Lessons from R1/PGY1

As an IMG navigating a different healthcare system, I have enjoyed the first year of my residency program and look forward to having a better experience in my second year of training. These are some lessons or tips from my first year of residency.

?

• Orientation is key: ?Just like starting any new role, for proper efficiency, you need someone to show you how things are done and where things are kept. Depending on where you trained, things can be very different. Do not take orientation for granted and ask politely when it is not offered. Residency is a rotational training, and some orientation can be carried forward from previous rotations but sometimes, the expectations and culture differ. Be sure you know what is expected and ask questions if in doubt. It is amazing how silly you could look versus how efficient you could be with the proper orientation. Sometimes things will not turn out as expected not because you are not smart enough but because you are not fully acclimatized to the new environment. Unfortunately, some things can only be figured out with time.

?

• Do not hesitate to ask questions: One of the ways I survived my first year was to ask questions with minimal hesitations. Of course, it might come off as “silly” to some people, but you are better off asking things you genuinely do not know. Residency is a training period and the best time to ask questions. Besides, the earlier you eliminate ignorance, the better your learning outcome on that rotation. Great teachers have described me as a student who was keen to learn. It is better to be “silly” at the beginning of a rotation than to be ignorant at the end. Besides, asking questions might be considered a show of confidence and humility, and great questions usually steer the class in a positive direction. On the other hand, try not to slow down your team when you ask questions and be open to self-directed learning when you should. You can not ask everything in class.

?

• Guidelines and culture may differ, but the medicine is the same: You have worked too hard as an IMG to reach here, and are smart. Trust your knowledge base and be confident in yourself. It may take a while to familiarize yourself with the Canadian guidelines, but the features of MI/ PE remain the same everywhere. Do not hesitate to give your opinion on disease management and bring your unique perspective based on your training and background. This is very helpful and appreciated in patient management. Also, identify your knowledge gaps and work on filling them.

?

• Time management: As much as this is obvious, your learning should be prioritized in your first year of residency. There is going to be a lot of learning and relearning. Most IMGs are mature candidates with responsibilities outside their training. Be careful to prioritize things that can not wait. Avoid long and nonproductive calls. Identify time wasters and eliminate them. ?Sleep well, your cognitive function depends on this. ?Do not take on high-commitment leadership roles if you feel overwhelmed and still trying to navigate the system. When you find your bearing, these commitments can be made in other years of residency. Do not feel pressured into accepting commitments that might be difficult to juggle with your residency training. Your first year should be used to lay a strong foundation for your training and create time for personal learning and development.

?

• Have an open and growth mindset: Every healthcare worker needs to develop skills in giving and receiving feedback. As you would realize, several staffs have different styles of providing feedback. Some are skilled at balancing the positive and negative feedback in a non-judgemental way while some are more direct and seem to focus only on the negatives. Regardless of the style, it might be easy to get stuck on how it was presented but try your best to go beyond that and see the intention and how it can improve your learning. ?Be open to feedback, seek feedback when you can, and avoid taking things personally. Also, in your interactions with people, you will realize that not everyone has experience dealing with IMGs. Feel free to educate people about IMGs if their lack of experience affects your learning but do not come across as being combative, aggressive, or seen to be resisting feedback. Also, when things do not go well at the workplace, make sure you take time to reflect on what you can improve on. Be sure not to accept responsibility for systemic issues beyond you as it can sometimes be hard to tell the difference as a new employee. Be mentally prepared for days that may not go as planned as this is all part of the learning curve. As healthcare workers we have a deep commitment to lifelong learning as this is important for providing safe and quality healthcare and feedback plays a key role in our training.

?

• Give yourself time to adjust and be gentle with yourself: Most healthcare professionals have perfectionism tendencies and hate making mistakes. Things might not be exactly smooth at the beginning and be mentally prepared for that. Depending on where you trained, where you are doing your residency training, and how supportive they are, you might have to deal with certain challenges. Note to self: you have worked so hard to get here and these are some challenges that you will overcome as well. Give yourself time to adapt to the new environment and remember these would improve over time as you continue to give your best to your training. For me, I had difficulty adapting to the new technology. As a one-finger typer, from a paper-based healthcare system, I am improving my computer and typing skills. For IMGs working on matching into the system, these are skills to work on to improve your efficiency and help with a softer landing.

?

• Balancing responsibilities with collegiality: Your colleagues are a rich source of help during your training, and it is important to show excellent team spirit and friendliness. It might be tough to balance family responsibilities with social events but try your best to attend and communicate effectively if you can not. Being in any community comes with certain responsibilities, be therefore certain you are playing your quota to ensure the collegiality, and friendliness in your residency community. Avoid isolating yourself and moving with only IMG colleagues.

?

• Remember no matter how hard you try, not everyone will like you: It is very key to remain professional at the workplace. Try your best to be collegial, say hello to your team of healthcare professionals and if you get the wrong vibes from certain people, apologize if you think you wronged them but be at peace with the undeniable truth that not everyone will like you. You are probably there for a few weeks. It might be about the other person not you being an IMG or a visible minority. Only take steps if they are being abusive in a way that affects your safety and learning or if it interferes with patient management and safety.

?

• Have a strong observational skill but remain you: You will thrive faster if you learn to observe your environment and learn things beyond medicine. Avoid making the same mistake repeatedly. Developing soft and hard skills will depend on how much you can observe and retain. In the process, remain true to your values and person, and do not lose your empathy while trying to be more efficient. Do not fit into a workplace culture that does not work for you. Bring your authentic person to work daily as most people value real people.

?

• Be attentive to your relationships: Look out for your IMG friends who did match and support them. Remember that there is life outside of and after residency. Keep in touch with your mentors and colleagues as this might be a potential challenge with the commitments of residency training. Treasure your loyal friends and do not take them for granted. Avoid taking your family for granted as well and communicate effectively. Do not let your spouses and children become victims of your stressful days and avoid trauma dumping. Be considerate and mindful of their needs as well.

?

• Lastly, please be reminded that the learning never ends. No matter how comfortable you get, there will always be that patient or staff encounter that will question your knowledge base. Stay humble and remain trainable. Medicine is a lifelong learning experience. Respect your limits and always ask for help when needed.

Thank you for reading this to the end.

?

Cheers to the new residents

Cheers to IMGs

Cheers to R2 / PGY2