January 2019: Relearning Study Habits
Among the major transitions in my life, the move from medical school to residency has been the most jarring. Every habit, every routine, and every strategy I had developed to succeed in high school, college, medical school, and the years in between suddenly felt irrelevant once intern year began. As a result, I feel like I am relearning everything. From managing my free time to interacting with patients, I now have to rethink what I once took for granted.
My study habits—something I thought I had nailed down during medical school—have had to adapt to the much-heavier demands of residency.
Back in medical school, studying was about memorizing associations and cramming enough information in my head before moving on to the next subject. Now, studying is about improving my clinical decision-making for real patients with real problems. It’s about developing a deep and lasting understanding of the orthopaedic problems I’ll see on rounds or in the office, rather than one that’s just good enough to pass an exam.
As a medical student, I had a simple approach to studying. I used one comprehensive resource, made digital flashcards based off of that one resource, and then studied those flashcards until I felt like I had “mastered” the material.
As an intern, that approach has proven both insufficient and inefficient. The breadth and depth of knowledge I find I need calls for numerous resources: Miller’s Review for a morning lecture on tibial shaft fractures, Hoppenfeld’s to learn the Watson-Jones approach for a hip fracture in a patient with Parkinson’s disease, and so many others. Demands, needs, and time constraints vary by the day, sometimes by the hour. I also know they’ll change by the year—the learning journey is a lifelong one—but for now, it seems strange that I got here by being good at studying, but as a resident, I have to relearn how to learn.
February 2019: Relearning Time Management
The transition from medical school to intern year has been a bit overwhelming. Early in my residency, time management was particularly challenging, as I suddenly found myself juggling multiple responsibilities in the hospital and at home: Managing patients, preparing for morning conferences and OR cases, wrapping up old research projects, starting new research projects, planning a wedding, and exercising regularly. I went from thinking I was pretty good at time management to feeling like time was no longer mine to manage.
The senior residents on my orthopaedic trauma team seemed to strike a healthy balance between their busy clinical workload, research, and personal life commitments. Meanwhile, I only had time for clinical work, and any free moments for my other commitments felt like a huge victory.
But those victories were rare, and my personal commitments sometimes suffered. For example, I failed to make a wedding planning meeting with my fiancée after a particularly hectic day in the hospital. That long weekend call shift on general surgery the weekend before the Orthopaedic In-Training Exam did not help matters, either.
Thankfully, as intern year has progressed, my time has become more manageable. To prevent one task from overwhelming all my other commitments, I started being more intentional in organizing my life outside the hospital, dividing my time into discrete tasks with specific time limits. To a certain extent, structuring my time in that manner has freed up unstructured time elsewhere to spend with my wife and friends. While I am still a far cry from a time management expert, I have noticed an overall improvement in my ability to utilize the amount of free time I do have, and that gives me confidence in tackling the next 4 years.
March 2019: Relearning Patient Care
In medical school, my role in patient care seemed clear enough: Student. As an intern, I was surprised to have to process a strange dissonance: I still felt like a learner, but many patients saw me (appropriately, to some degree) as a provider. I was so stuck in a student mindset that I had forgotten that in the eyes of my patients, I’m “the doctor”.
To my frustration, I initially let that disconnect affect my interactions with patients. I remember being on the orthopaedic trauma service, my first rotation of the year, and occasionally finding myself unsure of my words and actions at the patient bedside. Walking into the room of a patient with a hip fracture, for example, I remember feeling oddly distant from the patient and her family. As a medical student, I would have struck up a friendly conversation with the group. In fact, talking with patients and their families had always been one of my favorite parts about being in medical school. Yet as a new intern, I felt strangely robotic, answering their questions and addressing their concerns before excusing myself and moving on to the next task. The satisfaction that had once come from patient interactions had diminished, and I wasn’t sure why.
Over time, I realized that my discomfort stemmed from approaching patients as an “intern” when I should have been approaching them simply as a physician. I had let the “imposter syndrome” get the best of me. Over the last several months, I’ve found that having realized this, the quality of my patient interactions has improved, and once again I find conversations with patients to be gratifying and fulfilling.
While the quality of my patient interactions has improved overall, I admit that I still have worries in the back of my head when I walk into a patient room. The more I learn about orthopaedics, the more I realize that I don’t know the answers to the complex questions that patients and families may ask. In those situations, when I am unsure of an answer, I revert back to feeling like the “imposter,” knowing less than the patient expected from their “doctor.” On the other hand, in the moments when I can have a gratifying interaction with a patient and confidently answer their questions, I have started to feel like I do, indeed, belong where I am.
Footnotes
A note from the Editor-in-Chief: I am pleased to present to readers of Clinical Orthopaedics and Related Research® the next installment of “Residency Diary.” Although this column has been a CORR® staple for some time, residents move on, and this month’s column is the beginning of the next Residency Diary story: A new resident. Drake LeBrun MD, MPH, is a first-year orthopaedic surgery resident at the Hospital for Special Surgery in New York, NY, USA. In this quarterly column, our readers will have the chance to follow Dr. LeBrun as he chronicles his transition from medical school to residency, as well as events and interactions that have made an impression on him.
The author certifies that neither he, nor any members of his immediate family, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.
The opinions expressed are those of the writers, and do not reflect the opinion or policy of Clinical Orthopaedics and Related Research® or The Association of Bone and Joint Surgeons®.