July 1, 2019

Perspective: On the First Year of Residency

Jeff Dewey, MD of Yale School of Medicine

Jeff Dewey, MD is Assistant Professor of Neurology in the Division of Neuromuscular Medicine, Assistant Program Director in Neurology, and Associate Clerkship Director in Neurology at Yale School of Medicine. He completed his internship at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and his neurology residency and fellowship at Yale New Haven Hospital in Connecticut, completing his fellowship in June 2018.

Former resident member of the ACGME Review Committee for Neurology and the Council of Review Committee Residents, Dr. Dewey divides his time between seeing patients, supervising residents, and completing administrative duties. His research interest is in resident/fellow well-being, focusing on which factors allow learners to thrive, and the potential applications of positive psychology to the educational experience.

As thousands of new residents begin their journey toward independent practice this month, we asked Dr. Dewey to reflect on his experiences in residency and share lessons he learned.

ACGME: Why did you want to be a physician?
Dr. Dewey: I’m one of those who always knew that being a doctor was right for me. I had never considered the work of an academic physician until medical school, when I met a number of excellent physicians who were also amazing teachers. I admired the way they enhanced patient care through teaching while also enthralling me as a learner. This career seemed the perfect marriage of my passions. As for why I became a neurologist, it goes without saying that the nervous system is fascinating and worthy of a lifetime of study, but the real answer is that I fell in love with the neurologic exam. The art of close observation, real-time localization, and hypothesis testing is where I find my flow. I also love getting to know my patients and being with them and their families through their course, even when the conclusion may be tragic.

ACGME: What were the first few weeks of residency like for you? What do you remember the most?
Dr. Dewey: I distinctly remember the morning my wife (then girlfriend) dropped me off for my first morning as in intern. I was starting in the ICU, and my stomach was in my throat! Those first few weeks were a whirlwind, but in retrospect I am amazed at how much I learned. I can still recall the feeling of the small successes: getting my first arterial line, managing acute hypotension, independently admitting a complex patient. As stressful as it seemed to face these challenges, the joy of growing to meet them was the fuel that kept me energized.

I think it’s also important to share that I struggled with anxiety and imposterism during residency, particularly as a new trainee. I found the transition from medical school to residency jarring due to increased workload, responsibility, and autonomy. This shook my confidence and made me wonder if I was the right person for this job. It took me too long to reach out to someone to talk about this! I eventually spoke with my program director and some close colleagues. I realized I was experiencing a fairly common reaction and was able to seek appropriate help while continuing my training. Over time, I have learned to appreciate the root of these feelings – the desire to provide excellent patient care – while mitigating their adverse effects on my well-being.

ACGME: What surprised you about the residency experience?
Dr. Dewey: Everything I learned in residency, I learned from a patient. Coming from medical school where so much is learned in abstract, I enjoyed the context for my newfound knowledge that each patient encounter provided. I came to appreciate high clinical volume as the most valuable aspect of my education. Residency was the first time in my life when learning and doing my job were intertwined, and I found this very rewarding. After all, the privilege of spending a lifetime learning is one of the best aspects of being a physician.

ACGME: What are the top three things you wish you knew about being a resident or the residency experience before you started?
Dr. Dewey:

  1. Finding a mentor is crucial. I was fortunate to develop a mentoring relationship with a faculty member fairly early in my training, and he has been an invaluable source of support and guidance. I found this particularly important when planning for life after residency. There is so much we don’t learn about building a career in medicine, so having the advice of someone on the other side is invaluable.
  2. I wouldn’t stay magically in shape anymore. Despite being busy in medical school, I was able to get fairly regular exercise and also enjoyed the metabolism of a younger twenty-something. Residency can take busy to a whole new level at times, and at least for me exercise and good eating were the first things to go (not helped much by the cafeteria food selection). This combined with bad sleep habits took a notable physical and mental toll during my early training. It took some practice, but the extra effort to plan for healthy meals and time devoted to exercise and adequate sleep were worth it for my well-being.
  3. My partner would go through residency with me. Before getting married during fellowship, I was in a relationship with my wife throughout my intern and residency years, and I didn’t understand the stresses put on her by my training. She moved to a new place, sacrificed years of a “normal” life as a couple, and took up additional responsibilities around the house. Moreover, she had the not insignificant task of riding the emotional roller coaster with me through the highs and lows of training. She deserves a thank you every day for all that she did! I may have been able to do it without her, but I wouldn’t have wanted to.

ACGME: What advice would you offer physicians who are just starting this journey?
Dr. Dewey: Embrace this experience. Whatever challenges lie ahead are opportunities for tremendous growth, and you are all highly resilient or you would not have made it this far. Make time to for health and self-care, you will learn so much better if you’re well. If you find yourself struggling, reach out for help. Your peers, faculty, GME office, and even the ACGME are all available resources for support. Lean into the challenge and have fun growing your knowledge and skills!

ACGME: How did you become involved with the ACGME Review Committee and why?
Dr. Dewey: My mentor forwarded me the announcement about the Review Committee opening, and the rest is history. I was drawn to the opportunity to learn first-hand about the accreditation process and potentially have an influence on decisions governing neurology education. It was an incredible experience! I had far more influence than I had expected. I am very proud to have been involved in many initiatives that the current members continue to push forward.

ACGME: Is there anything else about the residency experience you’d like to share?
Dr. Dewey: Residency is a unique time in your life. With the responsibility of being a junior physician comes the freedom and joy of pursuing your field of interest in depth. Now you get to develop and realize your vision of your career! You will also develop lifelong friendships with your co-residents and future colleagues. Enjoy it, it goes by faster than you think!