Resident Rules of the Road: Chapter 10 Summary: “The First Year Out”

Originally Published: AAEM’s Rules of the Road for Emergency Medicine Residents, 7th Ed. Chief Editors: Tom Scaletta, MD FAAEM; Michael Ybarra, MD FAAEM; Leana Wen, MD MSc. AAEM and AAEM/RSA. Milwaukee, WI. 2010.

Chapter Summary Edited By: Andrew W Phillips, MD MEd, Stanford/Kaiser Emergency Medicine Residency Program

Summary Series Editors: Muhammad Alghanem, BS and Andrew W Phillips, MD MEd

There’s a light! Do you see it? The end of the tunnel! Except … wait — it’s fading as you realize that now your name is at the bottom of the chart, that utopic emergency department staff doesn’t actually exist, you still have disrespectful consultants, the boards are approaching, and Press Ganey now applies to YOU!

Never fear — your AAEM and AAEM/RSA colleagues are here, just as they always have been!

Tip #1: Become the type of doctor you wanted to be during residency. This means taking on more responsibility now as a resident (e.g., moonlighting), reading extra at the end of residency and as a young attending, and finding a role model (who may or may not be in emergency medicine).

Tip #2: Work and play well with others. Be involved in hospital committees to build relationships (and your own job security). Make your first impressions count: be known as “intelligent, efficient, resolute, qualified, and courteous.” As you learn the hospital policies, consider your clinical decisions carefully and don’t be afraid to look up information or ask.

Tip #3: Your utopia bubble will burst, so don’t take it personally. See the Rules of the Road for Emergency Medicine Residents chapter for more information on the book Emotional Intelligence at Work. Basically remember 1) maintain your cool in conflict; 2) fairly assess every situation, and allow the other party to provide their full opinion; 3) strive for the transformational interaction (our way) over a transactional interaction (my way).

Tip #4: Don’t be “that guy” or “that lady.” SEE EVERY patient signed out to you and re-evaluate EVERY plan. Don’t dump patients at sign-out. Try to resolve disagreements with consultants academically; if that doesn’t work, ask them to personally evaluate the patient. Above all, don’t argue in front of patients — no one wins.

Tip #5: SOFTEN your patient encounters.

  • Smile when you first greet a patient.
  • Openness: a projection of being open and honest.
  • Forward leaning: approach your patient and shake hands (or fist pump if you’re into that literature).
  • Touch: with empathy, as appropriate (e.g. hand on shoulder)
  • Eye contact: sincere, focused.
  • Name: say the patient’s name (correctly) and sincerely.

Tip #6: Don’t blow your chance to get out of debt! Easy there — you don’t need that Corvette yet. Be reasonable — enjoy being a real person finally, but within reason. If you’re picking up extra shifts to cover your lifestyle, chances are you need to tone it back a bit before you get caught in a shift overload loop. While you’re at it, talk to a qualified financial planner. We’re notoriously horrible investors, so be smart about it.

Tip #7 Study for the written and oral boards.
AAEM and several ACEP chapters offer courses for both. AAEM has an excellent board review book also, available here, that AAEM and AAEM/RSA members get at a discounted price (hard copy version). The AAEM oral board course can be found here. At the very least, see if you can use your residency’s practice oral board questions for yourself and a find colleague taking the exam so you can switch roles as examiner and examinee.

Tip #8 Take time for yourself. Sleeping, reading, running, eating more than saltines and a juice box for lunch — whatever makes you happy, re-energize yourself!