"How much longer do you have left in school?" asked Dana, a kind older lady from my church. I was used to this question – I had been in school for the past 21 years – but my answer was different this time: "I graduated in May, actually." "Oh, I mean residency," she asked, to which I replied, "I just started, so a little less than four more years." "Keep it up!" she said. After this brief exchange, I sat down with my family, and answered the standard questions from them: What rotation was I on? What hospital was I working at? How much longer until I was doing psychiatry? Why did I have to spend so much time in all these other things as well? Would there ever be a point when I didn't switch jobs every month?
Every resident and medical student has no doubt had many variations of these same conversations. Individuals in any field may find it difficult to explain their job to an outsider, but most people have pre-conceived notions of what a doctor does. However, this picture is of a practicing physician, and ignores the absurd schedule of medical education and training. Consider the average physician's path through medicine and medical education: first, there is the pre-medical classwork which may or may not have any relation to what a physician will do on a regular basis. But college and the concept of pre-requisite coursework is fairly understandable to most people, even with little educational background. Medical school is more confusing. The first two years, or the pre-clinical years, involve some classes, a fixed schedule of exams, near-constant studying, and very little patient care – so the medical student looks more like a glorified graduate student than a clinician-in-training.
The clinical years of medical school and the majority of residency are probably the most complicated part, and are the basis for why my family was asking me the usual questions. We move from one specialty to another on a month-by-month or in some cases a week-by-week basis. There is a temptation to view this as pointless, especially in residency, when most have chosen their specialty and know where and how they plan to practice. Why change every month, including numerous rotations in specialties that bear little resemblance to what the resident has already chosen to do? There are reasons, many of them valid, but it is easy to see why explaining them to an outsider can be both difficult and tiring.
Learning to navigate these conversations and explain the rationale is something we all learn to do early on, because of how frequently we get asked. This may have a hidden advantage, though; by articulating the good and bad things about our schedule, we might gain insight into why it wears us down and learn to combat it. Most of the known issues with medical education and its sometimes deleterious effects on our health and wellness have to do with the schedule. Good sleep hygiene, which we all learn in the context of educating our patients, involves many factors, but especially a regular bedtime and wake time. But residents simply cannot expect to have a consistent bedtime and a consistent wake up time; our pre-determined curricula prevent it. Further, in almost all residency programs, a decent portion of the time is spent in month-long rotations in different disciplines. This means that each month a resident must adapt to a new style of thinking and working; new preceptors and attendings; new co-residents and medical students; new curriculum schedules; and frequently new hospital systems, with new computers, new parking, new patient rooms.
This alone tends to wear residents down; it all relates to administrative tasks, but more deeply than that, to the disruption of rhythm. It's easy enough to explain that working weekends, working 80 hours a week, working a 30-hour-call shift can be tiring, but the more subtle thing that's hard to explain is the shift every month. For many residents, this continues for their whole residency – three to seven years. I'm in a psychiatry program, and so I have the third year to look forward to, which by ACGME requirements is 12 continuous months of outpatient psychiatry. This will give me the opportunity to actually have the same weekly schedule for a whole year, which to this point I've never actually done.
If this is sounding negative, let me clarify what I believe are the benefits to this model, which may provide insight to friends and family and remind ourselves why this matters. We gain valuable exposure time in a variety of disciplines because this is what makes us well-rounded and knowledgeable physicians. We switch services so that we can learn about subspecialties from the subspecialists and augment our training with their expertise. We alternate attendings and teams so that we are exposed to multiple ways of working and can continue integrating these examples into our own idea of how to be a physician. Further – almost as an unintended consequence of moving so frequently – we learn skills like cognitive flexibility, interpersonal communication, a willingness to learn, and resiliency, and those skills will no doubt benefit us in whatever job we land.
And so we return to the idea of talking to those outside of medicine and trying to explain all of this. Each time we’re asked about our schedule, it’s an opportunity to remember those benefits while making clear the negative parts that affect our health and wellbeing. By learning how to talk about it, we can help ourselves understand and help those curious friends and family to support us in it. Everyone craves a measure of stability, and if we can’t get that at work – and it’s clear that we often can’t, even to outsiders, once we’ve taken the time to explain – then maybe those same interested parties can better understand how they can be that source of stability, and maybe go easy on us with the frequently changing schedules.
Brent Schnipke, MD is a writer based in Dayton, OH. He received his MD from Wright State University in 2018 and is a first-year Psychiatry resident at Wright State. His professional interests include writing, medical humanities, and medical education. He is also a 2018–2019 Doximity Author.