health, medicine

7 Things I Wish I Had Known Before Applying to Medical School


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Good afternoon everyone and welcome back! I have a few friends who are writing the MCAT over the next week. It has been a blast cheering them on from the sidelines as they wade through the med school application process and seek admission to any of Canada’s medical schools. Understandably, they’ve had a few (okay, a lot) of questions as to what to expect with the MCAT, the application process, and medical school in general. So I decided to sit down and reflect on what I wish I had known before starting my own journey. I don’t believe knowing these things would have changed my desire to go into medicine, I just feel that it would have been helpful to have a little more insight into the application, admission, and academic process (especially since I am the first person in my family to ever go into medicine).

1. It costs a lot of money. Even more than you think.

Sure, you’ve done your reading online and probably had to scrape your jaw off the floor after seeing how much tuition would cost. The schools provide lofty estimates of how much you’ll spend on books, medical equipment, and other learning resources. What’s not listed online are some of the miscellaneous costs – for example, the amount you will spend booking and attending electives. Electives are your opportunity to network and explore programs outside of your home school. If your electives go well, they can help your residency applications. Electives typically last from 2-4 weeks. Once you begin to factor in flights, (maybe) car rentals, accommodation, food…it adds up pretty quick. Then there is the cost of applying to residency programs. In Canada, you pay a baseline rate to register with CaRMs and then an additional amount for every program you apply to. The list goes on and on and on. I won’t belabour the point – medical school is very expensive.

2. You might not get the residency spot you want where you want.

You have finally been accepted into medical school – Huzah! You’ve made it, the competition  is over…ish. In most parts of the world (although I can only speak to my experience in Canada), there are a finite number of residency spots with regards to discipline and location. Historically, some disciplines (ex. family, internal medicine, psychiatry) have significantly more spots than others (ex. dermatology, vascular surgery). There are a number of factors considered in the determination and allocation of residency spots including population demands, market trends, and funding availability. For example, if you are interested in providing primary care in rural areas, you’re chances of securing a spot are pretty good because there is an incredible need for more rural primary care physicians. On the other hand, if you want to be a neurosurgeon in downtown Vancouver, it might be more challenging to secure a residency spot. Why? Because there is a finite amount of OR time with a sufficient amount of neurosurgeons already battling for it. The government wants to train doctors to work in fields and regions where they are needed. Overloading the market when there is already an adequate number of specialists is not the best return on their investment. Does this mean you should give up on your “dream specialty” in your perfect location? Absolutely not. If you were born to be a cardiac surgeon in Toronto, go for it! What I’m suggesting is that you familiarize yourself with the current healthcare system trends and understand your professional goals in the context of what opportunities are available. Depending on your preferences, you might need to make some sacrifices along the way.

3. You are not expected to know everything. Actually, you are expected to know very little at all.

After writing the MCAT and fighting for your spot in the class, there can feel like a lot of pressure to measure up against your peers – but there’s really no need. Sure, you will be applying with your cohort in a few years for residency spots; however, residency programs are looking for people who are skilled learners, not individuals who feel they know it all. The reason why we complete residency training is to grow and mature our knowledge. If you knew everything going into residency there would be no point! So, how can you be a skilled learner? Try maintaining a sense of humility when identifying and addressing gaps in your knowledge base. You may have read all of Harrison’s, that does not mean you understand all the embodied concepts and are ready to incorporate them into practice. Recognize your limitations and honour them. Furthermore, understand the value in working with others and take advantage of how many learning opportunities are embedded in team-based environments. Most members of the team have been practicing for a lot longer than you have – be open to their perspective and ask their advice. Challenge yourself to test your knowledge. If you sit back and let others answer all the questions, how can you be sure that you know the answers? Take a stab at solving clinical problems, it may be more challenging than you think!

4. It can be hard to predict what time your clinical duties will finish at.

If you are someone who likes to know that they will be done at a certain time so they can be home for dinner, children, significant other, sports activities, hockey games – kudos for having a good level of insight into what is important for you. You will not always have that luxury in medicine. As a trainee, you are expected to stay until you are dismissed by your staff or they go home. As an attending, you are responsible for the care of your patients. If someone’s blood pressure starts tanking or one of your patient’s is in significant psychological distress, you don’t have the luxury of clocking out and dealing with it the next morning. This can make scheduling appointments, social engagements, child care, etc. challenging and, at times, pretty frustrating.

5. “Pimping” is not something that happens on the streets or in hip-hop songs.

Throughout the first few weeks of medical school, I heard several students discussing how much they were being “pimped”. I was confused and frankly a little disturbed by the thought until one of my roommates clarified what was going on. “Pimping” is a rapid series of questioning posed by one of your seniors to reinforce the traditional medical hierarchy. There is some debate as to how the term originated – one of my colleagues referred to it as the act of being “Put IMPlace”. Some physicians will debate and defend the educational merits of “pimping” suggesting that their questioning facilitates clinical reasoning. In my mind, questioning and “pimping” are two separate entities. I believe that questioning can be an effective teaching tool when it is used in a goal-oriented, supportive manner. Many of my favourite physician-teachers regularly use questioning to determine the knowledge level of the learner so they can use whatever foundation they have to learn new concepts. Questioning can help create a respectful dialogue between learner and teacher that builds on student’s strengths while addressing knowledge deficits. “Pimping” on the other hand feels as dirty and demeaning as it sounds. Instead of empowering and supporting the learner, it leaves students feeling demoralized, incompetent, and isolated. Still not sure what “pimping” looks like? Watch an episode of ‘Scrubs’ and pay close attention to how Dr. Cox asks his interns questions.

6. Short, case-based review sessions are more helpful than hours spent memorizing arbitrary facts.

During my undergraduate degree, I prided myself on my comprehensive note taking and ability to memorize slides prior to mid-terms and exams. This study strategy lasted for my first week of medical school before I quickly abandoned it. It felt impossible to read and retain all the information I was sifting through. My Harrison’s text was quickly relegated as a makeshift TV stand. I was feeling overwhelmed so I decided to ask for guidance from one of my early mentors, a rheumatologist. He smiled in a kind, understanding way and gently suggested reading for 30-60 minutes each day around clinical cases. He explained that the added context would add meaning to I was skeptical – how the heck would that amount of reading get me to the MD?? I decided to trust my mentor and give his suggestion a shot. Not surprisingly, he was right and I continue to use this strategy to this day. My studying has become significantly more efficient, meaningful, and relevant.

7. You won’t enjoy Grey’s Anatomy as much as you did before.

You’ll cringe every time Meredith puts her stethoscope on backwards and roll your eyes when a gown’d and glove’d surgeon pulls off their face mask and then resumes operating (Has anyone heard of sterile technique? Surgical site infection?). You’ll be pretty confused as to why the surgical department at Seattle Grace seems to operate every other department. You’ll feel irrationally angry watching all the top-notch surgeons let McDreamy die with his ETT 7cm at the lip (I would have saved you Derek, even as an MS2). Actually, who am I kidding. You will love it all the same. Maybe even a little more now that you’re able to pick out some of the medical flubs and that you can answer your mom when she asks if that’s what it’s like “in real life”.

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feminism, health

A Commentary on My Career as a Woman in Medicine


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The following are excerpts of conversations I have had with friends, colleagues, teachers,  and strangers about my role as a female medical student, and now, as a female physician. I have held onto these comments for a long time, resentful of their implications. I am choosing to re-state them here so that I can acknowledge them and move forward. I have intentionally chosen not to provide my own commentary to let the noise of these words become reverberate and become silent on their own.

 

“What does your partner think of you being in medicine?”

“Is your boyfriend a doctor? Wait, an occupational therapist? Well, that’s kind of backwards isn’t it?”

“Well I guess we know who wears the pants in your relationship.”

“He hit the jackpot!”

“So how are you going to manage having a family?”

“I would avoid any surgical specialties – they’re near impossible to have a family.”

“There is nothing worse than being a female medical student because all the men at the bar are too intimidated by you so you can’t get a date.”

“When do you think you will start a family?”

“I’m guessing that Andrew will go into internal medicine because he’s very intellectual. You’re very nurturing and I’m betting good with kids – maybe paediatrics?”

“Women don’t belong in medicine.”

“All you female doctors just have something to prove.”

“Seems like a lot of work when you’ll probably just stay home once you have kids.”

“I bet you are a good doctor because you’re pretty.”

“You’re too pretty to be a doctor.”

“Guys must hate finding out what you do.”

“Thought you were too good for nursing huh?”

“Wait, you’re the doctor?”

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health

Goal-Setting 101


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September has finally arrived! For some of us, the arrival of September means returning to school; For others, maybe diving back into work after a restful vacation (hopefully out in the sun). But for all of us, the start of a new month, if we choose to recognize it, can represent a fresh, new beginning. I thought this would be a great chance to talk about goal-setting.

I will be perfectly honest, I really enjoy the process of setting goals, but tend to have a challenging time following through with many of them – especially since becoming a resident. I was first introduced to the idea of setting regular goals in my pre-adolescent years when I began competing as a national-level synchronized swimmer. We were fortunate to have coaches who were exceptionally skilled in designing appropriate training goals and breaking them down into manageable steps.

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Setting and following goals for athletic performance is one thing, but professional and life goals feel like a totally different game – but do they have to be? Are all goals created equal? What strategies can you use to ease the implementation of your goals? I am by no means an expert, but experience has been one of the best (and brutal) teachers and here is what I’ve learned:

First, I am more likely to keep to my goals if I have them written down. So, over the last six months, I have been maintaining a ‘Goal Book’. The book itself is nothing extravagant or overly exciting, but I like to think that the ideas inside are. Throughout the pages, I’ve written (or even drawn) outcomes I’d like to see happen over the next month, six months, and five years. There is something about having a visual, tangible reminder of my goals that increases my motivation and accountability.

The next strategy I’ve learned is to break down the goals into reasonable steps. One of my longer term goals is to complete a fellowship in Addiction’s Medicine. On paper (and in real life), this can seem like a tall order and pretty overwhelming; however, when I start to think about what exactly I need to do to achieve the fellowship in smaller steps, I felt much more at ease and in control. Writing the USMLE? Not a problem, when should I write and how should I study? Completing additional elective time in Addiction Psychiatry? I’d be thrilled. What setting would be the highest yield? What programs am I particularly interested in? I write down these steps as well to keep me focused and grounded. I feel in control and ready to leap over the next hurdle.

I like to make a variety of goals outside of my professional development. Not surprisingly, I spend a considerable amount of time focusing on how I can become the best physician and psychiatrist I can be. I love this journey and I would not trade it for anything in the world; however, balance is important. Making goals outside of medicine helps keep me centred and well-rounded. It also helps to reinforce some healthy boundaries between my professional and personal lives.

Finally, I check-in regularly. I like to do both mental and written check-ins and I try to keep them as time efficient as possible. At the beginning of each month, I open up my book and consider how my goals for the previous month went – did I reach them? What behaviours were particularly effective? Which behaviours could use some modification? Throughout the month, I’ll try to jot down quick notes to track my progress. At the end of month, I’ll do more of a structured check in, using a compassionate lens, and really try to reflect on how on what went well and what I can change. Keeping these check-in short (and sweet) keeps this process fun and engaging.

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How do you plan to make the most out of your September? What are your goals? Do you have any good goal-setting quotes? I’d love to hear them!

health, medicine

The 5 Stages of Losing Your First Patient


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Stage One: Panic

You answer the page with a sinking feeling. The nurse confirms what you already know – one of your patients has passed. You slowly make your way up the hospital stairs, your mind on total overdrive. What happens next? Did we miss something? Are we sure they have actually passed? Did they suffer? What room are they in again? How many family members will I have to talk to? What do I say? You pause and take a breath. You pick up your heavy feet and try to ignore the cramping in your abdomen.

Stage Two: Sadness

You arrive at the bedside. The patient has had all their loved ones – children, siblings, grandchildren – circled around them in their final hours. Or maybe they haven’t. Both scenarios leave a dull aching feeling in your chest. They look so different from yesterday morning. I wonder if they got to speak with their daughter or see a picture of their dog – I can remember them saying how much that meant to them. Were they scared? Were they lonely? What would I have wanted if I were in their place? Pause. Time for another breath. We need to focus.

Stage Three: Numbness

You walk away from the patients room and begin to accumulate the modest stack of paperwork demanding your attention. How many forms can there possibly be? Once more, you become aware of the incessant buzzing and chirping of your pager. Does this thing ever stop? Did I really need to be told that Mr. A has had two normal bowel movements today? For a short moment, you catch yourself lamenting the passing of your patient for the additional work it has created. You take another deep breath, this one fuelled by disappointment and disgust. Where has that exuberant pre-med who wanted to help others gone? In a self-compassionate move, you let that thought go and focus on what matters right now – your patient. Where are those papers again?

Stage Four: Doubt

Finally, a pause. It’s almost comical how five minutes of silences can feel like a 5 star vacation. You find yourself waiting in line for your second (okay, maybe third) coffee of the shift and begin thinking back to your patient. A macabre carnival of “what if” situations takes over your mind. What if we had found the malignancy sooner? What if we had given more fluids? What if we had tighter blood pressure control? What if…you feel dizzy. You consider going to review the patient’s chart when another page comes. You hate to admit it, but you feel rescued and soothed by the obnoxious little machine.

Stage Five: Acceptance

You don’t think about the patient for a little while – maybe a few days, maybe a few months. You are surprised when they finally percolate back into your consciousness: “Oh….right”. You have had a few more patients pass since then. Again, you start performing a mental review of the events leading up to and immediately following your first patient’s passing. The reflection process is so much safer and more productive with a clearer mind. You identify things you commit to changing in your future practice noting the importance of honestly and openly engaging in early advanced care discussions. You also start to feel more a peace with the care you provided, realizing that you did your best to honour your patient’s wishes with the skills and tools you had at that time. You examine your patient’s face, laugh, and voice in your thoughts until the shrill sound of your pager brings you back. Buzzzzzzz. Buzzzzzzz. The moment is over and you keep moving.

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Medical School

Checking Luggage, Privilege, and Perspective: A Reflection on Responsible Tourism and Time Spend Abroad as a Medical Student (Part One)


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Good evening everyone! I hope that you are all having a wonderful day. As you may have gathered from my recent post A Letter to Myself, as a First Year Medical Student, I had the opportunity to travel internationally during my medical school training. On a bitterly cold January morning, we were spoken to by several faculty members arranging international pre-clinical electives. The last speaker, a distinguished family physician, discussed an opportunity she had been offering in India over the last several years. In all truthfulness, I knew very little about India; however, while the speaker was talking I felt my heart beat faster and my back straighten: I just knew I was going to India.

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My trip to India would mark my first official exit from North America. I was buzzing with excitement and uncertainty. As my departure date grew closer, I tried to get ahold of any and all information that would help me begin to understand India and my role as a medical student there. I had limited understanding of the importance of responsible tourism and wanted, as much as possible, to be mindful of my biases and what impact my presence would have on those around me. I asked friends who had travelled to India and other parts of the world about their experiences, hoping that hearing their narratives would help me to avoid any intolerant comments or behaviours.

A month prior to leaving, our school offered us some didactic and group cultural sensitivity training. I was thrilled and signed up immediately. The meeting involved first-year students travelling to a myriad of places: Tanzania, Uganda, Australia, Ireland, Croatia, and of course – India. During the training, we were challenged to discuss our reasons for wanting to complete clinical activities abroad. Other students eagerly discussed their hopes to better the lives of impoverished, marginalized populations. I admired their zeal but struggled to understand their intentions. How could our travels represent anything but personal gain? We had recently finished our first year of medical school and I felt that I had learned a lot of things but still really know quite little. I thought back to our recent OSCE where I put the blood pressure cuff on my patient backwards and watched in horror as it inflated like some sad inflatable swimming aid. I came to the rapid conclusion that I could not expect that I would be helping any patients. Instead, I turned my focus towards figuring out my motives for this trip. Why did I want to go to India? Could I use this experience to benefit others as a practicing physician? How might my presence impact patient care? What does responsible tourism look like in real life and how could I practice it?

I will admit, I did not have a good answer to any of these questions prior to my departure. Boarding the plane, I felt sure that this trip would allow me to get outside of my “cultural comfort zone” and to gain a general sense of what kinds of challenges and barriers newcomers to Canada might experience. I recognized that my experience could never be the same as other individuals; however, I felt that there was a huge learning opportunity for being in an area where I could not read, write, or speak the predominant language and lacked any sort of cultural knowledge. My first goal became to use these experiences to deepen my cultural humility and to use this humility when providing care to immigrants, refugees, and non-English speakers back at home.

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Some of my initial conceptions of responsible tourism began to take shape once I actually began my observership in several busy outpatient paediatric departments. I was absolutely floored by these experiences: the number of patients, the language difference, the amount of people present in the examination rooms, the heat and humidity…just to name a few. First and foremost, I felt extremely uncomfortable not being able to identify who I was and why I was present for the appointment. Understandably, I was the subject of many confused, suspicious looks from patients and family members. I felt like I was intruding in such an intimate space and desperately wished that I could ask permission to be present. I attempted to learn a few basic introductory phrases in Hindi; but after several botched attempts, I resigned myself to silence and naively hoped that my non-verbal behaviours would communicate trust and comfort.

I also struggled with how to adapt my learning process and goals to the clinical context and needs of the patients. Back in Canada, we are encouraged and expected to ask staff physicians questions about patients we have seen in clinic. In India, there were more patients waiting than I could have ever imagined. I was casually informed by a medical student that, for some patients, the journey to see a physician had been a perilous journey due to multiple road closures from heavy monsoon rains. I felt incredibly guilty asking questions knowing that taking time from my Indian preceptors to translate and answer might actually displace some needy child from having a full appointment. So I wrote my questions down and kept them with me when I had a few moments alone with a physician or resident. I had a much easier time falling asleep believing that I had not added to the already lengthy waiting times; however, I continued to think about how else my presence as a white foreigner may have distracted from the clinical process. Was this observership totally self-serving? How could I do better in the future?

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Have you ever travelled abroad to complete any type of clinical work? What have your experiences been like? Where did you go and what did you learn? Do you have any advice for medical learners planning international electives?

Stay tuned for Part Two where I discuss my experience in Lucknow, a northern Indian city, where I facilitated a professional competencies workshop for first year medical students.

Medical School, Personal Development

A Letter to Myself, as a First Year Medical Student


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A letter…to me,

It’s me, or I suppose, a tired-er, slightly older version of you  It is August 2017 and another eventful summer is winding down. Over the last two weeks, most of the medical schools in Canada have been gearing up to welcome their incoming classes and it got me thinking about you and your first day. You were so excited and with good reason – the next few years of your life are going to be some of the very best, but also some of the most challenging. So while we have some time, let me go over a few tips I wish I had known on my first day.

You are going to meet and make some of the greatest friends. During orientation week, you’ll connect with a few people and wonder how these relationships will evolve over time.  You will also be hopelessly day dreaming about your old city and social network. Take the visits and time that you need to grieve the ending of that chapter, but know, that you struck “friendship gold” with the group you met during your first week. This group will be your comedy show when you are feeling down, your ride when you are lost, your teacher when you are confused, your pseudo-therapist when you are angry, and your DJ when you feel like dancing. Soak up every minute, friends like these don’t come around often.

Take risks (within reason). There are an unbelievable amount of opportunities waiting for you. Medical school will be one of the most supportive and engaging learning environments you will have ever been in. So get outside of your comfort zone and try something new. You’ve never been outside of North America before – maybe now is the time. Ever considered India? Also, keep an open mind when setbacks happen or plans fall through, because they can and they will. These changes will land you in some pretty surprising and interesting opportunities which you may not have had otherwise.

Learn to set boundaries and say no. This is something we still continue to struggle with (Sorry!). I know how badly you want to make everyone happy but, sometimes, it comes at the expense of your own happiness. You do not have to do every extra-curricular activity you hear about (If you know that you are not into general surgery, why agree to do a massive chart review?!?). You do not have to attend every social function to maintain your friend group (Would you really want to be friends with someone who held missing trivia over your head?). Finally, and this is a biggie, you do not have to go on a date with anybody who doesn’t treat you well. Period. Draw those lines and stand behind them. I got your back.

There’s no easy way to say this one – you will struggle with your mental health, like, really struggle. At times, it will feel like there’s no hope of getting better. You will want to push everyone away and sleep for inhuman amounts of time. You will pass up meals and wonder if you will ever truly feel happy again. Don’t worry – you will. At the time, you will feel downright empty, scared, and alone; but you’ll come to realize just how many people you have in your corner. You are so loved. Go to yoga, take that nap you’re itching for, ask for help, hug the people who stood by you, and breathe. Take ownership of this illness and recognize it for what it is: an illness. It will help you become a better physician, and more importantly, a better person.

You are already concerned about what specialty you will do and where you will go for residency. Pause, take a deep breath, and know that everything will work out. I am not going to give you any spoilers as to how it ends (where’s the fun in that?). It will be a challenging process, you will cry on more than one occasion, and you will write an obscene amount of CaRMS letters. But you are so much better for it and so much more confident that the choice you made was right for you. Make sure you have lots of Reese’s Piece’s on hand.

Oh, and one more thing, when you get Tinder – and stop rolling your eyes, you do inevitably get Tinder – don’t chicken out on swiping on that handsome Occupational Therapy student – that story ends pretty cool.

Give Tucker pets and kisses as often as you can and I will see you in a little bit,

You (circa 2017)

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7 Steps for Making the Most Out of Your Overnight Call Shift


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Happy you Friday all you (c)all stars! I am writing to you hot off an eventful shift in psych emerge. On my bike ride home from the hospital, I found myself reflecting on my “call habits” and some of the behavioural changes I have been trying to make since starting residency.  Whether you are a clerk or a senior resident, call can be a physical, emotional, and mental marathon. Does it have to be? Is it possible to not only survive while on call, but thrive?

First off – for those of you who may not be familiar – what is is “call” and what does it involve? Just like New York City, healthcare never sleeps. Being “on call” means that, as a healthcare professional, there are periods of time where you are required to be local and available to assist with providing care. Some physicians are able to complete call from home. They will be called by the hospital if there are any questions or if they need them to come in. However, as a medical student and resident, your call typically takes place in house. The expectation is that you stay at the hospital throughout the day and overnight carrying a nifty little pager so that you can be summoned to complete consults or reassess patients as needed. Call can be an incredibly valuable learning experience; however, as I mentioned before, it can also feel sometimes like a tearful, Timbit-filled marathon. Let’s look at 7 easy ways to improve your call shift experience!

Step One – Radical Acceptance

Radical Acceptance is a popular concept in Dialectical Behavioural Therapy, a form of psychotherapy, intended to help individuals regulate their emotions. As a psychiatry resident, I try to practice what I teach my patients and this technique has really resonated with me! Radical Acceptance means acknowledging your present life circumstance and accepting it exactly how it is. Let’s face it – call can be really hard. You’ve been working for 20 hours straight and your mental faculties and patience can, and often will, run low. It’s is so easy to slip into a negative mindset and ruminate on how hungry, tired, angry, overworked, etc., you are. Sound familiar? Next time, try acknowledging whatever is happening during your shift and how you are feeling. Try not to assign any judgment to what is going on. Acknowledging your circumstance does not mean that you have to approve or agree with whatever is happening. Now, this is easier said than done; however, with practice it will become easier to stay focused and problem-solve effectively.

Step Two – Pack a variety of healthy snacks and eat them

This step takes a little bit of planning but can have such a huge pay off! Almost every call shift I work, someone asks if I want to order takeout. Now don’t get me wrong – I love a good meal out just as much as the next person; however, the huge servings usually leave me feeling ready for a long nap. I won’t even start with the nutritional value of the food but I’m sure we can all agree that I am not eating the beef gyro with loaded fries “for my health”.  Try to pick snacks that you know will make you feel energized and ready to tackle the rest of your shift. As much as possible, avoid foods high on the glycemic index – these are metabolized rapidly and the energy will not be enough to sustain you for any significant period of time. Some of my favourite snacks are red delicious apples, roasted almonds, strawberries, and zucchini noodles with a light tomato sauce.

Step Three – Do a ten-second check in

While I was working in addiction psychiatry, I was introduced to the “Big Book” individuals in Alcoholic’s Anonymous use to promote and sustain recovery. As part of recovery the “Big Book” encourages its followers to take a little time every day to HALT and check-in. HALT is an acronym which stands for Hungry, Angry, Lonely, Tired. I can think of several call shifts where I checked each and every one off the HALT states and I felt terrible. Now fixing some of these feelings may not always be possible, especially when you’re on call; however, if you never practice identifying how you are feeling – how can you go about changing it? Sure – you might have been up for the last 22 hours with no chance of napping in the foreseeable future. Identify the tiredness and think of what you can do to change it right now. Can you stand outside for two minutes and breathe some cool fresh air? Can put your headphones in and listen to some music while documenting? You might be surprised by what quick changes you can make in the here and now to ward off some of those negative feelings.

Step Four – Ask for help 

In addition to training you to be an effective physician, medical school and residency can sometimes seem like extended job interview and, to be fair, it kinda is. Yes, you are trying to learn so that you can become competent and one day practice independently; however you are also trying to set yourself up for a successful residency match, fellowship, permanent position etc. and in order to reach these milestones, you need the references. As junior learners, there can be an awful lot of pressure to impress and get that “slam dunk diagnosis”. It’s easy to lose sight of what really matters – the patients and your learning. Whenever you find yourself struggling with a clinical question, check your motives for wanting to solve it independently. We learn and practice in teams for a reason.

Step Five – Be a team player

We’ve said it before and we’ll say it again – call can be tough and different people are able to cope with the demands of call in different ways. When (and if) you find a pause in your work flow, check in with your colleagues to see if they need anything before running back to your call room. Maya Angelou once said: “People will forget what you said, people will forget what you did, but people will never forget how you made them feel”. You never know when you will need support (and you will need support) – building reciprocal professional relationships early will make it easier to access this support later on.

Step Six – Wear comfortable shoes

Now this one may seem like an obvious fix and kudos to you for having that level of foresight! I learned the hard way breaking in a cute new pair of flats while on medicine call. I can get a little crusty at the best of times when I haven’t had a good nights rest. Bleeding and throbbing feet don’t make it any easier to stay focused and maintain an appropriate professional demeanour. Now, my colourful Nikes are the first thing I back before heading off to an overnight shift!

Step Seven – Be here, be now

Regardless of what service you are covering, it can be easy to get overwhelmed by all the tasks on your “to-do list”, especially during those nights when your pager doesn’t seem to stop ringing. Practice your triaging skills – What absolutely needs to happen right now? What can wait a few hours? What can be handed over to the morning team? Categorizing your pending tasks this way can free up some cognitive space to focus on what you are doing right now. Being present, especially as a junior learner, will decrease opportunities to miss important steps or nuanced clinical clues. It will also make it easier to focus on the learning opportunities present in your current task.

What are your tips for staying well on call? Do you have any post-call guilty pleasures? Did any of these steps resonate with you? Share below!