Residency Road Map: Consider Professional, Personal Goals

After medical school, residency consumes 3-7 years of a graduate’s life. That time can be one of personal and professional fulfilment and happiness — or feel like a miserable, frustrating period.

For medical students, knowing what to expect and how to prepare is key to making residency a fulfilling time of achievements, experts said. Medscape Medical News asked five MDs — who went through residency decades ago or much more recently — how residency has changed over the years and for their best advice on what to expect and how to prepare.

Shifting Focus: Professional and Personal Happiness

Decades ago, residency programs had a much different focus than they do today, said Allan Peterkin, MD, professor of psychiatry and family medicine at the University of Toronto, Toronto, Ontario, Canada. He has seen major changes firsthand.

The first edition of his book, Staying Human During Residency Training: How to Survive and Thrive After Medical School, was published in 1990 by the Canadian Medical Association, the year he finished his residency. Now, the seventh edition (with co-author Derek Puddester, MD) is out from the University of Toronto Press.

In years past, Peterkin told Medscape Medical News, programs focused on impairment in resident physicians and how to manage that. Slowly, programs began to talk about balance and resilience. “But no one ever talked about physician happiness,” he said.

And he thinks that’s a must, both on a professional and personal level. Managers of residency programs now agree, he said. There is increasing conversation in residency programs, he has found, about mental health resilience, self-care, and personal growth for residents.

Peterkin tells medical students thinking about their residency plans: “This is a new phase of your life, full of the possibility to grow.” That growth should be both personal and professional, he said. During medical school, he suggests “developing your reflective capacity.” For starters, he said, “do a good review of your medical school experience. Review the letter that got you into medical school.” And a good question to ask, he said, is: “Am I still in touch with why I wanted to be a doctor?”

“Look at the highlights and challenges of medical school,” Peterkin said. That includes what was frightening. “I can remember I was distressed about suturing on kids,” he said. “I learned to do it and wrote a poem about it, which got published.”

And his fears declined. He finds writing a good tool to manage stress but knows it isn’t for everyone. He tells medical students to view what worked for them in managing stress during medical school and hang onto that coping mechanism. For some, it’s athletics. For others, it’s music, theatre, or religious involvement.

Relocating for residency is common, Peterkin said. That means paying attention to your life outside of medicine. Research the town and what it offers.

Postgraduate medical education offices at universities are rich sources of information. Many offer reduced rates at local gyms, discounts on journals, and help in finding a primary care physician.

On a professional level, Peterkin advises new residents: “Find out your rights in your contract — what privileges you have, what perks.” The Committee of Interns and Residents is one source of information on contracts and benefits.

Two factors predict whether a new resident will maintain balance and resilience, Peterkin said. One is maintaining both personal and professional relationships. The other is maintaining an internal locus of control. Despite the many demands and requests of residents, he said, it’s crucial to pay attention to empowering oneself. How? Schedule holidays and time off for medical conferences in advance, for example, he said, to maintain a sense of control.

Understand the Process With an Appreciative Mindset

Aerial Petty, DO, a family medicine health policy research fellow at the American Board of Family Medicine, Lexington, Kentucky, and The George Washington University, Washington, DC, finished her family medicine residency in June 2024, at NewYork-Presbyterian/Columbia University Irving Medical Center, New York City, in an underserved area of Manhattan. She’s now in a fellowship, conducting research, and seeing patients in primary care. It’s her happy place, she told Medscape Medical News.

She got there, she said, by being honest and focused about what she needed out of a residency program and making sure she emphasized that to everyone she interacted with. “Everyone has different priorities, but for me, I wanted to be in a family medicine residency program that was in a community with Spanish speakers, so I could converse in Spanish on a daily basis. I majored in Spanish in college.” “Keep that clear message of who you are,” she advises medical students. She made sure that everyone she interviewed with remembered she was the Spanish major family medicine doctor interested in primary care and health policy research.

Knowing the timeline of applying for residency is important, Petty said. A brief overview: Medical students apply in the fall of their third year, attaching letters of recommendation to the application and a statement explaining why they are interested in the specialty. Among the options to simplify the search for a residency program is the American Medical Association (AMA)’s FREIDA, the Fellowship and Residency Electronic Interactive Database Access, which includes information on more than 13,000 fellowship and residency programs.

Over the next few months, from September to January, residency programs offer interviews. Next, residency programs and students rank their choices. Through the National Resident Matching Program’s algorithm, a match is made and students learn where they will go.

Because not everyone gets their first choice, Petty said, it’s important during the interview process to find something to look forward to in each program. “For every interview I had, I found something I could appreciate in that program.”

A Mentor Is Good; a Support Team Is Better

Finding a mentor for support during residency training is often recommended, but assembling a team is a better idea, said Dorothy Andriole, MD, senior director of medical education research at the Association of American Medical Colleges (AAMC). Many advisors are needed, she said, including those knowledgeable about the residency application process and those who can advise on how to make personalized decisions.

The AAMC’s Careers in Medicine site has information on the application process, choosing a specialty, preparing for residency, and understanding oneself. Also useful, Andriole said, is the Residency Explorer Tool, which helps students explore and identify residency programs that they would be a competitive candidate for — and that meet their career and personal needs. It has information on more than 5000 residency programs across 25 specialties.

For the tool, she said, “many organizations — the American Medical Association, the American Association of Medical Colleges, and others — have come together to figure out how to share all the data they have to help students get tailored, personalized information.”

Making the Transition: From Student to ‘In Charge’

For a successful residency, medical students need to make a mental shift and assume more responsibility, said John Andrews, MD, vice president for graduate medical education innovations at the AMA. “One of the biggest challenges in residency is transitioning from being a student and having people actively teach you to taking responsibility for your own education, understanding where there are gaps in knowledge and skills, and using the experience of residency to address them,” he said. Andrews, a pediatrician, previously managed the pediatric residency program at the University of Minnesota and was associate dean for graduate medical education there.

“Some adapt quickly to that, and others don’t,” he said. “When they enter residency, they very much still have a student mindset.”

During that transition, Andrews said, new residents can expect to experience the “imposter syndrome,” he said. “All of us at some point in our training feel a bit of imposter syndrome — that we’re not fully qualified to do what we’re asked to do.”

‘Pull Up a Chair’

Electronic health records (EHRs) have greatly changed medical care, several physicians pointed out. In years past, residents would gather with paper charts and discuss cases. Now, with EHRs, that social aspect is largely gone.

“There is increased time spent with electronic medical records, creating orders, notes, and documenting care,” said Jeffrey Katzman, MD, director of the Silver Hill Academy for Research and Education. “This can deprive trainees of the experience they were seeking in supporting patients face-to-face,” he added, and this could lead to physician burnout and low patient satisfaction.

One easy solution?

“One mentor of mine, who passed recently, was a leader in psychiatric education for decades,” Katzman said. “As my residency training director, he advised us to pull up a chair and sit with our patients at the bedside, even if only briefly, rather than always standing over them in a large group. Developing our acumen of considering the patient’s experience in early training is extremely beneficial.”

Another bit of advice: “Get to know your patient’s background, so you can hold them in your mind, and have a connection beyond the medical work.”

Peterkin, Petty, Andriole, Andrews, and Katzman had no relevant disclosures.

Kathleen Doheny is a freelance journalist in Los Angeles.