Perspectives On Residency Transitions From a Resident and an Attending: Part 2

This blog is part 2 of a 2-part series, the first of which examines a resident's point of view, and can be found here. This final installment takes a look at how an attending physician approaches the evolution of a resident in training.

Attending’s Perspective: Managing New and Continuing Residents

For the past 19 years, July has been an exciting and extremely frustrating time of the year as we transition new and continuing residents up the food chain in the residency hierarchy. The infusion of new faces and extra energy can be invigorating. Residents are like pieces of clay, moldable into young podiatric physicians with the promise of reaching high clinical and surgical expertise. In many ways, these newbies become like my children, for whom I have taken on the responsibility of raising and nurturing as they mature through their residency training before facing the real world on their own. At the same time, the existing residents become older siblings. Just like dynamics in a large family with siblings, there are bound to be rivalries and squabbles that eventually necessitate resolution. Then, you have older aunts and uncles, the attendings of the residency family, who are also involved in their upbringing. Balancing these dynamics is a challenge. However, everybody realizes that they all have a role in this family. Keeping everyone together and maintaining the focus of training residents are what challenge me every day.

New incoming residents bring with them very little experience and do not have bad habits. One of my goals is to establish good habits when it comes to approaching and working up patients, being thorough in documentations, building rapport with fellow residents and attendings, developing intellectual curiosity, establishing good study habits, and developing a drive to constantly improve oneself. These traits are meant to be an outline of lifelong habits that they can modify to suit their style and personality. Keeping them motivated through the first year when they are covering the bulk of the call schedule and not necessarily getting the “cool” and interesting cases can be difficult.

Empowering continuing residents with responsibilities to teach junior residents has been helpful in bridging the gap when residents matriculate to the next post-graduate year. These residents typically find themselves with more responsibility during surgery and patient care with decision-making responsibilities. As they find their footing, they will take junior residents under their wing to instruct them in a supervisory role. Most residents take the teaching role very seriously. Some faculty members lose their focus in providing instruction to the residents because they are tired of repeating themselves year after year. The senior residents will often fill this void. Peer-to-peer teaching between residents can be a very valuable way to maximize learning, as they are closer in age and can relate to each other, since the senior resident was in the junior resident’s shoes only a year or two earlier.

Residents in their final year typically will focus on their surgical skills or start looking forward to life after residency, whether it includes fellowship or starting their podiatric career. I find they are most attentive for the first half of the third year before they start to shift their focus away from residency training. Learning coding and billing, understanding proper documentation, passing boards, and developing efficient clinical skills quickly become more important in the last six months before they graduate. I find using them as pseudo-attendings during this time has been helpful for the junior residents so that they can pass on the tips and pearls they have picked up through residency.

Lastly, there is the faculty which includes physicians who have different levels of involvement with the residents and bring their own perspectives from their experiences. The diversity of experiences the faculty bring to the training program is invaluable to the residents so they can see pathologies treated from different approaches. In our weekly discussions of cases, the best discussions are those in which faculty talk about their pros and cons with certain procedures. Keeping faculty engaged with the residents so they do not feel like they are repeating themselves can be offset by making them feel appreciated.

The dynamics between residents at different levels of training and the faculty within a training program are just like the ones in a family. Senior residents develop with guidance from the faculty and leave to start their career. At the same time, new residents are beginning their training with endless energy. The faculty are the parents who have to guide and nurture them to become the best version of themselves from a professional standpoint. At last count, I have graduated 57 residents spread across the country. I am proud to have contributed to their training. Although it has not always been easy dealing with so many personalities, I look at them as my children who have blossomed into young contributing members of our profession.

Dr. Husain is the Residency Director of the McLaren Oakland Hospital Podiatric Surgery and Medicine Residency Program in Pontiac, MI. He is a Fellow of the American College of Foot and Ankle Surgeons and a Fellow of the American Society of Podiatric Surgeons. Dr. Husain is also the President of the Michigan Podiatric Medical Association and Chairman of the Michigan Podiatric Residency Consortium.

Dr. Adame is a first-year podiatric resident at McLaren Oakland Hospital in Pontiac, MI.