Greetings from Ann Arbor! For the month of March, I returned to the inpatient psychiatry unit at the Dayton VA, which gave me the chance to use some vacation days to celebrate Match Day with friends in Michigan. Working at the VA has also given me the chance to reflect on my year as an R2 so far. There was a familiar poetic sense of homecoming returning to the VA for a month, similar to the sense of homecoming I had as a sub-I at the Ann Arbor VA (recounted in my post "Med School 360"). Inpatient psychiatry at the VA was my very first rotation as a brand-spanking new resident out of med school, and looking back at my previous retrospective post ("Another year older") I'm again struck by the progress I've made during my training. It's almost comical to read my thoughts and remember how I felt "at a loss" when carrying five or six patients on my second day as a resident, whereas now that patient load is all in a day's work. The most affirming part of returning to the VA was hearing the nursing staff comment on how noticeable my progress has been to them, staff whom I worked with as an R1.
I've also had a poignant sense of passing the torch these past couple of days. As an R1 at the VA, I worked with Luke Barton as the R2. I remember his words of encouragement and reassurance that, yes, somehow, magically I would find myself being able to handle more and more of a patient load. Neither of us knew how such a transformation would happen and to this day I still can't explain what exactly has changed over the past year and a half, but I've enjoyed providing the same perspective to the current R1 at the VA, Christine Molina. Attending Match Day in Ann Arbor has only strengthened that sense of passing the torch to a new generation. Maybe it's silly to think in such nostalgic terms when the current M4 class is only two years removed from me, but being invited to the ceremony was incredibly meaningful. I could participate in the excitement along with them, sharing bated breath and palpitations with everyone.
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[So proud of all of my Michigan med school M4 friends! So excited to have you join the ranks of physicians!]
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Now my focus is on my remaining years of residency training. Starting as an R3, I will be working semi-autonomously in outpatient clinics. The good news is my schedule will be awesome: outpatient clinics mean no work on weekends, major holidays, or (at least on base) snow days. The more daunting prospect is the semi-autonomous part. For my entire med school career and during my first two years of residency, my work followed a predictable pattern: I saw patients on my own, right after seeing the patient I discussed the case and my proposed plan with my attending, the attending offered some thoughts/suggestions/things I might have missed, which finalized the plan. As an R3, I will still see patients on my own and there will still be attendings available in the office if I have questions, but for the majority of cases I will be formulating my own plan, signing prescriptions, and sending patients off into the wild blue yonder without discussing the patient or my plan with an attending beforehand. Staffing patients with attendings happens after the patients are gone, a complete reversal of the work pattern I'm so used to. What's more, I will have to be more cognizant of my time-management skills in order to keep clinic appointments running on time.
I anticipate this drastic shift in my workflow will rekindle feelings of being "at a loss," similar to starting work as an R1. However, if history is any guide, I will somehow, magically find myself looking back and appreciating how comical it was for me to feel so daunted.
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[The Circle of Residency Life: baby Simba's face definitely mirrors my anticipation of being held over the cliff of R3 year, but maybe I should start growing out a mane in parallel with my own clinical transformation.]