Next Generation is a BWH Clinical & Research News (CRN) column penned by students, residents, fellows and postdocs. This month’s column is written by Daniel Weisberg, MD, a third-year resident in the Internal Medicine Residency Program.
For better or for worse, residency is all-consuming. At the end of a shift, after the day’s tasks are finished and documentation is completed, the stories of our patients linger in our minds. These stories animate casual conversations and deep reflections alike (and test the patience of my girlfriend, who is not a physician).
It struck me during my intern year that residents, on the front lines of medical care, bear witness to the miracles and missteps of a modern hospital in a unique way. But residency is fast-paced and short-lived, and even issues germane to residency training itself, such as work hour rules and burnout, are often debated in forums without a resident’s perspective. This is in contrast to more intimate resident forums – in the workrooms in the hospital, at the bars nearby or over meals together – where we recount our patients’ stories, our ethical struggles and revelations.
This idea that residents need a more formal outlet to articulate their views led me to Lisa Rosenbaum, MD, an attending cardiologist at BWH and a New England Journal of Medicine (NEJM) columnist. Lisa’s writing takes the most pressing issues in medicine and adds narrative to make them broadly relatable. I asked her if we could do the same for residents by way of a podcast. Podcasts have exploded in popularity in recent years, and trainees represent a prime demographic – young people who are often in a hurry and attached to their smartphones.
Lisa was enthusiastic about the idea and pitched it to the editors at NEJM. The staff there lent their support and the podcast, called “The House,” was launched as part of Resident 360, a NEJM website dedicated to resident education. The podcast marries narrative and data and, as such, found a natural home at NEJM. We interview trainees and academics exploring timely issues in medical education and policy.
Our first podcast focused on resident work hours and coincided with the publication of the FIRST Trial, a study comparing standard and flexible work hours for surgery interns. This was followed by an episode about resident burnout and depression. Building on initial positive feedback, we have several podcasts in the pipeline covering issues such as international medical graduates and the president’s travel ban, issues of gender bias in the hospital, making mistakes as a trainee, intergenerational perspectives on medical training and a special episode on intern year.
‘Stories Unite Us’
A conversation I had with my late friend and colleague, Darryl Powell, Jr., MD, formed the basis of the latest episode of “The House.”
This particular episode, “Diversity in Residency,” which was dedicated to Darryl, was the third podcast in the series. Darryl, a beloved member of the Brigham community, passed away in the spring after a brief illness. Darryl’s friends, family, colleagues and patients continue to mourn the loss of this kind and intelligent physician, someone whom I admired greatly and who generously shared his stories and insight many more times than I was able to capture on my recorder.
Darryl, who served as chief resident in the Harvard Brigham and Women’s Hospital/Boston Children’s Hospital combined Internal Medicine-Pediatrics Residency Training Program, was telling me about a night shift he worked where he admitted an overtly racist patient. Darryl was one of very few African American trainees in the program. After he introduced himself, the patient incredulously asked, “You’re my doctor?”
“Yes, I’ll be taking care of you tonight,” Darryl responded.
“Well, you look more like a street thug,” the patient said.
Darryl laughed about this encounter when I spoke to him about it. I was shocked. As a white male physician, I’m personally insulated from much of the implicit and explicit biases directed towards members of minority groups within and beyond the walls of the hospital. But the experience of black residents is very different. I recorded Darryl’s story and his thoughts on diversity and social justice in medical training.
The episode, which also includes an interview with Lachelle Weeks, MD, a BWH internal medicine resident, explores how residency programs can proactively address race in their recruitment efforts, bolster their programs in community outreach, train residents in implicit bias and create mentorship programs for minority trainees. Darryl’s voice was a wellspring of empathy and intelligence in the BWH community and I am grateful that, in a small way, it is preserved in this podcast.
Darryl inspired everybody he met. His commitment to social justice and diversity in residency training will have a long-lasting impact on our program. I hope that by sharing his thoughts on this podcast, his legacy will spread even further.
My goal for “The House” is to continue to amplify the resident voice and inform the dialog around pressing issues in medicine and physician training. For residents, stories unite us in our arduous work. Ultimately, they help us confront pain, find joy in our work and develop a sense of humility as physicians.