Advice for Surgical Residents

From the 7/9/2021 newsletter

 

Perspective/Opinion

 

Advice for Surgical Residents

 

Compiled by Bruce H Campbell, MD FACS

 

Dr. Campbell, who entered a surgical field decades ago, asked his current residents what they have learned to keep themselves whole and able to function despite living in high-stress times and working under pressure. Here is some of what he learned from them, and about “grit” in surgical residents …

 

 

What sorts of things have surgical residents discovered that allow them to survive as trainees? Here is a list from current otolaryngology residents (and their friends):

• Everyone expects surgeons to be arrogant. Surprise people in a good way.

• Ask the right questions and listen carefully - often this will tell you more about a patient's condition than any test or image can.

• Get to know your patients beyond their chief complaint.

• Learn to understand and appreciate the environment that your patient came from, and you will glean so much more. “For the secret of the care of the patient is in caring for the patient.” - Francis Peabody (“The Care of the Patient,” JAMA 1927)

• Listen to the nurses. Learn their names. They are the ears, eyes, and heart of the floor. They spend more time at the bedside than any physician or care team member.

• Be forgiving of yourself and your colleagues. We all have one common goal, and that is to provide healing and nurturing for our patients.

• Mistakes are an inevitable part of medicine. Always be honest, show empathy, and commit yourself to a lifelong endeavor of learning.

• Practice self-care. “Just as a car can’t go as fast on a flat tire, you can’t give your best effort if you aren’t mentally, physically, and spiritually running on all cylinders." - U.S. Surgeon General Jerome Adams

• Find yourself a good pair of shoes. This will take you far, literally!

• Do not forget why you are doing what you do. Our profession is unique, people trust us with their lives, and we cannot take that for granted.

• Do not forget that each of your patients is a person first and a patient second.

• Informed consent is a process and a relationship, not a piece of paper.

• Stay up-to-date on your administrative paperwork and be kind to the residency program coordinator.

• Always act in the best interest of the patient.

• Stay humble.

• Just keep showing up even when you feel like you’re not doing well. It always gets better.

• See the patient before calling a consult.

• Stay current on your surgical case logs.

• Before ending any conversation with a patient, always ask, “Do you have any other questions?” That usually elicits their deepest concern.

• Knowing when to operate is at least as important as knowing how to operate.

• Balance humility and ego. It’s not easy. 

• Remember to enjoy simple wins and to learn from loss.

• Sleep when you can, eat when you can. 

• Wipe your feet of the day before you walk into your home to greet your family. 

• Be an organized junior resident but ask for help. Remember you’re human, too.

• Each patient is experiencing something at the same time you are, so even if this is your hundredth consult of the night at 3:00 a.m., try to bring compassion to the encounter. 

• Remember, at the end of the day, you are a team.

• Check for speckles of blood on your scrubs, booties, face, and mask before going to talk to patients’ families.

• Surgical training is uniquely stressful. Stay self-aware. Reach out for help. Watch for warning signs in others.

• Know your stuff, do the right thing, and ask for help when you need it.

• Don't forget to engage in things that make you happy, as residency will trick you into thinking success must cost you joy.

• Residency can unmask underlying vulnerabilities.  Don't be afraid to lean on your co-residents (and even attendings), either professionally or personally. 

• An ICU consult is better than a rapid response, and a rapid response is better than a code.

• There are two kinds of residents: the ones who write it down, and the ones who forget.

• Trust no one, expect sabotage, and always have a backup plan.

• Stay current. There is no glory in being technically adept and doing the same, wrong operation every day for the next thirty-five years.

 

On a related note, a recent article in JAMA Surgery confirms that grit, as a personality characteristic, is a good thing. Grit is defined as “perseverance and passion for long-term goals,” and is measured with a standardized GRIT-S questionnaire that asks about a person’s ability to concentrate on a project, their reaction to setbacks, their constancy in pursuing goals and interests, their self-identified work ethic and diligence, and their ability to thrive in the face of challenges. General surgery residents with higher “Grit” scores were less likely to report burnout, thoughts of leaving their training programs, concerns about their career choice, and suicidal ideation than residents with lower Grit scores. Grit scores were higher in women, more senior residents, and in married residents. The authors recommended that programs do what they can to bolster their residents’ grit.

Surgeons have unique roles and responsibilities in society; what can compare to the trust someone displays by allowing another human being to render them completely defenseless and then rummage around their insides? As an institution, it is our responsibility to prepare our residents to enter the world as character-driven, compassionate, and skilled surgeons.

Thanks to my “gritty” residents for sharing the lessons they have learned.

 

Bruce H Campbell, MD FACS is a Professor in the Department of Otolaryngology & Communication Sciences and in the Institute for Health and Equity at MCW. He is editor-in-chief of the Transformational Times.