DIP Episode 497 - Avoiding trouble in residency (and medical school)

Welcome, this is Divine. This is episode 497 of the Divine Intervention Podcasts. And to this podcast we're going to be addressing a simple topic that I love to call Avoiding Trouble in Residency. Avoiding Trouble in Residency. You may wonder why should I make a podcast like this? Why should I care about this topic? Here's the thing. Following these roles will help you not just as a resident. In fact, maybe I should change the topic to Avoiding Trouble in Medical School slash Residency. But these roles honestly, they largely apply to both Med School and Residency. But I'm going to be focusing on the resident angle. Again, the thing is you may think that residency or the tale about how smooth sealing and everything it is. Yes, it can be smooth sealing. But I'm telling you, residency is front with many problems. You see people getting fired from residency, getting suspended, losing their jobs, not being promoted, being on probation, getting kicked out, you know, having to get in one issue with the other medical board. You don't want to face any of these things. And honestly, yes, don't get me wrong. Is this going to be an all exhaustive list? No. But these things you should try to follow. Yeah. So I'm going to focus on 10 things you should do so you can avoid trouble in residency. So you don't get in trouble. Because again, I'm telling you I hear stories every single year. You don't want to be among those people. So it was the very first thing.

The very first thing is the in-training exam. The in-training exam. So for those of you that don't know about in-training exams, these are things you do when you become a resident. Almost every discipline has in-training exams. Usually you're going to do it like at the end, you know, sometimes during the year, do it sometimes during the year. You take it, you get a score, your performance is pretty much assessed. Now, where does the trouble arise for many people? The trouble arise for many people because the program literally will tell you this. The program you seniors, even your program director will tell you this. Don't study for your in-training exam. Don't worry about it. It's just more of a self-assessment. Don't worry about it. It's not a big deal. Please, trust that advice. In order to advise, if you follow that advice, you will get in trouble. As long as you take the in-training exam, and you do decently well, the program is not going to be on your back. But if you take the in-training exam, don't study for it. So you're just like, yeah, just show up and take it. If you don't do well, you'll see a different side of that program that you did not imagine that you'll see. The thing is, in residency, bad press is the press you do not want. The residency environment is almost like the media. Bad press, you do not want. So you don't want anyone looking at you for bad reasons because that can cause a lot of problems.

You see many residents, they don't take the in-training exam seriously. They do poorly on it. Yeah, it's not that they get fired from residents or anything because of that. It is really rare for a person to be fired from residency because of poor in-training exam score. But here are the things the problems it brings. One, the program director is now aware that, okay, this may be a person that may struggle with exams. This may be a person that may struggle with a licensure exam for this discipline. And then they can begin to extrapolate your performance on the in-training exam to your clinical performance. This may be a person that may struggle clinically. They'll start seeing things about your fund of knowledge. And the thing is, it's almost like a route that then starts growing into a tree. That tree, like basically you just have more increased scrutiny upon your life when you have a bad in-training exam score. I'm not saying you want to try to, oh, that oh, wow, you must get a hundred percent talent in the in-training exam. No, I'm not saying that. But you need to do decently well. You need to do well enough at least to be off of anyone's radar. Because that's the thing. If someone has that schema in their minds that, oh, this person was a poor performer on the in-training exam, then everything you do will get a more critical evaluation. Everything you do will get a more critical eye. Because they think that schema that, oh, this person did not do well at this.

Hmm, okay, maybe they are also not doing well at this. Maybe they also not doing well at this. I'm telling you this, I've seen this so many times. In fact, this is probably one of the biggest risk factors, one of the most common causes of people getting to trouble in residency. Okay, what's principle number two? Principle number two is step three. Again, you see many people did elite taking step three as much as is humanly possible. As much as is humanly possible. You don't want to put yourself in that situation. You don't. Right? The moment you're done with med school, obviously you cannot take step three while in med school, at least in the US. You got to take it after you're done with med school. After you get your med school transcript. So here's the thing. Once you're done with med school, I will encourage you to start studying for step three. Start. Don't wait. Start studying for step three. Many people get into trouble because you're like, hmm, residency is intense. Let me focus on residency first. You know, at the end of my first year, I worry about step three or sometime, my second year, I worry about step three. The thing is, here's the thing. There are quite a number of programs where if you perform poorly on step three or you fail it, I'm telling you, you may you may not believe this, but actually a lot of residents feel step three. I could you not? A lot of residents feel step three. So the thing is that thinking is fallacious for some reasons.

And I'll explain some of the consequences that can happen from that decision. One, as you're proceeding residency, the knowledge you've gained from med school, you begin to lose a pretty significant chunk of it. Step three is actually not that hard. If I'm being completely honest with you, it's not that hard. If you just remember a decent amount of what you're learning med school. So why not take it early when you have that decent fund of knowledge relating to the US than later when a lot of that knowledge has disappeared. Another issue with delay in step three is that, and actually maybe let me give a query to that first reason I gave. When you take step three, when you study for it, it actually pick up a pretty decent amount of clinical information along the way. So chances are that will actually help you just be a more effective resident. But under issue with step three as well, is that as you proceed in residency, your responsibilities do not decrease. Your responsibilities and the expectations of you increase. So the amount of dedicated time you will have to actually study for step three becomes less and less and less. People think, well, let me wait till I get on an easy rotation. No, here's the thing. When you start of residency, do you know that you're pretty much a med student? You don't know much about the discipline. You don't even know where things are in the hospital. So the expectations of you are very mild.

So it's better to study when those expectations of you are mild. Because if you make mistakes in a residency, then you won't get covered crazily for it. But if you make mistakes as a second year or whatever, because you're trying to devote so much time to studying for step three, you will get heavily covered. So it's better to take it when you have more time intrinsically to study. Now another problem, and again, this is something I see a lot, especially with IM Gs. Well, honestly, not just only IM Gs, even USMD medical students get in this problem. You notice and also USD of students. If you don't do well on step three, you'll feel it. You'll be surprised. The program may not even have informed you of some of these consequences, but you may be surprised that would will come of it. You can see, oh, we're going to, you'll feel it. You feel the exam, or we're going to give you this deadline. I need to pass it by this date. If not your contract will not be renewed. If not, you will be fired from residency. Blah blah blah blah. You don't want to go through all those things and troubles. Avoid all of those things by just doing the right thing and doing it on time. Now, third thing I'm going to say about residency, third principle is, and again, you can apply these principles to med students. For example, in med school, if you start feeling exams, you're going to probably get a probation, take a leave of absence. And again, many of these troubles, you can avoid them.

That's the thing. Don't get me wrong. People get into trouble for reasons out of their control. But I've noticed that in the vast majority of cases, people like to blame their residency program. They like to blame their medical school. Don't get me wrong. They may be some blame in those quarters. But the thing is, many times, people just don't do the right thing. Right? Or they are just very complacent and then they end up getting in trouble. Now, the third thing I'm going to say is be careful with your speech, speech matters in residency. Speech. How do you speak? What do you say? What kinds of words do you use? Here's the thing. Before you talk, think. We're going to say that again. Before you talk, think. The thing is, the residency environment is gossip central. Gossip central is like the media. What you say can be massively taken out of context. And we know that we live in a time of the world where people get very easily triggered. You see something and they're just like, oh, it's making me uncomfortable. Yes, again, you shouldn't see things that meet people uncomfortable. But these days, people get uncomfortable for the most bizarre reasons. People will make up something that triggers them. We live in a world where people get easily triggered. So just watch your speech. Think before you talk. Give thought to your words before you talk. Because a person can live towards you. Say it can be someone that overhears.

Even though even be someone you spoke directly to, maybe someone that overhears what you're saying. They pick up what you say. And then you just get lambasted with lots of troubles. There's a part of the Bible that says he that keeps his mouth keeps his soul from troubles. Keep your mouth. Think before you talk. Okay. Now principle number four is don't let your business be known to all. Do not let your business be known to all. You see some people, they're so chatting residency. They come in where everyone knows how their personal lives are going. I'm not saying you shouldn't let people know about your personal life. We should kind of keep some boundaries. There are just some things that should not be shared. Right? Only share what needs to be known. When you see some people, they talk about their family problems. They talk about their home problems. They talk about everything with all the other residents. So everyone in the program knows their business. They know how things are going at home. They know how things are going emotionally. They know how things are going this. You know how things are going that again, many times is that going to be an issue? No. But the time it can be an issue is again, if you get into trouble down the line, people can use what you've told them about yourself as ammunition. Like say, for example, if you tell people that man, I've been so stressed. It's been a lot at home. You know, man, I'm having this relationship trouble or whatever.

And then let's say you perform poorly on an exam or you perform poorly in a clinical interaction. People can use what you've said as ammunition that, oh, yes, this person is taking a lot of stress. It's been stressed a lot at home. That's probably why they are not doing so well. This person is engaged in this activity. That's why they're not doing so well. So just keep your mouth shut. You're going to see, I'm coming here to see a person that says no words in a residency. No, you'll see what I'm going to see concerning that. Right? Because again, a residency is just gossip central. People gossip a lot. Right? So just don't let too much of your business be known out there. Now, a query to this, though, here's one thing I'll say. You also want to make sure, however, that you communicate well with your team and with your patients. That's an exception to this role. Not your business, but stuff relating to patient care. I'm telling you this, communicate with your team, communicate with your patients. Don't be the kind of person that, oh, you're just like, oh, yeah, I'm getting my work done. That's all that matters. No, communicate these things to your team. Who are the people on your team? Your senior, the attending that is leading your team on everything. Communicate things. Have the numbers. Text them that, oh, okay, I have run the list. I have met our patients, I've written my notes. Is there anything you want me to do? I just want to make sure I'm not missing all of them.

Just say it like that. Just give them updates during the day. I'm telling you, attendants and seniors, I appreciate a person that I'm not seeing many by many updates. No, they don't need that. You're not supposed to be a stock ticker for the attendants and seniors you work with, but give them periodic updates. You can give them a good update in the morning, a good update in the afternoon, like two or three times a day, give them a decent update. I think that will really keep you in good stead. If they see that, wow, okay, this person is actually making efforts. This person is actually getting his job. He's a hard job done. Then you'll be looked upon more favorably. You'll get much better evils from that. Principle number five is time, time, time, time. Time, time matters, time matters, time matters. What are the things I will discuss on that time? Well, the Australian things that are important, like training up to work on time. You see many people, they don't show up on time, or they always show up like, oh, a minute to when their shift is supposed to start. Don't be that kind of person. Be the kind of person that shows up like 15 minutes before your shift is to start. You'll help you get sign out and you'll help you even check out the list before sign out. There's a lot of comfort from doing those things, right?

So that you're just not completely thrown out of the loop, where you're like, ah, from the get go, no, it's good to come in so that you're almost like coming in on a relaxed basis before you do certain things. And also pay attention to your efficiency. Pay attention to your efficiency. That's one thing many people don't keep in mind with timing. And the thing is people will be more efficient if they were more missional in the way they approach to work. I'm telling you this, I see this all the time. You see residents, it's noon and they're still writing their notes. You see residents, it's noon and they're like, wow, I have all these things I gotta get done. I gotta get done. But check the content of the ad from whenever their shift started to noon and they spent 30 minutes in the hospital cafeteria. They spent 45 minutes talking with other residents. They spent 30 minutes to an hour looking up stuff on social media. And then you wonder why these people are not able to get tasks done on time. They have no checklists, nothing. No, that's not a smart way to go, right? Even the Bible says, I redeeming the time. You need to learn to redeem time. Time is one of the, it's not, money is not the most valuable commodity on earth. One of the most valuable commodities on earth is time. But people don't use time wisely. It always shocks me because I'm like, wait, I see that these people only have five patients. And it's noon. They've no routine, they are notes.

They've not done their discharge summaries. None of those things. No, it's not supposed to be that way. It's not supposed to be that way. So be a person that uses your time coming to work with a mission that way before I go on social media or before I go on this or before I start spending crazy amounts of time cheating chatting with people. And I'm going to make sure I get these things done. And that component of timing is doing things ahead of time. You see some people, they wait. You see I've literally seen, and this is literally one of some seniors I've seen. A patient has been discharged like a month ago. And the discharge summary has not been done. It shouldn't be like that. It shouldn't. Many people in residency are not proactive. And then they keep wondering, why am I getting into trouble? Why am I getting into trouble? Why am I getting into trouble? Well, hello, you put yourself in that mess, right? Like I remember when I was a medical student, and I think even when I was a resident, when I start, when I, how do I put this? When, at least I didn't necessarily do this for all my patients. Well, this is something I feel like I did pretty consistently. When a patient gets checked into the hospital and they're my patient, as once I'm done writing the admission note, I start up on the discharge summary almost immediately. And that discharge summary, I don't just start up on it, but on a daily basis, I make edits, edits, edits.

I just keep adding to that hospital course, adding to that hospital course. So by the time the patient is ready to leave, and all these things, it take me like two, three, maybe five minutes of extra work every day per patient. But when that patient is ready to leave, literally, I've written like 95% of the discharge summary. So all I just need to do is add a few words, throwing a few things, throwing the final physical exam, and hit submit. Most times before my patients leave the hospital, their discharge summaries have been signed already. That's been proactive. That's been proactive because that's one thing like many people wonder like, why is healthcare so inefficient and slow in the US? There are many reasons for that. There's a lot of bureaucracy, there's a lot of red tape, there's a lot of all these issues. I get it. I get it. But I keep you not a not insignificant cause of inefficiency. Why you see people while the emergency room, they're waiting for hours. Oh, they're there waiting for hours to get admitted. When you see a patient that man, this patient could have been discharged six, seven, eight hours ago. One very big major reason behind that is the inefficient healthcare professional. They don't get things done on time. Like sometimes, there are times where I literally was like, oh wait, this person, what's going on? What do they need to stay in the hospital? Do they still need to be here? Why are they here? Right? Make people's discharge summaries on time.

Make people's prescriptions. Get it out. Put it in the out folder. Tell the nurse that. Give it to the nurse directly that this is this person's folder. These are their scripts. This is this. This is that. Whenever you're ready, they can leave. Make because let me tell you this, staying in the hospital is not awesome, especially for a patient. Every minute you're spending the hospital is a minute away from their families. Some of these people may not have childcare. They may have to be for childcare and all these things. They may not be able to work because they're in the hospital. Right? So like try to make a patient's timing the hospital as short as it's possible. Don't be inefficient. Don't make patients pay for your for your inefficiency. Okay, I think that's enough with time. Let's go to principal number six. Principal number six is clinical performance. Clinical performance matters. Right? This is one thing that commonly gets residents fired or being on probation and things like that. Right? The thing is, you see some people because of sometimes they get very jaded. After you get jaded, you then start doing a very poor quality work. It's not good. You want to be an excellent person in residency. Do things and do it excellently. You see some people, they just copy paste everything. Don't be that kind of person. Right? You see their notes. Just a wall of text, a wall of crap that no one needs.

But they've just been copy pasting copy pasting copy pasting copy pasting copy pasting. And again, many times you won't have to resort to these things if you just did your job and did it right. If you just did your job and did it efficiently. If you just did your job and did it proactively. Right? So your clinical performance matters. If you do excellent work, excellent work will shine. That's just the truth. Excellent work will shine. People will see what you're doing and you will get good feedback as a result of it. Right? And that thing I'm going to send the clinical performance that's actually very helpful is something I like to call the copycat principle. This is actually something that's quite helpful, especially when you're because residency is just a basically a series of rotations. That's what residency is. Here's one thing that I love doing. When I start off a rotation, especially when I was a med student, a resident, I love to do these things where I say, okay, okay, wow, for this rotation, I'm going to be working with this attending, I'm going to be working with this senior, I'm going to be working with this resident. Okay. How do these people get things done? And it's very easy to figure out. Like literally, I tell myself, first few days of a rotation is for observation. And this is something that sometimes it can be as literal as just the first day. I ask myself, okay, how did this resident present this patient to the attending?

What does this resident's note look like? What do his or her notes look like? What are some questions that the attending kept asking on every patient? How does this attend in right there notes? What kind of addendums to deput with their notes? What kinds of things do these seem to care about? What kinds of things do these seem to check with every patient? Because I'm telling you this, everyone in medicine is different. People have their peculiarities. There are certain labs that people chase down that others don't. There are certain things, some attendants and residents want to know about the patient that others don't really care about. So the thing is, what each person wants is different. So you need to be a person that adapts to the rotation, adapts to the rotation. So the copycat principle is figure out the things that your seniors and your attendants care about from a clinical perspective, not writing perspective, presentation perspective. And then be that person to them. Dish out what they want to them. You're going to get a good evil doing stuff like that. And then another thing I'm going to say is be honest, be honest person. Don't lie. Be honest person. Be honest person. Because once you're caught in a lie, you're just sitting yourself up for trouble, sitting yourself up for failure, and sitting yourself up for professionalism issues. And then constantly ask for feedback. Ask for feedback. Ask for feedback. If you want to ask daily, there's nothing wrong with that.

Oh, and ask for feedback like, oh, can you tell me how did I do today? No, that's not a useful question to ask. Is not. Oh, how did I do to do? No, just say, are there any things you spotted today that you'd like me to improve on? Just say it like that. Just say that, you know, I'm trying to get the very best out of this rotation. And, you know, I know I only have 30 days here. So I want to pick up as much as is humanly possible on this rotation. What can I do to improve? That's a much better way. What did you say? How did I do today? That's not helpful. People will just tell you, you did well. That's it. No, no, you want to honest feedback, ask honest questions like what are some things I can improve on and try to get the most out of this rotation. You see, you can get a lot more done that way. Okay. And then principle number seven is actually study. I'm telling you this, people say, oh, residency divine is so stressful. I have no time to study blah, blah, blah, blah, blah, blah, blah, blah, blah. Again, I'm telling you this, if you're following many of these roles and principles that I'm discussing, you will have time to study a residency. You will have time to study a residency. Again, I'm telling you this, I wish people could keep track like, you know, just like there is like apps for weight loss. If people would literally keep track of every 30 minutes of their day, like, between 9 a.m. and 9 30, what did I do? Between 9 30 and 10 what did I do?

Between 10 and 10 30, what did I do? Between 10 30 and 11, what did I do? If people actively kept track of their days and times, they'll be shocked up to how much time they waste during the day. They'll be shocked out, wow, I could literally get four extra hours out of my day. If I just stop doing x, y, z, that does not matter for my future or is not as important. Right? You just need to be a person that recognizes the value of time. Many people don't recognize the value of time. That's why they keep getting a lot of trouble. All they notice is that, wow, I don't have time for anything. Right? Like you know the medical student that always seems to be studying so hard that night before an exam, they are pulling an all nighter. Why? Because they were just not smart with the use of their time for the weeks leading up to the exams. Right? This is something that helped me so much and I'm so grateful to God for that thing. College in med school and rising and see. I always try to do things ahead of time and just be efficient with my time. Right? Literally, if you spend three hours on You Tube every day, is that really helping your destiny? Could you be called that in half? I used that one and a half hours to study. Right? I kid you not. I remember when I was on my old big-eye rotation in med school, when I was doing the LeBron delivery, the hours were intense. Intense, intense, intense hours. But I went in being missionals like, okay, I'm going to be in LeBron delivery.

Yes, do you have like extended two, three hours of time ever? No, you may not have that, but you may have five, ten minutes free every hour. My goal was, oh, for my shift, I'm going to try to do three, you two or three work questions on my phone for every hour. That was a target I had. So I went in with that target, so my time was very well utilized. You notice me, and it's the end of a shift, and I've done 40-year-old questions already. So I'm not going home from a 12-13-hour shift, I'm going home to study. I'm going home to sleep and relax, because she have already done a bunch of year-old questions already. Right? So I think it's just very important. Be smart. Actually, study, that's one thing people think. People think that residency is all experiential. No, there's no way you can pick up everything you need for your board exams, for your training exams, just from your clinical interactions. Many people like to deceive themselves that way. No, you actually have to like study, right? You actually have to study. And if you're a person that is studying every day, that is studying on a regular consistent schedule, right? And that's the thing, build a study plan. You're doing this on a regular consistent schedule. When the time for your training exam comes, when the time for your board exam comes at the end of residency, you notice that you're not struggling, you notice that you don't have to start studying crazily for one full week.

You just notice that, oh, this exam is just a collective test of all I've been consciously learning or throughout my residency, right? So actually, study. I'm telling you this, studying is something that can vastly improve a person's clinical performance. It can improve your confidence with patients. It actually makes you very good because you know stuff. So when you're talking to a patient that has a presentation, you know what to look for. You know what they likely have. You know what test to order. You know what drugs to give. It's just a smart, simple thing to do. And especially disciplines that like internal medicine, radiology, anesthesia, Durham, surgery, I'm telling you, pretty much every discipline, you'd be very well served if you studied consistently every day. You would have used 30 minutes, but just do it. Make it a daily habit and you'll be well worth it to you. And the most principal number eight, be respectful to everyone. Everyone. The nurses, the janitors, the patients, be respectful. When you're respectful to people, they'll very likely want to give you a good evil. When you're respectful to people, they will try to help you. When you're respectful to people, they will try to get you out of trouble or prevent you from getting in trouble. I kill you not. I cannot count how many times I present the virus. I have been respectful to. They give me like some fair warning so that I avoid a problem. They give me some fair warning to avoid an issue. Right?

Trust me respectful. You see some people, they just have this incredible cockiness. Once they become attending, so once they become residents, or once they have an MDO deal behind their names, they suddenly think that they're a tear above everyone in the hospital. Don't be that kind of person. Trust me respectful. And again, I'm not seeing try to bribe people, but there's nothing wrong with every now and then bringing stuff for the people on your unit. Right? Because health care is stressful. Right? Again, you can do things from the right motives. Just be a nice person. Nice guys do well. That's just the truth. Okay. Now, principal number nine, be organized, be organized, be organized. Right? Be organized. I'm telling you this, if people were organized, they'll be able to get almost like double or triple the amount of work done every single day. In much less time, be organized. Checklists are very helpful. Have an approach to things. Don't just do things in random fashion. No. No, especially like in complex clinical situations. Like in the ICU being organized, boy does it help a lot? Just be organized. Be organized. Be organized. Have an approach to useful prayer on them and approach use for on them and approach use for no writing and approach use for new admissions. Right? Just be organized. If you're a person that's organized, I'm telling you, you'll make very few mistakes and you'll be extremely efficient. People will be wondering, man, this person has eight patients.

And why you say that it's 10 a.m. and you're already able to just sit down, chill and relax for most of the rest of your shift. Well, it's because they are organized. Organization matters. Right? Just going to your day, going to your life with a plan. Don't go in, let me see where the wind takes me. Mm-hmm. Don't be that kind of person. That's a person that's setting themselves a fulfill your or for being very inefficient. And then what's the final principal, principal number 10? Don't be a person that seeks to outshine others. Focus on the quality of your work, but don't focus on trying to warn up other people. The thing is, people that are experienced in healthcare, in the residency process or whatever, they will see right through that. And people hit that kind of person. You're answering every single question. You're doing, just now, you always want to be the star of the show. Don't seek to always be the star of the show. That's just not so smart way to live. Just in general, people hits the person that just always seems to wow. Wow, this person is no, don't be that kind of person. Right? Just keep a be, be modest. I just think that's a smart thing to do. You see some people, their juniors, and trying to outdo their seniors. Don't be that kind of person. I'm not saying don't do quality work. Right? If people come in that, wow, the work you're doing is really quality. I mean, like you're a pretty, the level of a senior. That's fine.

Take that praise, you humbly and move on. Right? But don't be a person that then starts lordying over people. Again, these things I'm seeing are common sense things. But again, as many people say, common sense is not exactly common. So again, just be mindful of these roles. And I think you're being good shape. So I'm going to stop here. Again, if you're taking any US Emily exam, I have a bunch of classes that start today that you can take advantage of. I have a test taking class starting this evening. And the all overs, that's for step one to step three. I have a bio stats class tomorrow, also for step one to step three. And then I have a social sciences quality improvement, ethics, healthcare systems, communication skills, and professionalism class. That's taking place on Saturday morning. So if you're interested in any of these classes, these are all for step one step three. Shoot me an email and I'll give you some more information. I'll give you some more information. But these classes, I think you'd find them to be extremely helpful. And then for both taking step two, step three, or shelf exams, I have a class that starts next week Monday. It's Monday Tuesday Thursday and Friday. 20 hour course, but it really hits on. It's a very good, pretty thorough review of a lot of the material. You're going to be seeing tested on your exams. The classes over Zoom, they're not lecture based. They are pretty much almost entirely problem based.

And then there are some charts and tables I go over with people, but for the most part is like probably like 90% cases and clinical scenarios, because that's how your exam is going to look like. And then I have a 100 hours step two, step three courses and extremely comprehensive course. That's going to be taking place next year. And then for those taking step one, I have a 25 hour step one review, taking place very early in January. So if you're interested in that, again, shoot me an email I can give you some more information. I have this podcast on Apple, Google, and Spotify, I have a You Tube channel, you can check out. Then I have another website called divine intervention, lifelessons.com. On that website, I post from a biblical perspective every week, I post about two podcasts that address a life lesson from a biblical perspective. We have almost, I think, 240 episodes now. So just check that out. There's actually an Apple podcast, associated with that called the divine intervention life lessons podcast. Thank you for joining me today. I'll see you in episode 498. God bless you. Bye for now. Thank you.

It creates a negative schema among staff, leading to increased scrutiny and critical evaluation of all subsequent clinical work.

As soon as possible after completing medical school, before starting residency, when foundational knowledge is still strong and expectations are mild.

Speech matters; one must think before talking because what is said can be taken out of context or used against them later (gossip central).

By being proactive, using checklists, and completing tasks ahead of time (e.g., starting discharge summaries immediately).

Observing and emulating the specific habits, presentation styles, and required checks performed by senior residents and attendings on a given rotation.

Nurses, janitors, and patients (and all staff members).

Staff can use that private information as "ammunition" if the resident performs poorly or gets into trouble later.

Because clinical performance requires more than just experience; continuous study improves knowledge depth and confidence for board exams.

"Are there any things you spotted today that you'd like me to improve on?" (This solicits actionable, critical advice).

Organization allows for significantly more work to be completed in less time and helps prevent mistakes.

To remain modest, focus on the quality of one's own work, and accept praise humbly, rather than trying to always be the star of the show.

Arriving early allows time for preparation (e.g., checking out lists) and helps maintain a relaxed, prepared start to the shift.

Staff can use that private information as "ammunition" if the resident performs poorly or gets into trouble later.

Because clinical performance requires more than just experience; continuous study improves knowledge depth and confidence for board exams.

"Are there any things you spotted today that you'd like me to improve on?" (This solicits actionable, critical advice).

Organization allows for significantly more work to be completed in less time and helps prevent mistakes.

To remain modest, focus on the quality of one's own work, and accept praise humbly, rather than trying to always be the star of the show.

Arriving early allows time for preparation (e.g., checking out lists) and helps maintain a relaxed, prepared start to the shift.