About the Discussion

@NEJM Ask the Author & Experts: Breaking Up Is Hard to Do

Perspective

Breaking Up Is Hard to Do

“It’s not you — it’s me.”

I blushed in bewilderment at hearing myself say it. The conversation leading up to it had been jumbled and unintentionally hurtful to both parties. I had been totally unprepared. After 20 more minutes and a packet of tissues, the encounter ended. It was not productive.

Despite all the oversight of today’s residents — the electronic fail-safes and hard stops, the hour logging, the quality-improvement committees, the personal advisor meetings — a key aspect of residency has been largely overlooked: ending it. In medical school, we do subinternships to prepare for the start of clinical training. As interns, we perform procedures and run treatment plans with supervision to solidify our skills. But we receive little guidance on leaving residency.