Transitions

Late June and early July represent a special time in residency training programs. As I have spent my entire career teaching medical students and residents, July triggers many emotions.

Today is the last day for our 3rd year internal medicine residents. Many will stay here to do their fellowships. Some I will never see again.

Each year I reflect on the “graduating” class of residents. Just as I am doing that, we have new interns starting. The contrast keeps one grounded.

Our new interns started last Thursday. Bright eyed, bushy tailed, well coiffed, white coats clean, they have a seemingly perpetual anxious appearance. They know that they are starting a challenging year.

The interns are bright. Many could pass the internal medicine boards already (although many could not). None are good internists.

New interns see trees, not forests. New interns have little ability to understand the hierarchy of the trees. They have difficulty sorting through the mass of data we collect – physical exam, history, labortatory data, imaging studies – and put those data into perspective.

So we (the faculty) try to teach the nuances of internal medicine. We remind them of what they know, and what they do not yet know. We allow them to not know everything, because we do not know everything.

We try to help them learn how to focus on the patient and his/her desires. We try to model humanistic behavior and work life balance.

Each year the new interns doubt their ability to succeed. Each year the finishing interns fear the next step – becoming a junior resident.

Each year the finishing residents are excellent physicians. They know the difference between very sick and just a little bit sick. Very sick patients do not scare them, they know what we can do, and initiate the plan.

Hopefully the finishing residents realize that their educational journey has not finished. We (the faculty) often discuss our desire to improve each month. I am always looking for growth as a physician and as a teacher. We try to model that for the residents and encourage their continued education.

I know that is important, as the medicine that I teach in 2004 is very different from what I taught in 1980. We have new diagnostic tests and new therapies. We even have a few new diseases (almost always infectious diseases).

So during this transition, I reflect on this excellent group of residents that has finished their formal internal medicine training. They came as faces with resumes, and leave as fully formed physicians, with unique personalities. I enjoy getting to know them, and I will miss them.

But as the phoenix regenerates, so does the residency (although each year rather than every 500 years). We have new senior residents, ready to take their leadership role in the program. We have new interns eager to learn. And I, an old attending, look forward to getting to really know this new group. I hope that I can help them succeed like the graduating class has.

During their growth, I will enjoy their journey. I hope they can stop to enjoy the journey also, because the journey itself has great meaning.