Deadlines for Deadlines for

abstracts, etc.abstracts, etc. Medical BoardMedical Board

LicensureLicensure

Hospital/GMEHospital/GME ACLS, etc.ACLS, etc.

DepartmentDepartment EvaluationsEvaluations CompetenciesCompetencies CommitteesCommittees Etc., etc., etc.Etc., etc., etc.

Barriers to SurvivalBarriers to Survival FatigueFatigue StressStress Autism spectrum disordersAutism spectrum disorders Personality disordersPersonality disorders

Cluster A (odd): Paranoid, Schizoid, Schizotypal Cluster A (odd): Paranoid, Schizoid, Schizotypal Cluster B (dramatic): Antisocial, Borderline, Cluster B (dramatic): Antisocial, Borderline,

Histrionic, Narcissistic Histrionic, Narcissistic Cluster C (anxious): Avoidant, Dependent, Cluster C (anxious): Avoidant, Dependent,

Obsessive-compulsive Obsessive-compulsive Not specified: Depressive, Passive–aggressive, Not specified: Depressive, Passive–aggressive,

Sadistic, Self-defeating Sadistic, Self-defeating

How You Can HelpHow You Can Help

Be direct in your Be direct in your communicationcommunication

Leave an excessive Leave an excessive interval before interval before deadlinesdeadlines

Repeat your Repeat your message at least message at least once within the once within the pre-deadline pre-deadline intervalinterval

Expect failure to Expect failure to complycomply

Expect ill-humor Expect ill-humor when confronting when confronting non-compliant non-compliant individualsindividuals

Keep your humor, Keep your humor, especially with the especially with the humorless – they are humorless – they are the ones with the the ones with the pathologypathology