The upgraded responsibility and authority given to starting residents is both a blessing and a curse. Suddenly, the need for co-signatures vanishes. There is greater autonomy in clinical practice. Residents get paid. However, residency can also be a time of significant stress. Residents are forced to navigate the demands of preceptors, other residents, medical students, nurses, patients, family members, and administrators. Residents have very little control over what they do, when they do it, or how they do it. The hours are long, and the density of the work is intense. Residents are the duct tape that holds academic hospitals together, but it can feel thankless.

1. Take care of yourself first. Being an effective clinician requires a sharp mind, and residency picks away at the elements that sustain it — things like sleep, nutrition, exercise, and socialization. Take care of yourself first. However small, what time you have control over, protect fiercely. Being strict with your time doesn’t mean you never go the extra mile, but sacrificing self-care needs to be the exception, not the expectation. If you let residency take anything it wants from you, it will quickly suck you dry.

2. You can say “no” and still be professional. “No” is a frightfully underutilized word in a resident’s lexicon. Residency is an incredibly vulnerable time, and being seen as even marginally adversarial is undesirable. Saying “no,” however, doesn’t require sacrificing professionalism. “I would love to help, but I already have a commitment.” It’s OK if the commitment is to yourself. Pause and think before spitting out an automatic “yes.” Is this something I really want to do? Can someone else do this task? What will I need to sacrifice to take on this extra commitment? Am I making a habit of forgoing self-care?

3. It’s OK to ask for help. Not only is asking for help OK, it’s a sign of self-awareness. Whether clinically or personally, asking for help says, “I am aware of my limits and can collaborate to push past them.” Having trouble processing a tough case? Ask a colleague to debrief. Feeling down or anxious? Enlist the help of a counselor. Make an anonymous phone call to your physician health program. Ask your residents association for help. You aren’t omnipotent, and that’s OK.

4. The work will never end. In residency, trying to get “everything” finished is like chasing the sun. Take care of your clinical responsibilities, but be aware that you can always do more. There are always more papers to be read. There are always more labs to be reviewed. No resident is ever bored; the supply of work in medicine is infinite. Do your part, then allow yourself to take a break.

5. Don’t let great be the enemy of the good. No one gets to be a resident by settling for mediocracy, but perfectionism can drive you into the ground. Medical students are accustomed to doing not a good job, but a great job. They give it 100 percent every time. If you didn’t learn to drop this quest for perfection in medical school, now is the time to do so. If you zoom in on the top 1 percent, within it there’s still a normal distribution curve, so the vast majority will have to be “average.” That’s alright. Be OK with being average.

6. It’s not a race. Residents end up delaying graduation for a myriad of reasons, including personal illness, to pursue research, a family crisis, maternity leave, burnout or academic struggles. Throughout medical training, our eyes are always fixated on the next step. You just have to make it through undergrad, just have to get into medical school, just have to get through clerkship, just have to match. Slow down, because the view from the finish line is a vast expanse of nothing. It is exhilarating to get to fill that space as you choose, but it isn’t going anywhere. If you need to slow down, or take time off, do it. Residency is indestructible — it will be eagerly awaiting your return — but your baby will only be a baby once.

7. You can’t make everyone happy. At the start of residency, a mentor said something that proved invaluable. “You need to remember that shit rolls downhill, and it’s not your fault that residents have to stand at the bottom.” Crude, yes. Effective? Also, yes. Don’t take anything personally. Just because your attending is crotchety doesn’t mean you did anything wrong. Don’t take anyone’s frustrations personally. Instead, the next time someone makes a rude comment, take a deep breath, and meditate on this: “Shit rolls downhill, it’s not my fault I’m at the bottom.” (Later you can help tear down that hierarchy!)

8. You don’t need to have all the answers. Residency is about learning. If you already knew everything, you wouldn’t need to be a resident. If a patient has a question to which you do not have an answer, just say so. “That’s a great question. I’m actually not sure, but I will look it up for you.” The same goes for preceptors. If you don’t know, say you will look it up — and actually do it.

9. Support your colleagues. Residency is really, really hard. Your co-residents are your greatest allies. Look out for one and another. If someone seems to be struggling, rather than ridicule, offer support. It doesn’t have to be big. Buy them coffee. Remind them of something they’ve done well. When people brighten your day, tell them. There is so much criticism and negativity in residency that just a few words of positivity really stand out.

10. Mental illness is not mental weakness. Having a mental illness does not make you a bad resident, and it doesn’t mean that you “aren’t cut out” for medicine. It just means that you are human. Medical school acceptance letters don’t come with a promise of protection against mental illness – they actually come with increased susceptibility. Depression, in particular, is exceedingly common amongst medical trainees. Unfortunately, mental illness in medicine is so stigmatized that we feel the need to fight the same, invisible battle in silence. Mental illness is not weakness, but it is serious. Residents have the knowledge and means to complete suicide. Take depression and suicidal ideation in yourself and in your colleagues seriously. Not only is it OK to seek help, it is imperative. Seeking help for mental illness shows courage, strength, resilience, and dedication — none of which illustrate anything close to “weak.”

Sarah Tulk is a family physician.

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