Next Generation is a Brigham Clinical & Research News column penned by students, residents, fellows and postdocs. If you are a Brigham trainee interested in contributing a column, email us. This month’s column is written by Sachit Singal, MD, a resident in the Department of Medicine.

Sachit Singal

A physician I admire once told me that the start of residency can feel like the first day of school. While this is true, as the new kid on the block, you will experience and re-experience the “first day jitters” throughout your first year of training. It will be hard to define your experience by a single first day – rather, you’ll have many “first days” as you cycle through different care teams as medical trainees.

I’d like to offer four key lessons I’ve learned through my training thus far. As someone interested in cardiology, I’ll use the Levine Cardiac Intensive Care Unit (LCU) as the backdrop for my self-reflections and musings.

1. Practicing Medicine is a Team Sport

As was mentioned to me on my interview day, the Brigham attracts a certain physician archetype, one you can recognize as soon as you see it. Part of that model includes a shared commitment to our individual betterment. Care delivery in the hospital, however, is not a one-person show.

On my first day in the LCU, my attending met with the interns and imparted words of advice, perhaps none more important than, “Lean on those who came before you.” That roster included our attending, senior residents and fellows, as well as the seasoned team of nurses, pharmacists, respiratory therapists and more. I still appreciate the nurses who showed me how to properly dress arterial and central lines, liaised with families and positively reinforced the growth they observed in me and the other interns during our shared time in the unit.

This understanding is crucial – learning from here forward must be experiential. For many interns, the knowledge you’ve accumulated up until this point has largely been obtained through lectures, reviewing notes and answering board questions. Now, your teammates will be some of your greatest instructors.

2. Make Your Needs Known and Anticipate Those of Others

As you progress through the year, you will have moments when you are asked to step out of your comfort zone, and I believe tangible growth can happen when you do this. During my time in the LCU, I gained more practice with procedures, discussed important (and at times devastating) news with patients and their families, and equitably shared the load of patient care with my senior resident. Still, while taking initiative is important, sharing one’s needs is equally as important, albeit sometimes more challenging for some.

In a culture of training where the rigor can frequently feel overwhelming, it is important to identify sources of stress and apprehension and share them with our colleagues. The best seniors I’ve worked with made it a point on our first day working together to create a space where we could share these thoughts to match expectations and promote a positive work culture.

As I transition to my new role supervising a team and incorporate this into my own style of leadership, you, as interns, should feel empowered to share what you are hopeful to learn, what you feel comfortable doing to advance your growth, and endeavors that feel jarring to you at your current stage of training. More broadly, as we work toward addressing burnout in our training (recognizing it as a layered, complex experience with many upstream contributors), practicing this form of interpersonal communication is a concrete step we can all take in the right direction.

3. Follow Through on Your Promises

Even before starting residency, many of you may find the hospital to be a familiar place, viewing it as both a place work and an institution for learning. The same cannot be said for many of your patients, to whom the hospital can and will feel isolating and anxiety-provoking as they find themselves removed from their families and friends.

As you go through the motions of rounding, signing orders, placing consults and writing notes, remind yourself of the lived experience of your patients. As you interface with them and their families, try to reorient them to who you are, why they are still in the hospital, and the steps you and the rest of their care team will take to make them feel safe.

If you tell your patient you’ll order a medication or call a certain family member to give an update, follow through on your promise. If you are later unable to, be kind to yourself (as working in the hospital can be unpredictable at times), and close the loop with your patient about what happened. I have found that a policy of transparency and accountability with patients and their families is widely received positively and goes a long way in ensuring they feel cared for and heard.

4. Remember Your Work Matters and Find Happiness Each Day (Even Where You Least Expect It)

Remind yourself that one of your motivations to pursue a career in medicine was to positively impact the lives of your patients, an aspect of your work that will continue to be extremely gratifying. Medicine positions you to be a difference-maker each day you report to work. Even on your busiest day, pause and identify the difference you’ve made before getting back to the grind.

My fondest memory from the LCU was seeing a critically-ill patient who experienced an out-of-hospital cardiac arrest recover to a point where he could safely ambulate around the unit. By the end of my intern year, I had a mental portfolio of similar moments when our team found happiness in many corners of the Brigham. While our medical training is a brief period in our lives, we gain a lifetime of memories from it. Try to embrace each memory as it is being made.

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