The final year of medical school offers a unique opportunity for students to consolidate knowledge, refine skills, and establish habits that will lead to a successful and healthy transition to the practice of medicine during residency. Internship and residency are incredibly demanding intellectually, emotionally, physically, and socially. Despite duty hour restrictions and an increased focus on resident well-being, these stressors still conspire to make burnout quite prevalent. NEJM Resident 360 hosted two discussions related to this topic this spring (Prepping for PGY1 and How to Maintain Balance in Residency). In these discussions, medical students and residents engaged with program directors and other experts to address how medical students can prepare for residency and how residents can maintain balance and wellness. In this post, we present some highlights from these discussions and additional tips for remaining successful in residency.
Making the Most of MS4: Preparation Goes a Long Way
Medical knowledge, clinical skills, and technical proficiency are critical aspects of medical school curriculum and preparation for residency training. As a student, take advantage of opportunities to apply your medical knowledge and clinical reasoning after core clinical clerkships by proactively pursuing clinical experience. Think beyond the minimum clinical requirements and seek clinical experiences that will prepare you for residency training. Also try to experience clinical rotations at the end of medical school and close to the start of internship so you can hit the ground running. Refining your clinical acumen during the MS4 year will set the stage for a smooth and successful transition to residency.
Although it’s important to enter internship feeling well-rested and energized, it is equally important to enter feeling well-prepared, both for the clinical work and the challenge of managing your wellness during residency. Residents who are confident, efficient, and productive will be more likely to feel the satisfaction of a job well done — a powerful force against burnout. Other ways to make the most of the MS4 year and prepare for residency include:
- Seek opportunities to practice the active skills of managing your commitment to wellness and your interests outside of work.
- Get into the mindset of a resident and practice getting enough sleep, remaining committed to your personal time, and utilizing your vacation and days off in ways that are restorative.
- Seek advice from faculty mentors and residents in your field about which clinical experiences will be high yield and how to maintain balance.
- Seek additional training in subjects or skills that you need to improve. Even with a rigorous final year of med school, you will still have time to rest, travel, and pursue other interests prior to residency.
Maintaining Wellness at Work during Residency
Burnout or depression are common during residency. Be kind to yourself and accept that you will need to ask for help. Then learn from the experience rather than beat yourself up when things aren’t going well. You are not alone — these feelings affect many residents and physicians.
Several medical education organizations, such as the ACGME, have recently focused on resident wellness and are developing interventions and educational programs. Many residency programs have resources for wellness and initiatives in place (e.g., resident or hospital wellness committees, wellness curricula, institutional wellness activities, gym memberships, and employee assistance programs for counseling). Listen for resource information during residency orientation and ask about available resources in the beginning of your residency. Take advantage of what’s available and get involved.
Use available resources: Your program director, chief residents, or other programs sponsored by your graduate medical education office are there to help you and can.
Stay connected: Maintain your support systems outside of work and establish a support system with your fellow residents and spend time with them outside of work. Your peers are experiencing the same challenges. Taking the time to reflect and share with each other will reduce isolation and burnout.
Take care of yourself: Doing so will allow you can take care of others. Exercise, engage in stress-relieving activities, and treat yourself. Working on time management and trying to simplify your life can also help.
Maintaining Balance Outside of Work
Time is your most precious commodity as a resident and learning how to keep things simple is crucial.
Use efficient technologies (e.g., online shopping, autopay for bills, note services to keep track of tasks, and an online calendar or reminders).
Grocery delivery is a great time-saving strategy. Cooking in advance and freezing or reheating later will help meal preparation.
Plan ahead and make use of days off for chores, but also try to keep up with a few tasks each day.
Use social media to stay connected with your social network when time is scarce, but be mindful of the deleterious effects of technology on wellness, particularly when your job already entails an overwhelming amount of information and connectedness. Take breaks to engage in social events or find time for yourself.
Find time to exercise, either on your own or take part in a team sport. Making exercise social can improve your motivation. Find activities you enjoy. Make exercise a part of your routine by doing short daily workouts or fitting it in right before or after work. Find exercise options to do at home when you are less motivated or the weather is poor. When you do fall off track, don’t worry, just get back into the routine again.
Make time to see friends and family. Help your family and friends have realistic expectations regarding your schedule and commitments in residency. Scheduling dedicated time with friends and family is important. Try to disconnect from work (physically, emotionally, and technologically) during these times. Check in regularly with a short call, video chat, or text.
Residents with children (or other dependent family members) face a particularly difficult task given the emotional and care needs unique to children. Seek help but be realistic about your expectations of your significant other, extended family, or close friends. Identify reliable and flexible childcare resources. Start by asking your program or institution if they offer childcare options and resources (e.g., sick call coverage or in-home last minute childcare) to help when children are sick or childcare falls through).
Residency Wellness Checklist
- Set your bills to autopay
- Use subscription services to deliver items you regularly buy (sometimes at a discount)
- Find a laundromat that can wash and fold your laundry
- Try a grocery delivery service
- Adopt a "bottom up" mentality toward exercise: 15 minutes is better than none, once a week is better than not at all
- Set up an online calendar
- Try an online note service
- Cook meals ahead on light days or days off
- Schedule time on your calendar to do something that you enjoy
- Attend social events with your co-residents
- Seek out and get involved in wellness activities at your institution
- Set a regular time to catch up with close friends and family
- Don’t be afraid to talk about your challenges and ask for help
Jason Poston is an educator who spans undergraduate and graduate education. At the Pritzker School of Medicine, his focus in on longitudinal education and mentorship that helps students through the complex transition from the classroom to the practice of medicine. In his role as the Director of Fourth-Year Studies, he has developed the MS4 Transitions to Internship course, focused on practical (interprofessional care, organization, wellness) and procedural (bedside procedures, ultrasonography, ventilator management) skills that are critical to success.
Amber Pincavage is an Assistant Professor of Medicine at the University of Chicago in the Section of General Internal Medicine. She trains medical students and residents in areas such as clinical reasoning, primary care, transitions of care, patient-centered communication and resilience skills. Her research interests include handoffs in the ambulatory setting, ambulatory medical education, patient-centered communication, and resilience of medical trainees.