July 23, 1999

New cadre of residents ready to learn and teach

New cadre of residents ready to learn and teach


Incoming resident Dr. David Murdoch (right) goes over paperwork with Dr. Mary Yarbrough at the recent house staff orientation. (photo by Donna Jones Bailey)


HealthPlus staff members were on hand to help record such basic information as height and weight, which was also a part of the house staff orientation process, as Dr. Donna Halloran discovered. (photo by Donna Jones Bailey)


HealthPlus manager Marilyn Holmes helps Dr. Roger Bhojwani get started on the orientation process. (photo by Donna Jones Bailey)

On July 1, 202 physicians new to Vanderbilt began their residency training at Vanderbilt University Medical Center.

Some came here from other residency programs, but the vast majority are recent graduates of medical schools across the country, and, indeed, the globe.

They got a jump on making the transition from medical student to house staff member thanks to an intensive five-day orientation program sponsored by the Office of Graduate Medical Education.

In addition to filling out the necessary paperwork for computer training assignments, health screenings, payroll and parking, the residents were treated to a Saturday picnic hosted by Dr. Harry R. Jacobson, vice chancellor for Health Affairs. During the orientation, residents also attended numerous seminars on a wide variety of subjects relating to their new status as house officers. Presentations covered everything from OSHA training, Medicare compliance, malpractice and information management to a history of VUMC and its culture.

All in all, the orientation provided the sort of much-needed information that will help new residents adjust to their new responsibilities, said Dr. Fred Kirchner Jr., Associate Dean for Graduate Medical Education.

"Many older physicians around here may remember their orientations as being briefly introduced to patients by a bleary-eyed departing resident. That's now evolved, and through this program we hope to put the new residents into positions where they can learn and be successful," Kirchner said.

Preparing for their arrival is a process that's begun six months earlier and is overseen by Jane Shoun, Assistant Director for Graduate Medical Education.

"It's an intensive effort by a great many different people at the medical center to help orient the new residents," Kirchner said. "We're trying to send the message that we recognize that this transition is going to be stressful, so don't try to be 'Lone Rangers;' ask for help. That's what we're here for and that's what we're trying to provide."

The total number of house staff at VUMC stands at about 680. Their residencies range in length from three years – the minimum to qualify for a board examination – to eight years for certain specialties. Their basic responsibilities include everything from evaluating and managing patients to assisting and performing surgical procedures.

However long they are here, though, they all have one thing in common – the ink may be dry on their medical school diplomas, but their education is far from over, said Kirchner.

"The awarding of the M.D. is one of the highlights of a doctor's life, but it's really only the half-way point for practicing medicine," he said. "When people have just finished their medical school, they've been, for the most part, pure students.

"Then when they come to an institution like Vanderbilt, they will go through a transition where, while still learning, they're going to be expected to be teachers as well."

Kirchner's office serves as a sort of central support center for residents, directing them to appropriate offices and people for information and support on a variety of issues, including dealing with the transition from student to resident.

However, when it comes to the move from medical school graduate to first-year resident, the term "transition" may be an understatement. There are a host of challenges that must be met and dealt with, many of which have nothing to do with mastering the art and science of becoming a physician.

Relocating, adjusting to a long and grueling work schedule, and balancing work, family and personal responsibilities are just a few of the obstacles to overcome. Toss in the fact that many residents are staring down the barrel of nearly $100,000 in medical school debt, and the odds are high that the stress will mount, especially early in the residency experience.

Dr. Kelly Blair is co-chair of VUMC's House Staff Advisory Council and is in the sixth year of his own residency. Created more than 20 years ago to help support residents, the council is made up of representatives from every specialty and every area of the medical center and seeks to be a voice of representation for members of the house staff.

"There are a lot of realities that kind of sneak up and sock residents in the gut when they first get here," he said. "They've just finished medical school where they've paid a tuition and now they're getting a salary. They have to budget and live on that salary and not only provide for themselves and their families, but also pay their medical school debts.

"There are other transitions as well. Social, academic and most of all, getting used to the work load," Blair said.

Ah, the work load. Long weeks weren't uncommon for Blair his first few years. Formerly a long-distance runner, soon after he began his residency, Blair found that jogging just a mile or two became a chore.

"It's pretty much work and sleep the first few years," Blair said. "Your job becomes the focus because you're not a medical student anymore. As a resident, you are the doctor now and you can no longer say that certain things are other people's jobs anymore.

"As a new resident, it's your job to make sure all the little details about patient care are followed up on before you go home that night – or the next day. It's a challenge for residents to not only work all those hours, but also to read up on different areas of patient care every night, because the technology is changing so rapidly," Blair said.

It's more than long hours, though. It's developing and honing the skills necessary to care for patients in an increasingly complex and multi-faceted health care environment, said Dr. Seenu Reddy, fourth-year resident and also co-chair of the House Staff Advisory Council.

"The first year involves a pretty steep learning curve. The key things you want to get out of the first year is organizational skills, good diagnostic skills and refined patient management skills," Reddy said.

While all new residents face common themes in the transition from medical student to doctor, certain specific changes are intrinsic to the various departments or residency tracks chosen. Experiences differ for residencies in pathology, internal medicine, pediatrics or surgery, Reddy said.

"Now you're really specializing, whereas in medical school you had a more broad-based exposure. You're going from holding books and holding instruments to suddenly being handed instruments."

That's where entities such as the Office of Graduate Medical Education and the House Staff Advisory Council come in. By helping to ease the many transitions involved and serving as outlets for information and support, the journey from resident to physician is made a bit easier.

It's an effort at VUMC that those involved in say is invaluable, and successful.

"I think it's important to realize that residents provide an important component of care," Reddy said. "And Vanderbilt is, in my experience, very impressive in terms of the resources it makes available to help make the adjustment from medical student to resident."