How to Be a Great Senior Resident

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Author: Alexandria Gregory, MD – AAEM/RSA Editor, Common Sense

Originally published: Common Sense
January/February 2021

Four months after the beginning of second year, I still feel weird being called a “senior resident.” It feels like just yesterday I was the intern, lowest on the totem pole, learning to navigate the flow of patient care and the ED. I didn’t expect July 1st to feel any different than the days prior when I walked into my shift, but I was wrong. Suddenly, it felt as if my attendings trusted me more, and now there were more junior doctors seeking my advice regularly. I am lucky to be at an institution that encourages independence and leadership early on, so even at the beginning of PGY-2, we are working senior shifts and running critical care pod shifts, helping to supervise interns and medical students while in those roles. Even in just a few months, I have learned a lot about what makes for a great senior resident and the qualities I hope to emulate. A great senior resident:

1. Encourages questions: It’s important to be open to any and all questions, whether they are about the electronic health record or where something is. This sets a tone of openness so that residents and students feel their senior is approachable, which becomes especially important if they have a sick patient or need to do something outside of their scope.
   
   
2. Encourages independent decision-making, but with appropriate back-up: When junior residents or medical students ask for advice on patient care, allow them to explain their thought process, which will help them learn more than simply giving them the answer.
   
   
3. Meets people where they are: This can be tough, but it is important to recognize. Not every learner will respond well to the same teaching technique. Additionally, the ED typically has a variety of rotators (junior EM residents, off-service residents, EM-bound students, and non-EM bound students). Assessing someone’s level of comfort in the ED is important so that you know how much guidance they require and what they hope to get out of their rotation.
   
   
4. Recognizes their own weaknesses: As a senior resident, you’re still a learner yourself. Letting a junior resident know that you don’t know something establishes that it’s okay not to know everything and allows for an opportunity to show them how you seek out answers.
   
   
5. Finds learning opportunities in spare time: While there usually isn’t a ton of downtime in the ED, a good senior resident takes even small opportunities for extra teaching. Putting someone on BiPAP? Take a second to ask if your student or junior resident understands the physiology behind its efficacy. If the ED does happen to be slow, offer to take a few minutes to teach about a topic of an intern’s or student’s choice.
   
   
6. Leads by example: Don’t expect junior residents to do anything that you wouldn’t do yourself. Be cognizant of you how you communicate with consultants, nurses, etc., because students and other residents are watching you, whether you’re aware of it or not.
   
   
7. Understands how their role is different than the attending’s: Being a senior resident allows for a different, unique role before becoming an attending. You are both a peer and a mentor simultaneously; try to embrace that by being open if junior residents approach you for advice they might not feel comfortable approaching an attending about.
   
   
8. Sees giving procedures to junior residents as an opportunity, rather than a loss: In my program, we strive to have a culture that gets the interns involved in procedures early on. The balance between wanting to practice your own procedural skills and share with junior residents can be tricky, but it’s helpful to view supervising procedures as just as valuable as doing them yourself. For example, in supervising an intern‘s first ever few intubations, I learned a lot more about the mechanics of intubation as well as how to teach without jumping in and doing the procedure myself, which is its own skill. At the same time, don’t feel pressured to give up procedures every single time, especially ones you’re not comfortable with or haven’t done in a while—your education is important too.
   
   
9. Asks for feedback: In addition to asking your attendings for feedback, it can also be useful to ask for feedback from junior residents or medical students so you can assess how you’re doing in the senior role. Even quick questions such as “Did that explanation make sense? Was that helpful?” can you give you ideas of how to improve
   
   
10. Recognizes that interns are in an especially unique and challenging position during COVID-19: It isn’t easy to become a physician during a pandemic. Beyond the obvious challenge of entering a stressed hospital system and learning the foundations of medicine in a time where nothing is “normal,” there are other challenges to consider. It’s likely that your interns have not been able to be as social outside of the hospital both among their own classmates and the other classes in your residency. Didactics are probably Zoom-based, your program may have budget cuts, and policies may be changing almost daily. Keep this in mind when interacting with your interns, ask them how they’re doing, and let them know that you’re there to support them however needed.