Chiefs, remember, one of those interns is going to fill your shoes in a few years. They may model you in that role, so you want to raise them well! As a former chief resident, I have lots of pearls for those entering residency. However, what I will tell you now is different from what I would have told you then. I have since learned that there are possibilities to create the results that we want and not just follow the path we are told to take.

Recently, a former intern of mine — who went on to be a chief resident and subsequently a program director — tweeted that he received advice from another chief: “If you are unhappy in residency, you need to adjust your expectations.” He pondered that this suggestion was a mixed bag. Can you see both sides?

Residents, who is responsible for your happiness? Is it the institution, the program, the program director, the chief resident — or you?

If the bigger entity is creating a toxic environment that endangers your emotional and physical health, then simply changing your expectations and accepting what you are given is not the right thing to do. But if you expect that it is up to them to make you happy every day and you do not have responsibility for this too, I would call this out.

1. If you go into residency planning to be perfect and do A++ work all the time, you need to adjust your expectations.

Many physicians are perfectionists and overachievers. Think about all those accolades mentors wrote in your letters of recommendation: “detail-oriented,” “goes above and beyond” and “seeks out more opportunities.”

We get things done, and we do them well. Residency is a chance to shine, but it is also a space to overdo and create burnout. Sure, you can do all these things, but if you do them all the time at the top level, it starts to dull your skills and your energy. I would challenge you sometimes to do B+ work and be OK with it to continue to be that ideal resident in the circumstances that matter most — in your interactions with patients.

Perhaps you do not need to write the perfect note but instead, leave one that relays what is needed at a minimum. The slides for the morning report do not have to be the best you have ever done. By doing this, you can create a more enjoyable experience during your residency.

2. If you go into residency thinking you will just plow through because it will be all worth it when you get done, you need to adjust your expectations.

Residencies are long and not easy. For some, the years go by slowly and for others quickly. I am sure you dream about the day you will be done and will be an attending, and it will “all be OK then.” If you sacrifice now to have everything you want when you “arrive” and do not enjoy the day to day you will miss out on so many wonderful things along the journey.

Knowing what fuels and sustains you during this pivotal time in your life can set you up for tools for resilience when you face challenges in the future. It is not all roses when residency is done. This is called the “arrival fallacy,” and it can affect anyone — not just residents. So, make sure you are still doing things to take care of yourself during residency.

3. If you go into residency thinking you have no control over your time and how you spend it, you need to adjust your expectations.

Expanding on the prior thought, there are long hours and commitments built into residency. It is true, you do not control the amount of time you will be required to provide patient care, cover roles, learn and teach others, but not all are prescribed.

You may not have hours easily accessible to spend time with your family, do exercise, read for pleasure or watch Netflix every night. But that does not mean that they must be eliminated from your life during your residency years.

In Effortless by Greg McKeown, he describes a strategy of having upper and lower bounds for important things that fill your time. He suggests setting both a minimum and a maximum number of minutes you will participate in those essential activities over a certain period.

For example, you are concerned that you will not be able to keep up running during residency, and it is a stress reliever for you. You are used to doing it four hours a week before residency. Ask yourself what the least amount is you need to benefit from it and make that your lower bound. Set an upper limit to have time for other things you want to do during that time. This upper bound is also helpful, so something does not become a buffer or a distraction. By setting protective boundaries and expectations, you can enjoy more things during this time.

4. If you go into residency thinking you must follow the plan to a T to be successful, then you need to adjust your expectations.

Lastly, many residencies have a cookie-cutter formula without much room for curiosity and exploration outside the box. Perhaps there is something you want to explore during this time. Know that your curriculum could be different to support needs for your family, your outside interests (like training for the Olympic games), or your volunteerism. How can you brainstorm strategies with your program to support your unique interests and create that happiness you deserve during residency?

I leave you with words of advice from this now more experienced, former chief resident: You control your own happiness through your thoughts and your actions. You can enjoy happiness during residency by setting expectations that fuel you during this time in your life and career.

Marion McCrary is an internal medicine physician and can be reached at Marion McCrary Wellness.

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