I don’t think I would be the first resident to claim that residency is hard. Anyone who has gone through, or is currently participating in residency, will attest to the challenge of medical training. Efforts have been made on national and institutional levels to address this with work hour restrictions limiting the number of hours a resident can work or the number of calls a trainee can take. These rules and regulations attempt to alleviate the burden on residents and improve patient care. However, I feel the problems in physician training are much deeper.
The practice of medicine has changed, and with this change, increasing burdens have been placed on physicians and trainees. The amount of time that trainees spend in front of a computer, as opposed to the patient’s bedside, is discouraging. The feeling and sense that we lack autonomy in our patient’s care is disheartening. And, the current political climate and uncertainty about the future of our patient’s health access is depressing. No work hour changes or call restrictions will change the frustration that currently exists or the subsequent burnout that occurs.
The other challenge residents face is the lack of time to digest the powerful experiences we do have with patients. Some of those moments are beautiful and inspiring, while others are devastating and distressing. The problem is, we never get the chance to process or cope as we are constantly being paged back to the computer to put in more orders or write more notes. It is tough to refocus when you have just pronounced a child dead. It is difficult to reconnect after telling a couple their daughter has cancer. This, I believe, is not a new phenomenon in medical training, but I do believe this stress is exacerbated by the clerical burden we face in our current medical system.
Now, what do we do about it? There has been an emphasis at my own institution at identifying principles that can help us build the resilience necessary to face the challenges in our career. There is no silver bullet to address this problem, but the goal is to find outlets for each individual that can provide a relief. One tool that I have found to address my own personal struggle, is exactly what I am doing now: writing. Hearing the clicks and clacks of the keyboard as my thoughts and emotions escape the storm within my mind is a cathartic release. However, writing is very personal and intimate to me, and until recently I had been reticent to share my work. That changed though when I met others in my program who also use writing as a way to channel their emotions.
This has led to the formation of a small group of residents and fellows who are interested in a safe space to write and share their work. We call ourselves the Inklings, pirating the name from the great literary group at Oxford started by C.S. Lewis and J.R.R. Tolkien. A couple of times a month we take the time to read our own work as well as learn from other great works of medical literature. It provides us both a creative outlet as well as a way to further advocate for our patients. Who knows where it will go, but it is exciting to see the enthusiasm in bearing witness to what we go through as trainees, and at least for me it has provided me a respite from the chaos of my clinical training.
As trainees, we see some of the most incredible and stunning aspects of humanity and nature. We also see some of the most tragic and painful. It is critical for us to share these experiences as the power of narrative can create a network of connections between people that few other things can. I doubt any of us will have the critical or literary success of the Inklings of yore. Nor do I believe this will solve all the challenges of medical training. However, I am excited to see my co-residents find tools to help alleviate the strain of residency and to channel our passion for people, which for many is what brought us into medicine in the first place.
Michael McNeil is a pediatric resident.
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