by Allan Peterkin, MD
- Aim to maintain an “internal locus of control.” This means that you seek to control what you can, rather than passively accepting everything that happens to you. For example, ask for things you would like, such as specific holidays, rotations, supervisors, or night call dates, rather than leaving decisions about your scheduling and training up to someone else.
- Draw a “self-esteem pie”. Draw a circle and label slices as: WORK (your medical life), LOVE (your relationships), PLAY (what you love to do outside of work), SPIRIT (your religious/spiritual beliefs and personal values/ways of making meaning). How big is each slice in your current life? How balanced are your goals? Use the drawing as a reminder of where you are now, and where you would like to be in terms of feeling whole.
- Seek support. Many residents compete with one another or attempt to be excessively stoic about the stresses in their work. Others lose touch with family and non-medical friends. Building and maintaining relationships is the most protective of all strategies in surviving residency. If you feel overwhelmed and isolated, your state residents’ association can put you in touch with confidential resources and professional counseling.
- Don’t neglect the body. Faced with demanding call schedules, residents typically sleep too little, eat badly and don’t find time for exercise. Follow the advice you would give to your own patients about self-care. Make sure you find a good family doctor for yourself!
- Know your rights. Read your hospital contract/collective agreement to clarify your work duties and benefits, including study, illness and maternity/paternity leaves. Most residents are unaware of mechanisms for dispute resolution (including harassment issues), but these protocols are usually delineated in contracts.
- Keep real people in mind as you read cases, not just people’s illnesses. Study time is usually limited in the context of ward work. Reviewing a topic when it is immediately relevant to your own patient’s care contextualizes and humanizes clinical principles in a way you will remember.
- Keep a journal to record your own thoughts, feelings, ethical dilemmas and “firsts.” These might include a first delivery, first death of a patient, first clinical mistake, and countless others. Writing things down can bring new perspective to your work, and may provide a safe place to ask yourself reflective questions about what it means to be a doctor. It will also enhance your narrative competence–your ability to communicate and to work empathically with the stories your patients bring you.
- Be a generous, patient teacher to junior residents and medical students. Treat all colleagues from other clinical disciplines with the utmost respect. How we treat one another can either perpetuate workplace abuse, or humanize us and the profession.
- Empower yourself to shape your own training experience. Don’t be afraid to say “NO” if a demand doesn’t fit or seems unreasonable. Fill out all rotation evaluations of senior residents/teachers/ staff supervisors, so that improvements can be made for other learners. Don’t sign an evaluation of your own work unless you agree with it. Get political–consider running for your state or national house-staff organization. If there are gaps in your training with respect to providing humanistic, person-centered care, organize seminars and luncheons on ethics, narrative medicine, physician wellbeing and the role of the arts and humanities in medicine.
- Try to live mindfully, and make time to reflect on who you are becoming. Resist the temptation to check social media and email compulsively throughout the day-especially before bedtime, as this may interfere with falling asleep. Don’t log into your hospital account in off hours. Be fully present to yourself and to your loved ones when you have time off.
Allan Peterkin is Professor of Psychiatry and Family Medicine at the University of Toronto and the author of the bestselling book “Staying Human During Residency Training-How To Survive and Thrive After Medical School “(University of Toronto Press), now out in its fifth edition. He heads the Program In Health, Arts and Humanities (www.health-humanities.com) and is a Founding Editor of “ARS MEDICA-A Journal of Medicine, The Arts and Humanities” (www.ars-medica.ca )