Survival Guide

There's light at the end of the tunnel, even if it's a few weekend call days and 27-hour shifts away. The original Scope writers are starting fellowship. Here are our top tips for getting over the residency hump.

 
 

Fellowship

Because it turns out there's life after residency

Pay attention to who's in charge

A program director who knows your name will invest in your future - they’re ultimately the ones connecting you to your future job. Take note of the program secretary. Are they the organizational pillar of the program or do they forget to order lunch on interview day? If they’re the latter be prepared for late schedules, credentialing nightmares, and a lot of unnecessary paperwork on your part.
— RYA

Relax, enjoy, be yourself

The interview process is actually really fun. It’s great to meet future colleagues with shared career interests and to talk to people about your plans. If you can relax and be yourself, you’ll get to enjoy the most out of the process and it will also help you find the place that’s the best fit.
— LPC

Remember names and faces

Pay attention to your interviewers and co-applicants. Subspecialty fields are all about networking and what better way to start than during fellowship interview time? You’d be surprised how often you see the same folks at conferences. Better yet, you’d be surprised how many may be your future co-fellows!
— ANB

Look at structure

Service vs. education is a big theme in the fellowship hunt, and not every program is upfront about how they balance the two. Make sure you understand how frequently you’re on call and how much time you have for research before the end of your interviews so you can ask questions to the program director or current fellows. Programs that appear similar on the surface may have very different insides.
— AJW

Hate research?

There’s an expanding demand for clinician educators in all top academic centers (as the river of NIH funding continues to dry). Being upfront about your interests, rather than saying what you think they want to hear, helps everybody.
— RYA

Get multiple opinions

Your mentors will probably have a lot to say about what programs you should apply to and your rank list. But you’ll be surprised how much perspectives differ. People have regional biases; programs have sub-specialty strengths. Hearing multiple inputs may give you a clearer idea of what program fits you the best.
— NN

Figure out your priorities

Whether it’s being in a certain city, being near family, or going to the top-ranked program, knowing what’s most important to you is key. Many hospitals like to hire faculty directly from fellowship, so where you choose to go to fellowship may be a place you’ll settle down. It should be a place where you could be happy living for the unforeseen future.
— LPC

Have a plan (even if you don't have a plan)

Programs want to know your 5-year plan. Speak the numbers (eg. I want to do research 70% of the time and clinical 30% of the time). It won’t matter if it doesn’t pan out - it gives the program a sense of how you would contribute to their community.
— RYA

Your move

Your co-applicants will likely be presenting next to you at the next national conference and your interviewers may very well be collaborators on a project in the near future. Don’t be afraid to request specific interviewers, especially if you have focused interests.
— NN

Find us!

It’s so worth tracking down the departed 3rd years who applied the year before. We’re the ones who can give you the nitty-gritty on the process and a real idea of what life is like on the job.
— AJW

Hospital tricks

What we wish we knew

Keep calm with monitors on

You’ll never get rid of the pit in your stomach when one of your patients is crashing, but it’ll get smaller if you have some time to think. Buy time by staying calm and giving clear directions. At a rapid, make sure the patient is hooked up to the monitor and that you have a full set of vital signs. At an arrest, make sure a board is in place and defibrillator pads are on and connected.
— NN

Pounce on tachypnea

In medicine, a lot of things can wait for a few hours. Tachypnea’s not one of them. If you see an abnormal respiratory rate (say high 20’s), you’ll save yourself a lot of trouble by investigating right away. Start by listening to the lungs and getting a chest x ray. Early nebs, BiPAP, or Lasix can spare intubation.
— AJW

Use your resources

The staff around the wards may not have suffered through organic chemistry lab in college or dissected a cadaver in medical school, but they know a lot about patient care. Ask your nurses, respiratory therapists, perfusionists, etc. what they think about a patient’s status and you’ll be humbled by their clinical intuition. You’ll find clinical medicine is more of an art than a science. Don’t forgot to use the huge amount of support surrounding you.
— LPC

Know thy consult question

Residents often have to defend clinical decisions that weren’t theirs in the first place or do call consults because the attending said so. Make an unpleasant consult better by understanding why you’re asking for help. Learn the patient’s relevant medical history and do a 2-minute review of the topic in question. Then call the consult with a clear question. You’ll get more educational value and your consultant will be more likely to engage.
— RYA

When you're unsure, be sure

Pages about low blood pressure are dreadful, and it’s hard to trust a cuff reading. If your patient looks well and you’re not sold, check the BP yourself. Always check both arms, use the appropriate blood pressure cuff, and make sure the arm is not bent. If in doubt, try to locate a manual BP monitor.
— ANB

Remember fingersticks

Get one on every rapid and arresting patient. Dextrose alone can turn around a comatose patient. It’s always nice to be able to address low hanging fruit with simple interventions before pushing t-PA on the floor.
— RYA

Have a plan

Have a low threshold to ask for help, but when you do, make sure you have a plan in place for who you’re asking. It doesn’t have to be right. People in the hospital will always be happy to help you if you’ve considered your options and have next steps in mind. It is a quick way to gain respect from fellows and attendings
— AJW

Walk about

Unsure why a patient with a SaO2 of 98% on room air and a clear CXR is being admitted for hypoxia? Walk her with a pulse oximeter and the answer may become clear. Identifying exertional hypoxemia can unmask a variety of pathology, including the always feared, often missed, pulmonary embolism. And for patients on the floor, knowing your patient still needs oxygen before they walk out the door may change your treatment or discharge plans.
— NN

Lifestyle

Because you're going to need to have some fun

Goof off

Oh, the places you’ll swab! And the many cracks you’ll explore. Just because you’ve graduated from med school doesn’t mean you and your co-residents are a group of stone-faced professionals. There are fun people behind those disastrously-too-big white coats. Let your guard down and crack a smile in the resident lounge. Only your colleagues understand the silly humor of your day-to-day.
— AJW

Mental health

It’s easy to let the little mistakes get to you when you’re taking care of patients, but trust us, don’t sweat the little stuff. We’ve all forgotten to order morning labs or missed clues leading to the diagnosis. Making mistakes is part of the process and the most important thing is to learn from your mistakes and not beat yourself up. Talk to your family, friends, and the people who would get it most, your colleagues, to keep a healthy attitude when it comes to hard times in the hospital.
— LPC

Seek sunlight

Too much time in the fluorescent box (aka: hospital ward) will make you batty. Finding ways to incorporate outdoor time will do amazing things for your sense of wellbeing. Signed out early? Take a jog in the park. Exercise not your thing? Have a glass of wine at an outdoor cafe. On call? Take a few minutes to walk outside the hospital as opposed to the usual indoor route.
— RYA

Stay connected

No, not just to your phones or Instagram account. Your family and friends, especially those outside of medicine, are an amazing source of support and often offer a much needed perspective about why residency is more awesome than you may think. In the middle of night float, it’s not easy to remember what a privilege it is to take care of people. Schedule in time to call or see the people important to you regularly.
— NN

Sports, sports, sports!

Lets agree: sports are always a safe topic for discussion at a large dinner table over the holidays. It’s also a a safe point for discussion during residency. Make it a plan to watch games together at local bars or head out to stadiums to cheer your favorite teams. The FIFA 2018 world cup is just around the corner and will be tons of fun for everyone, even those who don’t know who Cristiano Ronaldo is.
— ANB

Use brunch to flip your social calendar

Keeping an active social life is tough when you’re on night float and your off night is Tuesday. Frequent brunches with your nights crew can add some joy and sunshine back to your life. The local brunch spots will learn to recognize you quickly, and may offer freebies.
— AJW

Hit reset

One of the best work benefits of residency is the 3-4 weeks per year of mandatory vacation. Traveling is a great way to spend at least a part of that. Whether abroad or local, getting out of town for a couple of weeks, or even a few days, can be the perfect reset button.
— NN

Partner up

Regardless of the activity, you’re assured a co-resident who will be on board. Basketball and soccer leagues are crowd pleasers. Cold beers after a long day always attract company. Blasting Rhianna in the resident lounge will start a mini-karaoke party. Don’t discount the little things—the best conversations are had during cafeteria pizza runs!
— RYA