Steven Stites, M.D., Associate Professor of Medicine with the division of Pulmonary and Critical Care has been the Residency Program Director since July 2001. Dr. Stites graduated from The University of Missouri-Columbia in 1985, afterward completing his residency and Chief Residency at the University of Rochester, and Pulmonary/Critical Care fellowship at the University of Kansas. His current clinical and research interests include the Medical ICU, Lung Transplant, ARDS, Pulmonary Hypertension and Cystic Fibrosis.
"I remember being an intern, it was the best time of my life!"
It was 7:30 pm. I was sitting at the nurse's station trying to finish my notes on one of my fifteen patients. I was post-call. Tired. Hungry. Poor. I was only two months into residency. Best time in my life?
"No, really." It was Dick Gangemi, a practicing internist who later I would come to recognize as a mentor and who would become Chief-of-Staff. Now he was only keeping me from writing notes with his inaccurate and rose-colored memories. "The learning curve was so steep, and every day was different and challenging. Sure, I was tired and I was not so happy at the time, but as I look back on it, internship was fun!" Deviant.
Oh my, how the years change perspective. He was right. It was fun, or at least now it seems so. And the parts that made it fun were the learning, the camaraderie, and the challenge.
Surviving while learning. That's the key, and the best residency programs do both; that is they support you while providing you with the opportunity to learn. Success in residency can be achieved in many types of programs, but I believe there is a formula for the best. If you follow these rules, internship, while still hard, is much more bearable. So here is the Top Ten List for Internship Survival:
Yes, the first job is to save the patient. That, after all, is why we are here and remains the focus of the job. Of course, you cannot take on this responsibility all yourself. Indeed, you have to especially learn when to Do No Harm. Know your limits and, most importantly, know your patient's limits. That is why we have to be here to help each other; hence the Medicine is a Team Sport. You are the intern and not the attending. Situations that expect an intern to make crucial decisions while unsupervised put both the intern and the patient at risk; you need independence as a resident, not isolation.
Learn to recognize your limits and call for help and find a place that will be sure you are not isolated. This is very important for both education and stress management. Find also a place where teaching is not the final priority while recognizing that residency is much more of an independent study than was medical school. The patient's bedside is an important place to learn, but reading at your own bedside will help you grow immensely.
One of the other really hard lessons is to not identify too closely with patients. I learned a hard lesson on this as a resident and allowed a case to go too far. Perspective allows you to keep some separation. Your family and friends will appreciate this. Again, having other residents and faculty to help guide you here is crucial. We too often seek to rush our decisions. Remember that patients often take a while to get sick and will usually take longer to improve. Patience is a key component of patient care.
It is clear that part of the training for being a physician includes making crucial decisions when you are tired. Trust me, this will suit you well in practice. Patients get sick at odd and inconvenient times, so don't ever expect practice to involve easily defined limits. However, there are diminishing returns to sleep deprivation. Hence, our program has a reasonable yet challenging call schedule (q5 on the floors and q4 in the units). We fully embrace and have supported for years the concept of workweek limitations and strive to see that our residents are able to have a day off each week.
Remembering to take time for you and enjoying your friends and family is vital to internship survival. Laughter goes a long way in stress reduction. Find a program where this is part of the culture. And finally, remember that internship is only 8760 hours and that every minute brings you closer to achieving your ultimate goal: survival!
We hope you come visit us at the University of Kansas Medical Center and see how proud we are of our residents. We have great people. I wish you the best in your search for a training program that will meet your needs. As I look back, Dick Gangemi was right; it was a great year. It's just that I was only 1440 hours into it and had not yet been fitted with rose-colored lenses!
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The University of Kansas Medical Center