As July begins, residents across the country are getting their first real taste of patient care. At UC Health University Hospital, residents are exposed to the award-winning Education Innovations Project’s Ambulatory Long Block, which helps them transition from hospital-based rotations to an expanded outpatient experience.
Residents see patients in the ambulatory primary care practice three half-days per week but are required to be present in the practice or check the electronic medical record at least once every day. In short, the residents act like practicing physicians.
"We have established a long-block from the 17th to the 29th month of residency, where residents are expected to follow approximately 120-150 patients each, hold office hours and tend to patient needs by answering messages and refilling medicine,” says Eric Warm, MD, director of the Internal Medicine Residency Program. Warm adds that the clinic is organized in every way to focus on patient care, from implementing a patient-centered medical home to regularly integrating patient care into meetings.
However, it begins by simply being thrown in the trenches, and first-year residents are trying to learn the ropes as quickly as possible.
UC residents technically began last week and are adjusting to life as physicians. We spoke to first-year residents Cory Lucas, coming from the University of Louisville, and Elise Henning, coming from Marshall University’s Joan C. Edwards School of Medicine, about their first days on the job and what they expect from their residency experience at UC.
What made you choose UC? Do you know what "kind” of doctor you want to be and why?
Lucas: "The University of Cincinnati was my No. 1 choice because it had such a unique outpatient structure with the long block, found in second and third year. Additionally, the interview process showed that cohesion between the residents and faculty education was a primary focus of the program. The reason I chose internal medicine was because there are so many options remaining, and the next two years will help elucidate whether I want to continue as a general internist or further specialize in a given field.”
Henning: "Where do I begin? When I interviewed, I immediately connected with the mission of UC's internal medicine residency program, particularly its commitment to resident education and training residents to be well-rounded physicians. UC's Education Innovations Project curriculum is unique and has demonstrated excellent outcomes in resident training. UC's patient population is diverse, and though I very much enjoyed training in a more rural area, I decided I wanted to train in a more urban hospital system. I am considering a career in outpatient primary care, though I have thought about a fellowship in endocrinology or allergy/immunology. I am drawn to outpatient medicine because I like the idea of creating long-term relationships with patients and establishing continuity of care.”
What are you most looking forward to during residency training?
Lucas: "I am most excited about the academic half-days that come along with the teaching that is provided on the wards. I work much better in an environment where there is more hands-on teaching, and I feel that the academic half-days will really provide a more effective experience. As for rotations, I am certainly excited about the ward months, as they seem to be the best rotations to teach medicine, as well as time management and total patient care from admission to discharge.”
Henning: "Being able to employ what I learned in medical school to treat real people, how to manage patients comprehensively, meeting and bonding with other residents, evolving into a real physician … And while being in Cincinnati, I look forward to enjoying the city!”
What was your first day like? What kinds of things were you able to experience?
Lucas: "My first day was incredibly daunting. Having come from another university, I had to acclimate to the system and vainly attempt to find my way around the hospital without getting lost. It was very intimidating, as the first signature I placed was not immediately followed by MS IV, which means "fourth-year medical student.” Having to introduce myself as doctor bestowed a much greater responsibility, even when simply talking to the patients.”
Henning: "LONG—Haha. Very educational. I am currently on the inpatient neurology service and am seeing several interesting cases and learning how to best manage one of the most common neurology cases: stroke. One of the largest components of the beginning of residency training is simply learning how a different hospital functions—from the electronic and paper records systems, to consulting other physicians, to everything in between. Moreover, stepping into the role as physician, when just a few months ago I was a medical student, is an exciting, albeit very overwhelming, feeling. I am still adjusting to referring to myself as ‘Doctor.’”
What has been most challenging during your few days of residency?
Lucas: "Keeping everything organized and ensuring that I am getting everything done in the proper time frame. I also feel much more pressure, as patients and doctors would ask a question and expect answers much more than they would a student. The responsibility of informing the patient with proper information will certainly come easier with time but remains challenging this early in our career.”
Henning: "The biggest challenges have been juggling the many tasks that must be completed for each patient—much of the paperwork and dictation is where I feel most like a novice. Learning how to enter orders, check on the results of those orders and adjust treatment plans as necessary are challenging in a new hospital, but I have had tremendous support from my co-junior residents and my senior residents. The attendings, too, are very patient.”
What has been the most rewarding experience during your first few days of residency?
Lucas: "The most rewarding experience over my first few days was seeing my first patient, taking their history, performing a physical exam and providing their care. It was a great feeling to reaffirm my decision to become a physician. The next step is to make sure that the passion I felt during my first patient visit is the same when I see my thousandth patient and beyond.”
Henning: "Knowing that what you're doing for your patients will actually make a difference and walking into patients' rooms, making them smile—these are some of the best moments of the day. One of the things I've really enjoyed is knowing that the communication I have with everyone on the team is extremely valuable and can really impact a patient's outcome. Keeping everyone in the loop about things is rewarding because it automatically guides and unifies the team.”
Any advice for others who may read this later?
Lucas: "If you plan on taking the tunnels the first day, make sure to know where you are going or you will spend a lot of time trying to navigate through them.”
Henning: "Well, this is advice for me as much as it is for future interns: Do not get discouraged when learning a new hospital system. Most interns come from different medical schools and hospitals and have different experiences; we are going to learn how to do things together and eventually will come out on the other side, stronger and highly capable. Take deep breaths. Triage your tasks from most to least important, then focus on completing one thing at a time.”