DIP Episode 362 - 10 Tips For Successfully Making The Residency Transition

Okay, welcome. My name is Divine. This is episode 362 of the Divine Intervention Podcasts. And today's podcast, this is something that's going to be educational for people that are going into residency. I know, in fact, I'm going to title this topic. I'm going to title the title of this podcast will be 10 Tips for Successfully Making the Residency Transition. 10 Tips for Successfully Making the Residency Transition. Now, for those of you that are taking the Step 2 CK or Step 3 exams, I do have a course that's coming up in about 10 days on the 24th of this month. So, that's the 24th of January. I will be having an MBME Test Ticking Strategies class. That's going to be taking place from 2 to 4 30 PM Mountain Time on the 24th of this month. Again, we use a ton of questions to address very methodical approaches to avoiding MBME traps, getting the most useful information from questions, dealing with 50-50 situations where you narrow it down to two answers, answering a fixed questions, even answering questions where you have a limited knowledge of the material that's presented. Again, this is something that, of course, hundreds of people have taken, tons of people have taken this course, they've done extremely well. Again, I've had people where their Euro Cubans percentage is jumped 20-30% from taking this course.

I've had people like, oh, they take a practice exam and then boom, they take another practice exam after the test taking course, and they are jumping up like 30-40 points. So, again, if that's something you're interested in, should be an email through the website. And then, I have the 24-hour comprehensive review course for Step 2 CK or Step 3. Obviously, this course is also attuned to complex level 2 and 3, but basically, it's going to take place from the 25th to the 28th of January. So, that's Tuesday to Friday. And it's going to be taking place from 7 a.m. to 1 p.m., mountain standard time. So, that's about 9 a.m. to 3 p.m., eastern standard time. Again, we're reviewing about 2,000 concepts from Pediatrics, Surgery, OBE Guy, Neuro, Psych, Internal Medicine, Biosat, Ethics, Communications, Healthcare Systems, and also this section I call Multi-Systems Processes and Disorders. Again, we're going to use entirely Vignette. We're not going to be doing stock lectures. Most people end up having about 130 or so pages of notes from the course. Again, it's a very high-level course. There's actually about 1-6th of the total course time we spend that just taking an answering the questions people have. So, again, it's a very good course. I've had, again, tons of people take this course. I get emails like pretty much every Wednesday of people that, or the vine I took your course, I got into 250's on my exams. I got into 260's on my exams. I got into 270's.

I've had people get as high as the 280's actually after taking my course. So, again, if you're interested, again, obviously your mileage varies, right? But it's a course that, again, many people have taken and I will say the vast majority of people have found you to be extremely beneficial. Even if you're beginning your dedicated period just to build a knowledge base for it. And everyone had people take it like a day, literally like they finished the course and the exam is the next day. And they've done extremely well as a result of it. You'll see, wow, I saw so many things on my exam that I didn't see any other place, other than what we discussed during the course. So, let's just jump right into these 10 tips for successfully making the residency transition. The thing is, transitioning to residency is something that induces a lot of anxiety in people. It induces tons and tons and tons of anxiety. I mean, I know from me, you know, I made that transition a few years ago, after graduating from medical school at Hopkins. So, what was that transition like and how can you thrive through that transition? At least for me, I would say that, were there challenges? Yeah, there definitely were challenges. But was that transition pretty smooth and seamless for me to be honest with you? I would say yes. First things first, you know, thank God and I'm grateful. God really helped me. But I mean, many of you listening to this podcast, not a man of faith.

But really, like the transition was not as terrible as I feel like many people made it out to be. I feel like many people, just like before you start medical school, people say, oh, your life is going to be over. You're going to be sleeping in 30 minutes every night. You're going to be eating ramen because you don't even have time to cook. Again, all these, I feel like many people are very good at fear mongering. But at the end of the day, you can do really well if you just have the right approach. Like to be honest with you, there were certainly actually there were many months during residency that were a lot easier for me than when I was even a 30 year medical student. To be honest with you, in general, like my training has been relatively chill. Why? There isn't been chill is just because again, they are just certain principles you can apply so that you don't go through the stressors, the anxiety and the problems that many people seem to face. So what's the first principle? The first principle is taking step three. I know some of you may be like, wow, wow, wow, the line seriously. Let me tell you this. Taking step three is one of the smartest things you can do. Taking it early, you see people, they wait till the end of their first year of residency, the end of their second year of residency, or even their final year of residency before they take step three. And the thing you don't realize is that at the end of the day, you're pretty much hurting yourself when you do that.

The thing is, the time you're graduating from medical school is probably one of the times where your USMLA knowledge is still okay. Let me tell you this. The forgetting curve is amazing as you begin residency. Because the thing is when you start residency, again, you're trying to learn a new series of skills, you're trying to learn new crafts, you're no longer like some medical students with this massive security blanket around you. You actually have to take decisions that are necessary for patient care. So the thing is, as your mind gets filled with those things, then the basic science or the clinical science things you learned from medical school, begin to just see part of your brain at an accelerated clip. In fact, let me tell you this. By the time you hit December of your first year of residency, so most people got here from medical school in June, but at the time you hit December, I can pretty much almost promise you that most of the things you've learned in medical school, you've absolutely forgotten all of it. So again, it's very helpful. Just put it in and take step three. Again, I will share my personal experience. I remember I graduated from medical school a few years ago. I took my step three exam roughly about two months after I graduated from medical school. So studying for that step three exam was not as challenging as it could be. I mean, I still have to study, but it was not as challenging as I see many people go through.

Because again, I was just able to take it quickly, while a lot of that knowledge was still fresh in my mind. Obviously, I teach a lot, so thankfully, a lot of the material is still fresh in my mind. But again, I'm telling you, taking step three sooner rather than later is usually the brightest decision for people. Let me tell you this. Here are some other benefits of taking step three early. One is, if you're in a discipline that does moonlighting, sometimes you cannot moonlight without having like a state license. And in most of the 50 states of the US to get a license to practice or to moonlight, right? There are some ways you can kind of get around those rules, but they are far between. But if you want to like care for patients in a moonlighting role, one of the smartest ways to do those things is to have a step three score. Because again, without a step three score, most states will not give you an independent physician practice license. And again, some people I'm telling you, there are some residents, especially like insure residences, like radiology, derm, anesthesia that can pretty much almost double or triple their salaries. We just moonlighting, especially with COVID, I'm telling you, if you're a person that can take care of like ward patients and your person that has like a step three score, you have an independent physician license, you can make a ton of money in residency.

Again, obviously, you're going into your going into residency to learn, but I'm telling you like there are some people have heard and heard crazy stories of people that made 100,000 or 150,000 per annum just from moonlighting, right? So again, it's just something you want to keep at the back of your mind, right? And the thing is when you also take step three early, that's studying for step three actually helps with most disciplines. I'm telling you this, many people don't realize this, but the foundation that will ultimately carry you through residency in many cases, right? Or set you up nicely for residency is the foundation you've built up from appropriately studying for the USML East. The thing many people don't realize is a lot of that content you learn, especially like step two, CK step three content and some step one content. Those things are represented in clinical practice, that's the truth. Like many PIM questions you get from an attending or from a senior, right? Or even just reasoning through patients in a very streamlined way, you're able to, your clinical reasoning is just a lot better when that base of knowledge is there. So I encourage you if you can take step three, like most disciplines like, for example, family medicine, internal medicine, right, OB-GYN, anesthesia, right? Psychiatry, neurology, many of those disciplines, just having a step three knowledge base alone will make you very comfortable in the first few months of residency.

So that's the first step, take step three early. Now what is the second tip? The second tip is having a reading plan. Having a reading plan. Again, many people will be like, ah, come on, divine. You know, I don't have time in residency. Who has time to read and study? I mean, I'm barely trying to keep myself afloat. Let me tell you this. That's just an excuse that you're given. The thing is, when, and I'll explain how you can get more out of your day in a, in a later tip. But the thing is, when you have a reading plan, again, it's going to help you clinically. It's going to help you clinically, right? Again, many people have this misconception that you know what? The only time you should be studying in residency is when you're studying for your body exams, like towards the end of residency. That makes absolutely no sense. The thing is, usually with the way exams are spaced out in residency, they lend themselves very nicely to some kind of space repetition format, right? Or some kind of just longitudinal reading plan, right? Like most people, like for example, I'll give an example, like an interim medicine resident, can probably do well by reading like four or five pages of like some good text or resource or doing like ten questions from a cue bank throughout the year. Just do it on a daily basis. It may be like a 30, 45 minute commitment, but over time, those things will pay off in speeds, right?

Again, the thing is, when you have a reading plan, right, when you study like regularly, again, you don't need to do anything crazy like ten hours a day. No, that's ridiculous, right? But you can probably put in an hour pretty consistently every day. You can do like 30 minutes in the morning, 30 minutes when you get home from work. If you do that, it's going to help you again do well clinically, and it's going to help you do well on your in training exams. That is just the truth. And the thing is, when you have a reading plan, when you have that knowledge base, you get a lot more from your rotations than the average individual. Let me tell you this. It's almost like doing cue bank questions when you've done some studying. You get a lot more from those cue bank questions than if you have no knowledge base to start with, right? So again, and let me tell you this, when you have a good knowledge base, believe it or not, people notice. Don't let anyone deceive you saying that, oh, you know what? Who cares if you know that? No, let me tell you this. Attendance notice like your knowledge base will be reflected in some of the evaluations that you get. Your knowledge base will be reflected in the quality of your clinical care. Your knowledge base will be reflected in your reputation in that residency program. And let me tell you this, your knowledge base will be reflected in some of the opportunities you're able to take advantage of. So again, I'm encouraging you have a reading plan.

Now, what is the third tip? The third tip is having foundational skills. The good thing about residency is that when you're studying as an intern, most people don't expect much from you. So in that period of low expectations from you, spend that time building foundational skills. Let me tell you this. One of the smart things you can do as an intern getting into a discipline is sit down with a senior or most time sitting down with a senior, the chief resident to ask this question is a good thing. Just tell them what are the 10 skills that you feel are very common to this discipline that is something you need to just get good at. Write those things down and start working on them methodically. Believe it or not. Some of these skills may just be things like even being able to navigate the EMR. For example, let me give you an example. Let's say for example, you're an anesthesia resident. There are certain skills you need to have down very quickly. You need to be able to intubate relatively quickly. You need to be able to place lines like placing I Vs, placing like central lines very quickly. You need to be able to do certain calculations very quickly. Those are just examples of common classic skills. You should keep at the back of your mind. Sit down with a person that has gone through this process like it's two, three years ahead of you.

Please, can you tell me a list of 10 things within the EMR and just practical skills that I should have that will just make the things that you know that I will almost always have to do every day. Learn those things well, develop and approach to those things. You'll see that you'll be very successful in residency. Now, what is the fourth tip for successfully making the residency transition? The third tip, fourth tip is what I call reputation. Let me ask you this. Who do you want to be known as in residency? One thing many people don't realize is that the reputation that you build early in residency will many, many times define you for the rest of your time at that program. The theme is establish a good reputation. Even the Bible says that a good reputation is better than riches. A good reputation is better than riches. Let me encourage you to do this. Build a good reputation. Be known as a person that is kind to everybody. Let me tell you this. Medicine is stressful. You're going to encounter a lot of people with very negative attitudes. Don't get angry at those people. Let me tell you this. When a person gives you negative attitude, the smart thing to do is to kill those people with kindness. Kill those people with kindness. Let me tell you this. There's this part of the Bible that says that if you have an enemy that you should pray for them, you should treat them well. Because by doing that, you're literally building a cause of fire on your head. Build those cause of fire.

When a person treats you wrong and you treat them right. Those people will respect you a lot more than if you give it back to them. We live in a world where people are like, oh, let me go ahead and I'm going to get my pound of flesh. No, don't get your pound of flesh. A person that is trying to get the pound of flesh is a short term, short term thinker. A person that does not get the pound of flesh, but builds those cause of fire is a long term thinker. I encourage you be a long term thinker. Again, have a good reputation. That reputation will follow you. I'm telling you this. When I was in my transitional year, I worked hard to build a certain kind of reputation. I worked hard to not build the reputation as the person that is just mean to the nurses or disrespectful to the janitorial staff. No. I always made it an effort to be respectful, to greet people, to work hard, to do my best. Again, that reputation really helped me as an intern. What is the fifth tip? The fifth tip is half standards of excellence. Half standards of excellence. The thing is for everything you're doing residency. The thing is when you start off residency, you don't know much. You're not able to do much, but the thing is the little you do, do it excellently. Let people see your work and be like, wow, wow, this is an intern that did this. Do an excellent job. Again, this is one of the good ways to build a good solid reputation in residency. Write good notes. Write good notes. Give good presentations.

These are things that you should have gotten good at as a medical student. The thing is half standards of excellence. Set a standard for the kind of person that you will be. Let me tell you this. There is this part of the Bible. I don't know if you feel like this talk. It just has a lot of really good biblical references. If you look at the book of Daniel chapter 6, it talks about how Daniel was so excellent that you could not find any error in his work. Ask yourself if I'm doing things, even if they are mundane, I'm telling you do those mundane things excellently. The thing you don't realize is that when you do even mundane things excellently, people notice. I'm telling you this. Again, people notice when excellent work is being done. Simple as that. You will be known by your product. You can talk, talk, talk, talk, talk, or you want. But the quality of your output is the quality of your product that in many cases can define how people view you, how people, you know, people's perception of you. So again, I will encourage you to have that standard of excellence. Don't just do a possible job. Even if you're tired, you're like, man, I just want to go home, do an excellent job. The rewards will be far better. The thing is you can actually do an excellent job in a timely fashion. Again, it's just a matter of applying certain principles, which I'll talk about. Now, what is the sixth step? The sixth step is be proactive. Be proactive.

I'm telling you, again, I'm not doing this to call out residents, but to be honest with you, I'm going to call out some residents right now. Obviously, I'm not going to mention any names, right? But one common problem I've seen with so many residents is just living things for the last minute. Living things for the last minute, many residents, studying for step three, they live it for the last minute. Starting for the entry and exam, they live it for the last minute. Writing their notes, writing their progress notes, calling consults, they live it for the last minutes. Folks, don't leave things till the last minute. The thing is, you're going to, the thing is, when you leave things till the last minute, when you're not proactive, you are killing your mental health. Let me tell you this. One of the best ways to ensure proper mental health is just to do the right thing. When you do the right thing, I'm not saying, you know, people get mental health problems from many reasons. When you can't significantly lower your mental health stress by just doing the right thing. Or give me an example, right? I'll give you an example. I'm in a period of my life now that is really, really busy for me, like extremely busy. Right? Now, there was this class, there's this class that I happened to have been taken between Monday and Thursday. On Monday, I took this class and there was a five page paper that was due, we're given a week.

On Tuesday, took this class, there was another five page paper that was due in a week. Wednesday, I took this class and there was a small paper that was also due as well. Right? And then on Thursday, I took this class again and there was, you know, like a one page paper that was due and another like four page paper that was due. The thing is, after I took the class on Monday, by Tuesday, like afternoon, I had written the paper from Monday and then I wrote into the class on Tuesday. By the end of Wednesday morning, I had written the five page paper for my Tuesday class. Right? And then on Wednesday, I wrote into my class by the end very early on Thursday morning, I had already written the paper for my Wednesday class. Right? And then on Thursday, there was one of the papers that was due before class, I completed that in the morning. And then by Friday morning, literally like after I woke up and I did my personal devotion, the next thing I wrote into was doing that paper from Thursday, the four page paper. So now, I can pretty much sit down and enjoy my weekend. Why? Because I don't have these papers that I need to worry about. Right? But contrast this with people that were like, oh, you know what? I will deal with this over the weekend or I will deal with this early next week when it's due. Right? Then imagine you're trying to write a five-pager, five-pager, four-pager, one-pager, one-pager. Right? That's essentially 16 pages of writing. Right?

That's a lot to handle all at once. Right? Those people will feel stressed. And when you're stressed, you begin to do my adaptive things. Right? But if you just did the right thing and just had a sense of urgency about life, then like look at me, like I don't have to stress out this weekend. Although I also have many other commitments. But I don't have to stress out because I've just done the right thing early. Right? You see many residents, they wait till the day the patient is being discharged to start writing their discharge summary. And then they are spending hours or nip because they just did not do the right thing early. I remember for myself, discharge summaries, the day I admit a patient, I've already started their discharge summary. And the thing is for every day that they're in the hospital, I just add a little bit to the discharge summary. Oh, okay, these were the things that changed. These were the things that changed. So when you then came time, the patient was ready to be discharged and had to put in a discharge summary. Most of my discharge summaries, like the final day, will be like a two, three minute process because I've been investing like five minutes every day while those patients were in the hospital. Right? So be proactive. I'm telling you, if you just make this one change in your life this year, you will end this year far better than you started it. Right? Just be proactive. This is like an epidemic in healthcare.

People love to leave things till the last minute. Now what is the seventh tip? The seventh tip is be a planner. Be a planner. Be a planner. Be a planner. Be a planner. Right? It kind of works with being proactive. Right? The thing is many people say, oh, divine. I don't have time in residency. You know, by the time I get to work and then I admit patient and then I do this and then I do that. And then I do that and then I do this and then I do that. My time is gone. Before I know it is 5 p.m. I didn't have any time to study. But blah, blah, blah. Let me tell you this. The reason you were not able to accomplish much is because you did not plan. Let me tell you this. One of the best ways to create more free time and to get more from your day is to just plan. It's to just plan. Again, I know some people may be like, oh, divine. Come on. I'm sure you did not have that many patients. Let me tell you this. There are many times. As an intern, where I have like six, seven patients that I was managing. Right? I was writing their notes. I was calling consoles. I was checking in on them. I was rounding on them in the morning. But still during the course of the day, I will have like four or five hours to sit down and do whatever I wanted to do. Why? Because I went in every day with a plan. Right? There is this Christian author. I really love his name is John Bevere. He has used this term that people should live life like it's like a mission. Right? Be emotional.

I really love that concept of living life with a mission. Have a plan. Right? The Bible says that when there is no vision, the people perish. Right? You need to have a vision for the day. Don't just like leave the day and oh, like you see many people say, oh, I'm going to see wherever the wind takes me. No, or wherever the day takes me. That is one of the most awful ways to think about life. Going with a plan. If you plan and you stick to that plan, you notice that you have so much free time to like rest, to relax, to study, to do all these other life things while you are resident. Now, what is the eighth tip? The eighth tip is you need to develop systems of success. What do I mean by this? A system of success is an approach to something. Again, I've talked about this pretty thoroughly in other podcasts, but it's very important to have a system for everything. Have a system for admissions. Have a system for discharge summaries. Have a system for progress notes. Have a system for rounded. Have a system for managing the ICU. Right? The thing is when you have a system for things and you practice those things over and over again, those things will become like second meter to you. Again, I remember my first ICU rotation as an intern. I think they give me like two patients and you probably took me like four hours, just like a crazy amount of time to you know, pre-around on those patients, get my notes done and everything.

But again, within the first few days, I started developing systems. Once I developed systems, you could give me five, six ICU patients and I would see them pre-around, write my progress notes on everything in about an hour or an hour and 15 minutes. Why? Because again, I had systems. So it's almost like when I come to work, it's almost like I was working on auto pilots. Right? And again, I was pretty detailed in my care of these patients. Right? But again, in combination with a good knowledge base and just having a system, these things became very easy and straightforward. Now, what is tip number nine? Tip number nine is keep your head low. Don't be loud. The thing is, if you're doing excellent work, people will notice you don't have to be the one blowing your own horn in residency. Right? You see some people that are like, oh, I want to be visible within the department. So you see them, they are always in every conversation. They are always giving their two cents. No, you don't always have to give your two cents. Two cents are pretty worthless. Keep quiet. Right? There is this adage in my jacket that says that empty barrels make the most noise. Right? Just keep quiet. Keep your head low. If people see that you are doing really good notes, you are giving really good presentations. You are really smart with your answers to questions and stuff. They will know that you are good residents. You don't have to tooth your own horn. Don't be the one blowing your own horn.

Let others be the one doing the horn blowing for you. Right? So keep your head low. Don't be a loud person. Right? Don't be a loud person. Just be a calm quiet person. Be calm and be quiet in spirit. And then the final tip tip number 10 is have clear expectations set with your superiors early. This is very important for rotations. At very beginning of a rotation, just ask the chief resident or the senior and your team or the attendant. What are the things that I need to do so that I can do really well on this rotation? Have those expectations. And then just at the end of the day, spend five minutes asking yourself, did I am I meeting these expectations? I really like maybe like once every week, meet your senior, meet your attendant. Or how do you feel like I met these expectations? Again, if you do these things is almost like you are setting your you are putting yourself in a position to succeed. The putting yourself in a position to get a very good evaluation. So again, I encourage you apply these 10 tips. Take step three on time. Develop a reading plan. Right? Have developed foundational skills. Look out for your reputation. Have standards of excellence. Be proactive. Be a planner. Develop systems of success. Keep your head low and have clear expectations. Set with your superiors early. If you do these things, I will be happy to see you. I will be happy to see you. I will be happy to see you. I will be happy to see you. I will be happy to see you.

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Taking Step 3 early, while basic science knowledge is still fresh before it degrades significantly due to residency demands.

The forgetting curve causes significant loss of foundational USMLE knowledge, making preparation much harder.

"Kill them with kindness"—treating them well and respectfully to build positive reputation capital.

Be proactive by starting the summary/documentation elements daily, rather than waiting until the patient is discharged.

Creating repeatable approaches for routine tasks (admissions, progress notes) so they become second nature and save time.

Reputation defines them throughout the program; it is a long-term asset that follows their work quality.

The concept of building a continuous "reading plan" or knowledge base over time.

To avoid spending hours at the last minute; adding small details daily makes the final process quick and easy.

It can provide an independent physician license necessary for moonlighting/side income opportunities in many states.

Setting a "standard of excellence"—doing even mundane tasks excellently so that people notice your quality output.

Short-term thinkers demand their "pound of flesh"; long-term thinkers build positive reputation capital through kindness and respect.

Being proactive (doing things early) and being a planner (having a vision/plan for the day).

The concept of building a continuous "reading plan" or knowledge base over time.

To avoid spending hours at the last minute; adding small details daily makes the final process quick and easy.

It can provide an independent physician license necessary for moonlighting/side income opportunities in many states.

Setting a "standard of excellence"—doing even mundane tasks excellently so that people notice your quality output.

Short-term thinkers demand their "pound of flesh"; long-term thinkers build positive reputation capital through kindness and respect.

Being proactive (doing things early) and being a planner (having a vision/plan for the day).