1. Accept that your life is never going to be “normal.” What type of people decide to be surgeons? The type who have something a bit “wrong” with them, that’s who. The type who are OK with having their career occupy most of their identity. If you’re considering surgical residency, this is probably you. Accept it. Each person’s path is different, and there is no absolute correct one. A work-life balance is important to some people; they have many fulfilling hobbies and an identity outside of work. This is not you. You have chosen to have your career become a part of who you are, to live to work, as they say. It’s OK—just as the world needs well-rounded people, it also needs career-obsessed maniacs. Without people like us, we wouldn’t have medical advancements, nuclear reactors, or the theory of relativity. You’re going to work long hours; you’re going to be exhausted a lot; you’re going to have to study and do research in your little bit of spare time; you’re going to miss a lot of special occasions when a case gets added on; your significant other is going to be angry at you often. These are the trade-offs because you can’t have it all despite what people try to sell you. You have to choose. But remember, neither option is inherently better than the other. Make sure you think long and hard and choose the correct one for you.
2. Be OK with being average. As someone aspiring to be a surgeon, you’re likely competitive, which has helped you reach this point. While wanting to be the best is understandable, it’s important to recognize that everyone in surgical residency is intelligent and driven. You will not be special. Accept that. There will always be someone better than you, and that’s OK. As long as you can honestly say you’ve given your best effort, there’s no need to fret. After residency, it won’t matter who had the highest ABSITE scores or who was the fastest at doing lap choles. Residency programs don’t graduate people who aren’t competent for the job. If you finish residency, it means a group of qualified professionals has determined that you can safely do your job. Everyone has their place, so do your best, accept where you stand, and be content. Regardless of your rank in residency, you will be a qualified surgeon.
3. Remember to filter feedback. As a resident, you’ll receive a variety of feedback—positive, negative, constructive, and not-so-helpful. It’s crucial to filter this feedback and focus on the constructive and helpful aspects. Be open to hearing about your shortcomings and view feedback objectively, separate from your identity. Don’t take it personally. Remember, you have the power to decide which feedback to take to heart and which to discard. Four types of attendings will give you feedback during residency:
The chill/nice attending: They give everyone generic, generally positive feedback. Unless explicitly asked, they will likely only tell you what you’re doing right, and this will likely be sugarcoated.
The rude attending who hates everyone and who everyone hates: This person will never have anything constructive to say—they only know insults. They usually have some good zingers, though. The best way to deal with this attending is to learn to laugh at yourself—they don’t seem to enjoy insulting you as much when you don’t get flustered. Don’t react and take away their sadistic joy.
The micromanager/drill sergeant: This can be one of the most frustrating attendings to work with. You’ll be under their microscope whether sewing a vascular anastomosis, closing the skin, or even placing a dressing. They are particular down to the exact millimeter of your stitch placement. My advice is to stay patient and listen to them. While they can be quite “extra,” they usually have helpful tips.
The tough but fair attending: They are blunt, direct, and likely to roast you unintentionally. This attending will tell you what you need to hear and how you can improve. Their feedback does not come from a place of condescension; they genuinely care about educating residents. Try to listen and grow from their feedback. You will learn the most from this attending.
4. Learn the art of dissociation. There will be endless tough times during residency. You must work with attendings and residents you don’t vibe with. There will be long, boring cases where you are doing nothing more than retracting. You will get yelled at by angry patients for things you had nothing to do with. You will be stuck rounding with the chatty attending who stays in each patient room for 20 minutes after a 24-hour shift. You will be frustrated and feel powerless—because you are powerless. In these situations, it’s important to learn the art of dissociation. This means mentally separating yourself from the situation, focusing on the task at hand, and accepting that there is no way out of the current situation. This coping strategy got me through a good portion of my intern year.
5. Find a philosophical perspective that works for you. As a resident, you will encounter many situations beyond your control. Your work schedule, decisions during cases, decisions regarding patient care, and the endless piles of paperwork will all be beyond your control. This is where Stoicism can help you cope. Stoicism teaches that while we cannot control the events that happen to us, we can control our reactions. It also emphasizes not wasting energy on being upset about situations we cannot change. This mindset has helped me power through the most grueling parts of residency.
While an off-putting term to many people, nihilism has helped me deal with anxiety-inducing situations. This philosophy states that life is inherently meaningless and the universe is indifferent to human existence—it is up to us to create meaning within our lives. While this can be a depressing sentiment for some, for me, it is a freeing mindset that significantly reduces anxiety and helps me not take myself too seriously. For instance, if I feel nervous about giving a presentation, I remind myself that, ultimately, none of this matters in the grand scheme of things, and my anxiety usually disappears. It’s a dark but comforting thought that works for me. Do you prefer a less pessimistic approach? Find whatever works for you—there are many other options.
6. Build a support system. Fortunately, I have a supportive spouse who understands the long hours and is quite independent. When you decide to become a surgeon, ensure your spouse is also up for that lifestyle—it has to be a joint decision unless you want a divorce. My spouse, family, and awesome co-residents have been great sources of support. It’s important to find your tribe in your program and not alienate yourself from your fellow residents. Some may want to come into residency with the “gunner” mindset, trying to show how much they know, steamrolling over their fellow residents. Don’t do this. No one will like you. My advice is that you’ve already made it and have nothing to prove. So long as you are competent at your job, no one cares about how many facts you know. Always support your fellow residents and never throw them under the bus. Life as a resident is already hard enough; we must stick together and care for each other. You’ll find yourself making great memories with awesome people.
7. Enjoy the ride. I have a countdown on my phone of the days until I complete my training—1,033 days, to be exact. While it can be tempting to want it to be over as soon as possible, it’s important to enjoy your life while in training. We’ve all seen the movie Click and the pitfalls of wishing your life away. These are years of your life you will never get back. You will never be this young again. One day, you will miss the days of complaining and goofing off with your co-residents. You may even miss scrubbing in with that one attending who always drove you crazy but who you secretly had a soft spot for. It’s OK to look forward to being done, but remember to enjoy the ride.
Audra King is a surgery resident.
