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    The birth of new beginnings: Reflections at the end of residency and fellowship

    “The line it is drawn / The curse it is cast / The slow one now / Will later be fast / As the present now / Will later be past / The order is rapidly fadin’ / And the first one now will later be last / For the times they are a-changin’” – Bob Dylan

    Change. It is a concept and a system of livelihood that defines our training. These include changes in the conditions of our patients, in the standard of care, and in the daily workflow. Permutations of change occur on rounds and in the operating room, which is what we learn to expect and accept. There is not a single hospital day or clinic visit that is like any other. In one patient room, we confirm a planned, desired pregnancy in a previously infertile patient; in the next, we discuss end-of-life care in a patient with recurrent gynecologic cancer.

    This dynamic fluidity can be both unsettling and exhilarating. Adaptability to change is simply a part of being a physician, and more so for one that is in training. Eventually, change becomes paradoxically routine as we learn to anticipate a certain element of variability in our “irregularly regular” surroundings.

    During our years as trainees, with these acquired skills of adaptability, novelty aside, there comes an end; a time when we must reset to that naïve optimism and the uneasiness we felt when we first started this journey in medicine.

    With the medical “new year” (see July 2015 blog) on the horizon, this distinct transition falls upon many of us who are graduating from our programs this June—be it residency or fellowship. The prospect of new jobs, new training programs, new surroundings, or even new salaries is thrilling; yet, it remains unnerving and destabilizing.

    As we prepare for July, our core knowledge is fully ingrained, and we reflect upon the deceivingly modest yet profound lessons we have learned throughout our training. Simple rules of thumb have become part of our medical ideology: “Treat the patient, not the lab value,” “Never turn your back on a multip[arous patient],” and “An LMP is a vital sign.”

    Now, at the peak of our training, we tell ourselves that we will always identify the ureter, examine the placenta for completeness, and offer an intrauterine device. Surgical advice as basic as “If you don’t know where you are, know where you’re not,” and “Always start at the leading edge” will play in our minds like a broken record as we develop our own independence in the operating room.

    Physicians who have confidently navigated this sea of change before us have imparted this invaluable wisdom. In some capacity, whether as significant as commiserating with us after a bad patient outcome or as simple as providing one useful critique in the OR, the physicians before us have forever shaped how we will practice medicine. The lessons we have learned from our mentors transcend the fluorescent lights into the “real” world outside of the hospital.

    In a few weeks, the umbilical cords will be cut. For a period of time, we might feel like first-day interns—pockets full of guide books, highlighters, and an unnecessary amount of medical equipment. But quickly, we will find that we have outgrown our training wheels, and we are now responsible for teaching others how to ride. We will consolidate the lessons we have learned from others while simultaneously developing our own individual styles. Our mottos, catch phrases, and tricks of the trade may even become part of another trainee’s emerging ideology. And in this way, in the face of unremitting change, and despite the daily unpredictability, the heart of medicine truly remains the same.

    Yalda Afshar, MD, PhD
    Dr. Afshar is a Maternal-Fetal Medicine Fellow in the Department of Obstetrics and Gynecology, University of California, Los Angeles

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