The “What I Wish I Knew” series of articles is a service of CPNP’s Resident and New Practitioner Committee. Articles are intended to provide advice from experts for students, residents, and new practitioners. Articles are not intended to provide in-depth disease state or pharmacotherapy information nor replace any peer-reviewed educational materials. We hope you benefit from this “field guide” discussing approaches to unique problems and situations.
Dr. Musco is Assistant Professor of Clinical Sciences at High Point University Fred Wilson School of Pharmacy in High Point, North Carolina. Shaina received her bachelor’s degree in molecular biology from Colgate University in Hamilton, NY and her doctor of pharmacy from the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences in Aurora, CO. She then completed a general pharmacy practice residency and a behavioral health specialty residency at Community Health Network in Indianapolis, IN. During her residency she served as an adjunct professor of pharmacy practice at Butler University College of Pharmacy and Pharmaceutical Sciences and gained experience teaching topics in psychiatry. Shaina then took a position as an assistant professor of clinical sciences at High Point University Fred Wilson School of Pharmacy in High Point, NC. She currently coordinates the psychiatry and neurology pharmacotherapy course and completes clinical research investigating the use of long-acting injectable antipsychotic medications at Cone Behavioral Health Hospital in Greensboro, NC.
Now the fun begins… sort of. If by “fun” you mean “working long hours doing a job with a high level of difficulty and low level of experience while having less sleep and more stress than you have likely ever felt in your life.” It is no secret that residency training can be challenging. So why do we choose to put ourselves through these arduous years of self-induced educational purgatory? Deliberate introspection on this tremendous endeavor is vital; it solidifies the commitment level and justifies the amount of effort and sacrifice you are making. Celebrating small accomplishments along the way brings positive reinforcement that in return pushes you forward. Keeping sight of your ultimate career goals is critical. It can also help to maintain perspective on the finite amount of time that goes toward this intense learning and growing experience. The one or two years of residency will fly by at an incredible pace, and in the grand scheme of things are a small price to pay for thirty-plus years of being able to do what you truly love in your career.
Residency starts out like a rollercoaster ride. Anticipation, fear, and excitement build as you climb up to the apex of the track, but this smooth and steady section is short-lived. All of the sudden, often abruptly and before you may even realize it, the full-speed plunge begins and there is no turning back. This is why preparation is crucial. Use this time early, before the inevitable nosedive into chaos, to plan the year out. Get the due dates for projects, meetings, classes, and the like into your calendar during the summer while you are still orienting. I also found it useful to schedule intermediate checkpoints along the way to keep myself on track. Don’t stop at just setting a date for yourself to have a draft due, but take it a step further by making it a calendar invitation that includes your co-residents, mentors, preceptors, or anyone else who can help to keep you accountable. Just by including my program director in my self-assigned deadlines I instantly felt more motivated to keep on track, and I also was able to easily keep her informed on my involvement and progress with various projects.
Your calendar during residency shouldn’t contain all work and no play, however. Make it a point to schedule activities of enjoyment, and stick to them despite the temptation to spend any of the free time you get sleeping. It is absolutely critical that you do not neglect your hobbies despite the hectic schedule. Engaging in activities outside of work will keep you physically and mentally healthy, and ultimately improve your quality of work. Making time for family and friends is also key to staying on track, as they will provide you with the support and grounding that you need to not lose sight of what is truly important in life (hint: it is not only your career!). The challenge of residency may, at times, cause you to second guess yourself, but it is important to interpret this, not as a white flag signaling surrender, but instead as a red flag that you are overdue for some “you” time. Take the time to remind yourself every day of the things that inspire you, and that led you to choose this ambitious path to the most gratifying reward. Strive to maintain your earnest pursuit of knowledge and passionate curiosity that started you on this professional journey.
Reflection can also be a tool to ward off burnout. This is different from stress and an important distinction to make, as stress is a necessary expectation in the life of a resident. While stress is the immediate physical, mental, or emotional effects of tension, burnout refers to the consequences of severe, chronic stress and high ideals, often experienced by people working in “helping” professions like ours1. Burnout is not just the occasional bad day or transient feelings of being overwhelmed or negative but the cumulative effect of being overworked that leads to a lack of inspiration and excitement about a job. Individuals who are burned out tend to stop feeling they are making a difference and become pessimistic about their work. This can manifest in an environment of decreased productivity accompanied by feelings of frustration and cynicism.
To prevent burnout, it is important to maintain a sustainable work-life balance, take time to mentally disconnect when off duty, and know when to turn down projects or assignments that would add an undue burden of stress2. Time management and sleep are also critical to staying healthy and able to cope. But the strategy that I found most helpful to prevent burnout was practicing the “art” of gratitude. I tried to constantly remind myself of just how much I had accomplished to get to this point. Less than 2% of the American population holds a doctorate degree, and even fewer get residency training in their specialty. Because of your hard work and dedication, you too have arrived at a unique position that most people will never experience- cherish that!
As I approached the end of my residency, I felt that I was in position to provide an honest examination of the experience as a whole. Like a roller coaster, there will be many twists and turns ahead on the residency ride. You might scream. You might cry (it’s ok, that happens). You may have your world turned upside down (or at least feel like it). But eventually the ride will end. Residency is less so about walking in knowing what to expect, because it is such an inimitable, individual experience that it is nearly impossible to ever be truly prepared for what is about to begin. Rather, it is more about navigating those inevitably difficult times through planning, reflecting, focusing, and remembering to have a little fun along the way.