Lessons From My First Year in Residency

One of the strangest parts of becoming a physician was realizing how little changed overnight—and how much changed at the same time.

A few weeks earlier, I was a medical student presenting my plan and waiting for someone else to make the final decision. Then residency started, the pager went off, a nurse was asking me what I wanted to do, and suddenly “my plan” actually meant something.

I’m only into my second year of residency, so I won’t pretend to have medicine figured out. If anything, that may be why these lessons feel worth writing down now. The transition is still fresh enough that I remember what I expected—and what has turned out to be completely different.

You Don't Have to Know Everything—But You Have to Know What to Do Next

Early in residency, I put a lot of pressure on myself to have the answer before calling my senior or attending. Part of that was wanting to learn. Part of it was probably wanting to prove that I belonged there.

It didn’t take long to realize that practicing medicine isn’t about immediately knowing the answer to every problem. Sometimes the most important thing is recognizing that a patient is getting sicker, figuring out what needs to happen right now, and knowing when to ask for help. I’ve spent twenty minutes thinking through a decision only to talk it over with a senior and realize I was making it much more complicated than it needed to be.

I’ve also watched physicians with decades more experience than me ask colleagues for their opinion. That has probably been one of the more reassuring things to see. The goal isn’t to eventually know everything. It’s to become better at recognizing what you know, what you don’t, and what to do next.

Real Patients Don't Read the Textbook

In medical school, I could spend an afternoon reading about heart failure and feel like I understood it pretty well. In the hospital, the patient with heart failure also has worsening kidney function, blood pressure that won’t tolerate half the medications I want to give, five other chronic conditions, and a family asking when they can go home.

Real patients are messy.

Initially, that complexity could be frustrating because I wanted there to be a “right” answer. I’m starting to appreciate that figuring out those competing priorities is a huge part of the job.

Guidelines matter. Evidence matters. But so does the person sitting in front of you.

I’ve started thinking less about treating individual diagnoses and more about what makes sense for this particular patient at this particular moment. That distinction seems obvious now, but I don’t think I fully appreciated it until I was responsible for making those decisions myself.

Communication Is More Important Than I Expected

I entered residency expecting most of my growth to come from learning more medicine. I underestimated how much of the job would involve learning how to communicate.

I’ve walked out of a patient’s room thinking I explained something perfectly, only to have their next question make it clear that I hadn’t. I’ve learned that a five-minute conversation can completely change how a patient or family feels about a hospitalization.

The same is true with the people you work with. Nurses often notice changes in patients before anyone else. Consultants are much more helpful when you can clearly explain why you’re calling them. And difficult days become much more manageable when you work with people who communicate well and look out for each other.

Knowing the medicine is obviously important. Knowing how to communicate it—and how to listen—is part of practicing it well.

Medicine Is a Team Sport

I knew before residency that medicine involved teamwork. I don’t think I understood how much it depended on it.

There is no version of taking good care of a hospitalized patient that happens alone. Nurses, pharmacists, therapists, case managers, consultants, residents, and attendings are all seeing different pieces of the same patient. Some of the best decisions I’ve made so far started because someone else noticed something I hadn’t or challenged me to think about a problem differently.

That has also changed the way I think about leadership. Being a good leader in medicine isn’t about being the person who always has the answer. Sometimes it means making a decision when one needs to be made. Other times it means listening, staying calm when things get hectic, or recognizing that someone else on the team knows more about a particular problem than you do.

I’ve watched physicians I admire do this exceptionally well. They stay calm when things are going badly, treat nurses and staff with respect when everyone is exhausted, and sit down next to a frightened patient rather than talking to them from the doorway. Those moments stick with me. I’m realizing that the kind of physician I want to become has as much to do with how I work with people as it does with how much medicine I know.

One Year Can Change a Lot

I didn’t expect it to feel this different.

The hours can be long. There are days when I leave the hospital mentally and physically exhausted, replaying decisions in my head or thinking about what I could have done better. It is easily one of the hardest jobs I’ve ever had. It is also the best. In just a few months, I was given more responsibility than I had at any point in medical school. I’ve had to make decisions when I wasn’t completely certain, have difficult conversations with patients and families, rely on people around me, and become comfortable admitting when I need help.

I expected residency to make me a better physician over several years. I didn’t expect to notice so much growth this early.

Conclusion

My first year was an amazing learning experience, and I’m sure some of these lessons will look different a year from now. That’s part of what makes this stage exciting.

I’m becoming more comfortable with uncertainty. I’m learning that asking for help is not the opposite of independence. I’m realizing that patients rarely fit neatly into the boxes we learned in medical school, that medicine is fundamentally a team effort, and that being a good physician also means learning how to be a good teammate and leader.

There will always be another guideline to learn, another paper to read, and another diagnosis I haven’t seen before. That part of medicine never really ends.

I entered residency expecting my first year to teach me how to practice medicine. What I didn’t realize was how quickly it would begin teaching me how I want to practice it.

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