DIP Episode 386 - Rules for Newly Matched Residents

Okay, welcome. My name is Divine. This is a piece of 386 of the Divine Intervention podcasts and today's podcast is going to be focused on roles for newly matched residents. We're going to focus on roles for newly matched residents and then at the end I will see some things about individuals that we participate in in the ERAS 2023 cycle. If you're going to be taking the USMELIS step 2 C kill, step 3 or complex level 2 or 3 exams, anytime within the next month, I have a few courses that you might be interested in, I have an MBA me, Test Ticking Strategy course that's going to be taking place today, it's going to be in the evening from 5 to 7 30 p.m. Pacific Standard Time. That's each to 10 30 Eastern. Or I also have a 30 hour, I mean a 20 hour course that's going to be taking place tomorrow that Saturday and the Saturday next week, so the 23rd and the 30th of this month, we'll cover a lot of internal medicine, psychiatry, surgery, pedes, OB-guine, neurology, multi-system process and disorders, ethics, biostatistics. We're going to be covering a ton of very high yield material. Again, I've had many people take this course and drink extremely well on the exams.

The Test Ticking Strategy course today, we're going to be focusing on how to answer MBA me questions, how to pick out the right answer in 50-50 situations or in situations where you're not sure of what's going on, we're going to talk about how to still answer those questions even when you have very limited knowledge of the material that's being presented. There are many, many high yield things that will go over. Again, many people, I've had tons of people at this point attend the TTS course, the Test Ticking Strategy course and they've done extremely well. Then, if you're taking a USMLE exams, step two, step three, complex level two or three this summer, I have a step two CK school, I call it the disk DISK school. It's going to be taking place in the first two weeks of May, it's 75 hours, there's limited attendance because again, I really truly want to invest in everyone that's attending. The school is literally like two years plus of very deep research and planning. Again, it's going to have an expanded Test Ticking Strategy course. We're going to have, we're going to review a lot of stuff and we're going to review it in a very deep, very thorough way. By the time you're done, you will feel very well prepared from a knowledge base and from a Test Ticking Principles perspective for these respective exams. So if you're interested in many of those things, shoot me an email through the website and I'll be happy to give you some more information.

All these courses are going to be held over a few days. Okay, so for those that have matched with some rules you need to follow. In no particular order, the first one I will say is, don't splurge and overspend. Don't splurge and overspend. There's this thing that happens. I don't know why it happens a lot to people when they're starting new things in life. They feel this need to spend money. They just feel this need. There's this unseen as, oh, I got to spend. I need to get a new home. I need to buy a new car. I need to buy a new home, new car, new gadgets, get a new laptop, get these books that I'm going to read in residency. Blah, blah, blah, blah. Let me tell you this. You're going to be wasting a lot of money. Ask yourself what are things you absolutely need? Get those things. Then ask yourself what are things you absolutely want? Even if it's like 10 things, get one of those things you want and leave it at that. The thing is you're getting into a period of your life where you may be like, wow, I'm going to be earning money for the first time. Glory be to God. But you need to remember that your residency salary, remember there's this thing cost student loans that you have. You're going to have to pay. Remember there's this thing called eating that you're going to have to deal with. Sometimes residents, they just don't have time. So you may be eating out quite a bit. So just kind of keep that in mind. Remember inflation is a thing in this currency column.

There was a time not too long ago where gas was going for under 3 a gallon. Surprise surprise. There's now a time where gas is going for almost 5 a gallon. So don't overspend. The thing is people that are graduating from residency, they recognize that people have this overspend thing going on with them. They start pointing off all the things they owned in residency that they probably didn't really use. But they're like, hmm, I see these wonderful people that I can maybe take, get some of my money back. Don't overspend. Just buy what you need. If you have a card that works perfectly fine, you don't need a new card right now. I mean, I wish you all the best. Buy in a car in this currency economy. You're going to be paying a bove MSRP with this chip shortage and everything. Right? And to be honest with you, most books that people buy for residency, you don't need any of them. I'm telling you this. Most times in residency, you need like a Q bank to do one of your boards and stuff. You need a Q bank and maybe a one book. I mean, it's not one book. Your residency program already has it. Are they going to give it to you for free? Don't buy new books. Just don't. Not smart. Now, what is the second thing? Sort out your housing. Sort out your housing. I see some people do imagine to a residency program and then they wait till the week before they are moving before they start sorting out housing.

And then because they are waiting for the last minute or they get a crappy place that they don't want to live or two, they get a place that's very far from the hospital. You don't want that if you can avoid it. Sort out your housing. The thing is many people like residency many times, success in residency, many times we boil down to two principles. Being proactive and being organized. That's it. Being proactive and being organized. If you're feeding your life with those two principles and also doing the right thing that also helps. If you're feeding your life with those three principles, you're going to be very successful. So sort out your housing ahead of time because you don't want to be stressing out about housing and squatting in another residence apartment where residency has started. All those things just stress you out. When you start residency, you want the week before residency starts for you to be relaxed, for you to be enjoying yourself. Because you are making a new transition in life. You don't want that transition to be horrifying because you are worried about other things besides just residency like housing and food and things like that. Now another thing that also helps is take a vacation. Before you start residency, take a vacation. To be honest with you, is a vacation absolutely necessary? No. Is it probably more of a want? Yes. But is it one of those ones you should probably splurge on? Absolutely. Take a vacation. Just relax. Just relax. Take a week off.

Go somewhere. Sometimes even you can take a vacation in your home. Just relax. Sleep. Do the things you love to do. Enjoy yourself. Because again, your schedule is going to get very busy. That's just the truth. Take a vacation and relax. You see some fourth-year medical students, they're like, oh, should I do some more rotations? No. Don't do more rotations. That is not smart. That's not predict. Don't do more rotations. The thing is, regardless of how much prep you do, you're still not going to be really greatly prepared for residency. Your third-year rotations are plenty. When residency starts, you're going to feel lost. But that's okay. Many people go through that exact same spill every year. But after a few weeks, you'll begin to feel comfortable. If you're prudent and you apply wisdom in the way you handle your residency activities. And then also don't stress. Just calm down. Don't stress. One of the most stressful experiences I think of having clinical work was doing my first ICU rotation. The ICU, super overwhelming, sick patients left right and center. And this was during November, December. Very concerning and everything. But just don't stress. It's all going to work out well in the end. To be honest with you, I love this life perspective of it's all going to work out well in the end. Always keep that perspective. Personally, for me, that's a perspective I like to keep. Especially when I'm in situations where I'm like, and I don't really know what I'm doing here.

I am out of my league here. I just tell myself, you know what, divine? It's all going to work out just fine in the end. Just calm down. Calm down. Take a chill pill. Calm down. Everything is going to be fine. Now, the one key principle I said I really want to discuss today. I want to discuss organization and productivity. Be organized. I'm telling you, when you start residency, just be organized. If you're organized, it will take away almost like 80 to 90% of the stressors that people face as new residents. Be organized. Be organized. Don't do things randomly. Your day should be structured. I'm telling you, you can get a lot more from your day as a resident if you're just organized. Have an organized approach to how you pre-round. And to be honest with you, your first week of residence you may be lost and that's fine, but you shouldn't be lost for too long. How do you avoid those problems? Just observe people that are successful. Look at the second year residents. Look at the 30-year resident. Look at the chiefs. Just observe. I'm telling you observation. You can learn a lot by simple observation. Ask yourself, how does this person that has seven patients pre-round and finish go through them so quickly? Ask yourself, how does this person write their notes? Then go for the EMR. Look into the EMR. Look at their notes. Look at how they organize things. You can even ask them for their templates. Be organized. I'm telling you this.

That was one thing that helped me tremendously when I started ICU. I see you. You saw the device. The first three, four, five days. The device was extremely slow. You could give me like two patients. You would take me like four, maybe five hours to knock them out. But after I observed, I was really slow because I was observing. Observing. Observing. Observing. And then I started creating my organized approaches. In the ICU, this is how I'm going to pre-round. In the ICU, this is how I'm going to run. In the ICU, this is how I'm going to write my notes. In the ICU, this I'm going to follow up on my patients. In the ICU, this is what I'm going to do. The came up with all these roads. And then, after a while in the ICU, you could give me five patients. I will come in around past six in the morning. And by 8.30, I've seen all those patients. I've written my notes. Most of the tasks that need to be done for them have done them already. Right? Again, that speed came from just being organized. Right? Or if you look at your own personal life, your resident, you know that residency is a stressful period. Many people get a lot of weight in the first year of residency. And how wide do they get that weight? Because many people just have to eat out because they don't have time. So be organized. What do you do? You tell yourself, okay, Sunday is my day off. Let me cook on Sunday. Half-foot for the whole week. So now, when you come back, just put it cover out your portions.

You come back home, throw in the microwave, pull out your food, eat it, take a shower. Right? Don't go to sleep right with all the going from the hospital. That does not very prudent. Right? So, you know, take a shower. Boom. Go to bed. You simply, your life just gets simple and less stressful when you're just organized. Be organized, organized, organized, organized. Have a plan. Have a plan. Be organized. Don't sit around chatting, chatting, chatting, all the getting nothing done. Right? You see some residents, they come in in the morning. You know, they have these tasks that they know they have to do, but they are chatting with the other residents. They are doing this. I'm not saying it should not be sociable, but they are ultimately to take care of patients. You see some people, they are chatting so much. They are shifting, supposed to end by three. And then they are running like all over the place at 2 p.m. because they are things that they should have done that they neglect to do. And you see some patients just staying in the hospital for longer than they need to, just because of an irresponsible resident. Right? So be organized, be organized. And let me tell you this. The next principle is be proactive. Be proactive. Do things on time. Do things on time. You see people, the day that patient is being discharged, they don't do the discharge summaries that they, and then you notice that a month down the line, the EMR people have to stop boeing them.

A month down the line, they have a list of 30 discharge summaries that they have to write. That they could have just done the day the patient was discharged. To be honest with you, I had this very strong policy. Before a person, patient left the hospital. My discharge summaries was signed and completed. Just do things on time. Why stress? Why wait for something to have accumulated for 30 days? Well, you could have just done it that day. Because like many people are very fond of same divine. I don't have time. Let me tell you this. If you minimize distractions during your day, you can get a lot of stuff done. That's just the truth. Be proactive. Do things on time. And you'll see that you won't need to stress. Most of many of my days during my intern year, I did a transitional year, we're pretty low-key just because I was proactive. If your residency says, oh, you know, by a month into residence, you should have done these models. Do wait till the end. You see people, they want to wait till the night before those things are due. And then that might where they could have spent maybe sleeping or spending time with their families or whatnot. They're spending six hours just banging, banging, banging out modules. That's not the way to go about things. Just be proactive. The thing is, where you are proactive, you can take life easy. If you're like, hmm, let me spend 30 minutes at the end of these modules.

And then you notice that a week before their due, you're already done with all those things. Why don't you make your life easy? I don't know why people just have, have, have, have, have to meet their lives as challenging as is humanly possible. No, don't do that to yourself. That's not smart. That's not product. And then another thing I will say, in fact with this productivity, takes the three and get it over with. The thing is, you've got an interresidency. You want to limit the amount of time that the USML Es still have control over your destiny. The thing is, many of you study residency. A lot of the knowledge from med school is still a little bit fresh in your mind. Why don't you put in a little bit of study time at the beginning? And the thing is, at the beginning of residency, people don't have many expectations of you, because they know you're brand new. But as you go deeper and deeper into residency by month six, by your first year, by your second year, people see that, okay, you've been here for a while, you should know you're left from your right at this point. Or when you become a senior, when you become a senior, you then have more responsibility. You then have to control the junior residence and everything. You're going to have much less time as time goes on to study for step three. So why don't you just study for it and get it over with? I remember when I studied my transitional year.

I told myself, I graduated from medical school, you know, graduated from Johns Hopkins in May, right? And for me, I was like, hmm, divine, just get this step three over with. By the end of July, I was done with step three, and I was really happy, right? So I graduated in May towards the end of May. The moment I finished graduation, I started putting my step three application. June studied, July studied, and this was studying on a very leisurely pace. My end of July, boom, I'm taking step three. And then I didn't have to worry about it anymore. Again, it was completely gone from my plate. And the thing is, sometimes you cannot moonlight without getting an unrestricted medical license. To get these unrestricted medical licenses, you need to have step three done. So just take step three and get it over with. It's a little bit like, oh, divine. Come on, you're too intense. I'm telling you, pretty much, because, you know, I work with people like two or three for step three. Most people like two or first step three that I've withered left it till later in residency. You're pretty much always as a rule regretted it. So don't leave a life of regret if you just take the right steps in the very beginning. And I think this podcast is going to be quite long. So I think I'm just going to be focusing on rules for newly mature residents. I'll have another podcast where I comment on people going through the ERAS 2022-2023 process.

And then many people say that the intriguing exams do not matter. Let me tell you this. In residency, you're trying to learn your craft so you can become a good physician. The thing is, you might as well learn your craft well. And learning your craft well is not something that happens only in the hospital. It happens by opening books and reading and studying and doing practice questions. You might as well learn your craft well. The thing is, one of the greatest predictive factors for persons' ability to pass their board exams is their performance on the entry in exams. So the thing is, you might as well just study hard now. And again, this study hard in residency doesn't mean like a dedicated period. It would just be like, I'm going to keep this daily commitment of studying for 20 to 30 minutes a day. I'll make five flashcards and then keep up with those flashcards. If you compound those wise good habits over a year, over six months, over all your years of residency, you will come out being an extremely knowledgeable clinician. You may not even have to take a week or two weeks to study for your board. You may just be able to go and straight up take your boards. So the thing is, study for your entry in exams. Because one thing with residency that many people won't tell you, they will tell you, oh, you know, if you're a new resident, entry in exams don't matter. You know, we don't really care. Just don't study for it. Just come and take it.

The thing is, as a new resident, especially if you're an international medical graduate, you don't want to get on anybody's radar for bad reasons. So say, for example, you take the entry in exam and you score like in the fifth or the tenth percentile or something really low. Even if they say the scores don't matter, I can almost promise you you're going to be on somebody's radar. You're going to, you don't want to be the kind of resident where they're like, let's, let's make a learning plan for you. How about you, go on, meet with the program director at the end of every month. Let's assign this senior, that will be your coach. Let me tell you this, when all these things start happening, you're on somebody's radar. You're on somebody's radar. The thing is, let me tell you this, the fact that you marched and you're in residency does nothing in your spot is guaranteed. Again, people can always build dirt on you and use that dirt to kick you out. And let me tell you this, that spot you think that, oh, let's see if they'll find another person. I can promise you, when the dirt is being prepared on you, there's another person already waiting in the wings to take your spot. Residency spots are more valuable every single year. So the thing is, just don't give anyone reasons for you to be on the radar. So just do the wise thing. Do well on these exams. Even if as a new resident, you're like in the 40th or the 50th percentile, that's better than being in the 10th percentile.

Again, just don't be on anybody's radar. That's just the truth. I'm telling you this, once you start getting on people's radar, that's how people's problems begin in residency. People's problems begin in residency because the thing is, I'm not saying that as a resident, you have to be perfect. You can make mistakes, but the thing is, if you're making mistakes, but people see you academically sound, they'll be willing to overlook some of those mistakes they will chalk it up to. He's a new resident. She's a new resident. But if you do very poorly on your training exams, and then you then start making mistakes, those mistakes become more magnified. They become more noticeable. They'll say, wow, this person is establishing a consistent pattern of not doing well. You then become the problem resident. And then all these learning plans, action plans, start being made for you. Let me tell you this, avoid all those things, but just doing the right thing to start. I'm telling you the pain of regret is much worse than the pain of being proactive and doing the right thing to start. That is just the truth. And then the next rule, as I wrap up, is be nice, be humble, be respectful. You see some people, the moment they get that empty behind their names, they start talking to the nurses, treating them like trash, talking to respiratory therapy like they don't know anything. Let me tell you this, that's one of the quickest ways to getting trouble in residency.

Just be respectful to the nurses. They work hard. Even if you have whatever grind you have with them, just be respectful. Be nice, be humble. Be a good person to work around. Create a good work environment for your fellow man, for your fellow woman. So be nice, be humble, be respectful. It goes a long way. And then finally, show up on time. I can't tell you how many residents, right? It's the first rotation, first day, and boom, you're showing up five minutes after rounds have started. Again, first impressions matter a lot. Don't be a person that makes a bad impression from the beginning. Just show up on time. Personally, for me, most times, I would show up like 20 or so minutes before I was supposed to be in the hospital. Because again, things happen. Accidents happen on the road. If you leave in a quarter part of this country, snow happens. Snow happens. You may not be able to drive at the speed that you imagined you could drive at. So just leave one time. Again, just be proactive. Many of these things I'm discussing today, they are just common sense rules, common sense principles. But unfortunately, as I've learned over the course of my life, common sense is not really common. So I'll encourage you to just apply these rules. And you'll see your residency transition be a lot smoother. You'll see your residency transition be a lot smoother. So I'm going to go ahead and pause here again.

As I do at the end of every podcast, I go for one of one, two, three, four of the USML exams and really all the complex exams step one, step two, step three, complex level one, two and three pre clinical medical exams, 30th grad chip shelf exams. I have these podcasts on the major podcast apps, Apple podcasts, Google podcasts, Spotify. I have a You Tube channel, Divine Intervention USML podcast and videos. That's where I post the videos that I make. But on these podcast apps, you'll see my, just look for it, the Divine Intervention podcasts. The most recent 150 podcasts I've made will be on there. If you want everything from a episode one to this episode, which I believe is 3 D6, go on the website, divineinterventionpodcasts.com. If you have a Word Press account and you subscribe to my podcast, you'll get an email notification whenever I make a new podcast. And then again, I also offer review courses which I've talked about at the beginning. And then I help with Eras applications, personal statements, recommendation letters, editing those things. Again, I've been on an admissions committee before. I've worked with tons of people that are now residents. I know a lot about residency. I know a lot about admissions. I know a lot about residency selection. I can put you in a very good position to succeed with your Eras applications. And then I, many of you listen to this podcast, Norman Christian. I have a, many people send me emails. Wow, the vine.

I really love your life lessons podcasts. Really, like the life lessons you throw at the end. So I decided to make a life lessons website. It's called divineinterventionlifelessens.com. Right now, I believe I have about 75 podcasts. I started it this year or maybe like late last year or something like that. But basically what I do is every week, I make about two podcasts that uses the Bible to explain, to basically bring forth life, bring out life lessons that help you deal with classic problems that are faced by humanity. I even have the podcast on Apple podcasts. It's called the divine intervention life lessons podcasts. So again, just subscribe to these things. I think you'll find them to be helpful. But again, I'm encouraging you new residents don't stress. All will be well. Just remember those forwards. All will be well. You're going to have very good days. You're going to have highs. You're going to have lows. But the thing is there's no journey to success that does not come with highs and lows. Just remember that through those highs, through those lows, you can keep pressing on. Just keep pressing on. Keep matching forward. I love the spot of the Bible that says I press on toward the mark. Keep pressing on. Keep pressing on. There's going to be challenges. There's an open door before you, but there's going to be a lot of challenges along the way to that open door. But keep pressing on. Don't give up.

I'm telling you you're going to have thoughts within your first few days, weeks, months of residency that I could offer this. Everyone is doing better than me. I'm going to give up. I'm going to quit. Don't quit. Don't quit. Just keep pressing on. Just remember divine saying, keep pressing on. All be well. Keep pressing on. All be well. And again, connect with your family during residency. You see some people when they start residency, they ghost their family. The family families don't hear from them anymore. No, you need a support system. Support systems, very helpful. So, reach out to your support systems. It's just a very good way to keep yourself centered and whole. So, thank you for listening to this podcast. Have a wonderful weekend. I will make another podcast on rules for the ERAS 2023 cycle. Thank you for listening. God bless you. Thank you.

Being proactive, being organized, and doing the right thing.

Complete discharge summaries on the day the patient leaves, rather than waiting until weeks later.

Be nice, humble, and respectful; this is crucial for maintaining good working relationships.

Performance on in-training/entry exams.

Take a vacation or take time off to relax and de-stress, as the transition will be demanding.

Observation—watching successful senior residents model efficient workflows (pre-rounding, note writing).

Study early in residency (e.g., immediately after graduation) to get it over with and reduce future stress.

Sorting out housing ahead of time, and taking a vacation beforehand.

It can put the resident "on somebody's radar," leading to unnecessary learning plans or scrutiny.

Developing an organized approach to pre-rounding (e.g., knowing how to quickly assess multiple patients).

Do not overspend; most books and gadgets are unnecessary, and money must be budgeted for loans/inflation.

Study early in residency (e.g., immediately after graduation) to get it over with and reduce future stress.

Sorting out housing ahead of time, and taking a vacation beforehand.

It can put the resident "on somebody's radar," leading to unnecessary learning plans or scrutiny.

Developing an organized approach to pre-rounding (e.g., knowing how to quickly assess multiple patients).

Do not overspend; most books and gadgets are unnecessary, and money must be budgeted for loans/inflation.