Chief Resident

I finally made it to the Chief year of my surgical residency. There weren't any moments where I didn't think I could make it through, but it's been the toughest job I've ever had. I've learned a lot, grown as a person, and become a better doctor through it all. Don't get me wrong - I don't think I'm the world's gift to surgery, but the residency process brings about a unique transformation from medical student to surgeon. However, it is a little bit of a hazing ritual to see how much work a doctor can take. The hours are much better than the old days, but it's still a grueling process.

On the night before my chief year began, I stayed all night in the hospital. I was about to go home at around 7PM and read about Pediatric Surgery (my first chief rotation.) The last thing I was going to do was check up on a patient in the recovery unit. He was hypotensive and tachycardic and his labs made us think he was bleeding. I hung out in the recovery unit and resuscitated him, but his labs and vitals worsened and I posted him for a takeback, then spent about one hour trying to convince my attending we had to take him back. It took two calls, but we took him back and found 2 liters of blood in his abdomen. We identified a small area of bleeding (who knows if it was the cause) and he was much more stable after. Still though, I spent the night in the hospital continuing to resuscitate the patient.

When the morning came, I switched gears, handed the patient off to the new chief of the service, and went to the children's hospital to round on the pediatric surgery service. We had about 30 patients to see and it was a whirlwind to see them all in 1.5 hours since they were all new to me. Both interns were brand new, but thanks to the medical students (who were on their last day of their 3rd year of school and knew the patients) we made it through rounds.

During my intern year, I posted a lot on this blog and got some comments (mostly from my dad) but I got too busy to post midway through the year. My wife blogs a lot and I think there has been something about the blogging process that makes her a more self-aware person. Whether it's the self reflection that comes with writing or accountability to the unknown people who may be reading the blog it seems to work! So I decided that I'd try to do the same thing for my chief year of residency. I'm not sure about the frequency that I'll blog, but we'll see.

I just spent some time looking over the various reviews through each year of my residency and in summary it seems:

• Attendings think I'm a hard worker who pays attention to detail.
  
• Medical students like working with me.
  
• Initially, I got comments that I was technically behind other residents at my level, but lately I've been getting comments that I've been improving and it's been less of an issue.
  
• Efficiency has always been something I should work on, but now this is less of an issue but it has translated into a new one: I need to delegate better.
  

For the upcoming year, as a chief resident, I'd like to be a good leader and I thought about several ways to do this.

• Set expectations: I wrote out a list of things that each person on my team should know when we work together. I have a card for med students, interns, and junior residents. I had been doing this informally for med students and it turns out that most of them really appreciate this (at least according to the comments they send about me.)
  
• Seek feedback: In the past, I didn't really care about what people thought about me. I knew I was trying hard. I've been paying attention to the criticism attendings write about me in annual reviews, and trying to address things they've pointed out. However, I need to schedule meetings with my attendings 2-3 weeks into a rotation and seek their feedback on what I can do better. I also need to seek feedback from the junior residents and interns and try to meet their expectations for myself as a leader.
  
• Be nicer: In the past, I've tended to lose my patience especially around 3AM when up all night. From now on, I'm going to try to take a deep breath every time I get a page that bothers me, and return the call with class. Also, at the end of last year, I lost my patience with some of the OR staff. The specific thing that bothered me is when OR nurses treat me like a novice / newbie. I've been a resident for 4 years and I know how to do things in the OR, and I'd lose my patience when they didn't respect that. So I have to just ignore it when it happens. However, it seems that most of the OR staff have started treating me better in the last two weeks once they realized it's my last year of training.
  
• Lead: The role of chief resident should be one that people look up to. I should also be training junior residents and interns how to be better doctors. I need to project the image of unflappability and professionalism. I need to delegate better and focus on that. I will try to make all the social and recruiting events which I've tended to blow off in the past.
  
• Read: I'll be taking the boards at the end of the year and starting a vascular surgery fellowship, so I need to step up the literature review. I've been doing a good job recently in terms of preparing for cases and reading, and I need to continue. I need to set a board prep and fellowship prep reading list and stick to it!
  

We'll see how the above works out in the posts to come.