Top 10 do’s and don’ts in residency

If you’re transitioning to residency, the move has been a long time coming. The journey to residency can be filled with excitement, doubt, empowerment and stress, and starting GME is a milestone in a physician’s career. We are thrilled to have more responsibilities and our own patients, but we must adapt to the new duties while also finding time to take care of ourselves.

The quality of your relationships with your co-residents and mentors can deeply influence your learning and emergence into the physician you hope to be. Often the habits we develop now seep into our professional careers.

I am currently a PGY-2 in psychiatry. I talked to many residents, fellows and support staff from different specialties to compile this list of Do’s and Don’ts for residency. I hope they propel you toward a path of self-realization and actualization as you immerse yourself in your training.

What to DO in residency

1. DO set boundaries and take care of yourself

“There is always more to learn and there are always more opportunities available,” shares Janae Rasmussen, DO, orthopedic surgery resident. “However, it can be easy to become so entrenched in your career responsibilities and aspirations that you neglect to make time for taking care of your health, calling family or using your time off.”

Kelly Shaffer, DO, psychiatry resident, makes it a point as well to prioritize self-care and take care of herself.

“Protect yourself like no one else will,” shares Dr. Shaffer. “Stick to your boundaries, take your sick days, know when to say no and don’t martyr yourself.”

Staying true to yourself and your goals will keep you on the right path.

Akiha Hassan, DO, pediatrics resident, also shares the importance of understanding your needs. “Sometimes that means being a couch potato after work, and other times it means brunch with friends or going on that hike.”

She further elaborates, “submit vacation/day-off requests early. Even if you don’t have a specific event planned, it is important to anticipate when you might feel burnt out. I try to request a vacation or day off every four months to recharge.”

For more wellness resources, see the AOA’s Wellness Toolkit. The following webinars on wellness are also available on-demand:

• The Stigma of Mental Health
• The Plight of a Pedestaled Physician: Prostration and My Path to Resilience
• Beating Back the Blahs (Burnout)
• Your Inner Well: Cultivating Resilience

2. DO pay it forward

“Look for ways to mentor or teach medical students, such as volunteering to give mock interviews or sharing research opportunities. I’ve found that connecting with students pursuing orthopedics reminds me to be grateful to be in this position,” mentions Dr. Rasmussen.

Mentoring students helps to strengthen the profession as you pass down wisdom from your own mentors. It also bolsters your relationships with others in the DO community.

David Choi, MD, chief resident in psychiatry, mentions: “teach as much as possible. It helps engage the team and solidifies your own knowledge.” When talking to patients, he advises using both open-ended and close-ended questions.

“Open-ended questions may allow a more natural discovery but also allow for avoidant behaviors from both parties,” he says.

3. DO prep your sign-out

 “I print a short list and jot down major events from the day, and things I’d like to happen overnight,” shares Dr. Hassan. “It makes things smoother for everyone involved.”

4. DO read the guidelines of your specialty

“As you get exposed to the common ailments, these guidelines can help you know what decisions to make and keep you at the standard of practice,” shares Casey Love, DO, PGY-4, psychiatry.

Knowing these guidelines can help your mind be less jumbled—if you feel confident in your decisions, you’ll feel much less overwhelmed by what needs to be done.

Similarly, Andrew Rylaarsdam, DO, child and adolescent (CAP) fellow, adds, “you’ll pick up tons of ‘clinical pearls,’ but you need somewhere to store them. It helps a lot to build a framework by reading guidelines relevant to the care of your patients to learn the basics.”

5. DO check in with nursing

After years of collaborating with nurses as a volunteer, scribe, medical student and now resident, much of the feedback I received involved recommendations of frequent communication between doctors and nurses to help the whole health care team work better together.  

Nurses are at the front line with patients. They have a poignant understanding of how patients are doing. For example, a patient could be agitated or escalating, which can place residents or attendings in danger. Communication with nurses is vitally important for excellent patient care.

Explaining to nurses the rationale behind medication changes is also helpful. Doing so can help nurses explain changes to patients who are confused about their treatment plan. This saves time and phone calls for both nurses and physicians as well.

Residents may have explained something already to patients, but patients don’t always hear or remember it. Brent Wells, RN, shares, “sometimes, the patients would just prefer speaking to the doctor. Let the nurses know when you place an order in. Sometimes they don’t see it until hours later, especially if the medication is STAT. We’re not constantly looking for medication orders.”

6. DO be present during a code

Nurses have often stated that they would prefer physicians present if a patient is having a breakdown so that PRN medications can be offered. It helps physicians understand why nursing staff are recommending certain medications that don’t always align with the physician’s treatment plan.

7. DO write things down

“It’s easy to forget and miss things. You’re not at a point in your training where you have a head template to interview patients,” shares Joel Yost, DO, psychiatry attending.

8. DO remain positive

“Stay positive, make the most of whatever situation you are in and make connections with those around you,” said Andrea Sparkman, DO, general surgery resident.

Dr. Hassan adds to lean on your co-residents.

“They are your teammates—we matched, we’re in this together,” she says. “When things go wrong, they’ll have your back. My co-residents and I worked so well together that we’d take turns short-calling and doing small tasks for each other so we could both leave on time.”

In addition, Dr. Hassan recommends bringing snacks to work to share. “It’s so fun to try new things together.”

9. DO hold onto your support system

An internal medicine (IM) attending from Burma once told me about the importance of having a strong support group, especially if you have children while you’re in residency. She graduated from University of Yangon in Myanmar, completed IM residency in Taiwan, then repeated it at the University of Southern California (USC) to have American licensing, all with two children under 5 years old. The vast time commitment of residency and parenting young children tested her trust in her support system during vulnerable times.

When her children were sleeping, she was in the hospital, wishing she could say goodnight, and she sometimes cried on the way to work after her children begged her to stay home. Fortunately, the attending later told me that her life eventually stabilized after owning her own practice, where she could practice the way she envisioned.

10. DO be honest—it’s the best policy

“The most important keys to being a good intern are being teachable and telling the truth,” said Aaron Chavira, DO, academic hospitalist. “You are not expected to know everything. Somehow we are conditioned in school to think we need to be perfect, but there are too many unknowns in medicine. The most challenging interns are those who are defensive, continuing to try to prove that they were right, when the senior residents are just trying to make sure they understand the teaching points/conceptual management.

“It’s not personal. I promise. Just learn. If the senior resident asks you if you checked a telemetry, lab or X-ray, and you feel pressured to not tell the truth, know that if that resident knows you lied, then they will not trust you for the rest of the rotation. It is just not worth it to say anything but the truth.”

Don’ts: What to not do in residency

1. Don’t neglect your health

“There will be weeks and rotations where your free time will be severely limited, but making time even for five minutes of stretching before bed can make a significant difference. And as challenging as it is, find time to establish a primary care physician and dentist,” advises Dr. Rasmussen.

It’s vital to not let residency keep you from doing the basic things humans need to do to function and thrive.

“Sleeping, eating, movement and connection are the fuel which propels us,” Dr. Love says.

While it may not be possible to prioritize each of these at the level that we would like, keeping them on your radar and doing your best to make time for them will serve you well in residency.

2. Don’t burn any bridges

“Always be kind and helpful to those around you. There will be days when you are running on fumes, but do your best to show appreciation for nurses and those helping you,” shares Dr. Rasmussen. “Take ownership of mistakes and say you are ‘sorry.’ Leave your ego at the door. Some of the best lessons for managing patients have come from nurses and operating room staff.”

3. Don’t go behind your program coordinator’s back

“Things come around, and it will always come back to bite you in the butt,” says Judy Hallet, program coordinator at Good Samaritan Regional Hospital in Corvallis, Oregon.

4. Don’t expect to know everything

“If you don’t know, say you don’t know. A lot of times I already know the answer, I just want to ask if you know,” says Dr. Yost.

Others agree, including Dr. Hassan. In the long run, it is far better to admit you don’t know something than to risk compromising patient care.

People will respect you for working hard and wanting to learn.

Dr. Rylaarsdam shares, “asking questions about things even when you feel like it’s something you ‘should’ know is valuable for your learning and everyone else’s too.”

For AOA members, UptoDate (a clinical decision support tool that provides extra guidance) is available with a 20% discount as well.

5. Don’t lose sight of yourself

“Don’t forget who you are at your core,” says Dr. Sparkman. “Despite the long hours and distance from your loved ones, stay true to yourself and don’t lose sight of what matters in the midst of pursuing your dreams.”

6. Don’t make things harder than they need to be

Unfortunately, while it is highly unprofessional, bullying happens in residency. A conversation I recently had with a dear friend stuck with me. She is an internal medicine resident; as a senior for two interns, she repeatedly had to remind them to be respectful and kind to each other. She reiterates the importance of creating a healthy work environment, and reminded her interns that they cannot always expect to be understood the way they intended.

Residents help create the culture of their program—do your best to be a force of positivity and support in yours.

7. Don’t be inconsistent

“One thing I find hinders a lot of learners is not having a thought-out plan,” says Andrea Comiskey, MD, ICU fellow. “When presenting or creating a plan for the day, it is important to keep in mind the end goal, why you are doing what you’re doing and to have a contingency plan for when something doesn’t go as planned. A recent example I had presented to me was when a resident said they were concerned about a cervical spine fracture, but then also recommended PT/OT in their plan.”

Dr. Comiskey notes that those two thought processes don’t match up; she says it’s a good idea for residents to monitor their plans for consistency.

8. Don’t forget your place

“Don’t forget that you are a trainee,” states Bikash Adhikari, DO, psychiatry resident. “Avoid going to work just to work, go to work to learn too. It is easy to get sucked into the workflow. Even on the busiest of days, be curious, open and teachable. Take advantage of the final few years of sheltered medicine before you flow out on your own.”

9. Don’t take it personally

“Try not to take it personally when the system fails you,” advises Dr. Shaffer. “Residency often runs on hospital priorities, not resident well-being. That disconnect can feel personal when your needs aren’t met—but it’s not about your ability or effort. It’s about how the system is structured.”

The fact that there are systemic issues in the health care system that hinder resident wellness make it all the more important to take steps to prioritize your own wellness and set boundaries (see DO #1 and #9, and Don’t #1, above).

10. Don’t rush

“Don’t finish your day too early,” says Dr. Choi. “Once in a while it is fantastic, but don’t compromise quality for speed. This can be detrimental during the learning phase when foundational habits are being built. Yet don’t finish your day too late. Juxtaposed to the prior, verbosity is useless to most everyone and often does not lead to better care despite the feeling of fulfillment that often accompanies hard work. Lastly, don’t assume the worst when others are likely doing their best. Instead, focus on the shared mission.”

Finding your way

Every journey in residency is unique to the individual. I wish you all the best in making your way in this phase of your training, and I hope these pearls from current and past residents are helpful to you. May you continue to thrive and succeed throughout your training and come out kinder and wiser.

Related reading:

Professionalism in residency: Managing interpersonal relationships during this journey

Developing a growth mindset: Are you asking the right questions?