Surviving Residency: The Professional Socialization of Family Physicians (Addison 4/20/2022)

Many many thanks to Dr. Ritch Addison for his wonderful Grand Rounds this morning (and his 40+ years of teaching and mentorship at Santa Rosa Family Medicine Residency. It felt like a warm cup of perfectly brewed tea to sit and listen to Ritch share his observations from the professional socialization of family physicians. 

For those of you who missed it, the recorded presentation is available HERE and is definitely worth watching!

I have jotted down just a few notes. The talk is definitely best absorbed by listening/watching.

To start, Ritch asked us to consider what resonates with you?

• How do physicians get trained?
• How is residency a process of habit formation?
• How is residency a "stress test" of emotional capacity?

A long time ago (40+ years) in a galaxy (not so) far far away, Dr. Ritch Addison followed nine family medicine interns around for three years-- "I wanted to see what they did." His notebook always in hand, Ritch took call with them, observed them delivering babies, suturing folks in the ER, race to clinic, etc. For three years, he watched them live and process their entire residency training experience.

Today's talk was a summary of observations and models derived from that research. Ritch highlighted a number of important themes:

Surviving residency involves  a TON of immediate issues that new R1s are confronted with

• information overload
• work overload
• dying patients
• control
• time pressures
• sleep deprivation
• inexperience
• responsibility

Working relationships are a complex piece of residency identify formation. Relationships with:

• patients
• nurses
• providers
• attendings
• private doctors
• faculty
• other residents
• AND. . . family (which often takes a back seat because residency can be totalizing)

Asking for help >> too late, too early

When?

Who?

How?

Learning the ropes>> equates to decoding local customs

where to sleep 

when to cry

who to ask

how to put in orders

how to write notes

Spheres of existence evolve over time

                                         work                                    education                        life outside

initial purpose/weight        take care of patient           learn family medicine    maintain some QOL

evolves into                        GET done                        do procedures                whatever is left

There is an inherent conflict and contradiction between a resident's ideals/goals/visions (expectations) and the everyday practices of being a resident. 

Ritch finished off with his assessment of the "modes of surviving" 

Over-reflecting: too much self reflection (favorite patient dies, yelled at by attending, make a mistake)

Covering over: using little self-reflection, so focused on what you are doing you cannot see what is happening to you 

Moving between these two takes wide movements and is extremely jarring. How do residents learn to move between these modes? Ritch said clearly that it's really NOT about finding the sweet spot of reflection, but rather being able to smooth out the space and integrate these two forms of being. 

Finally, Ritch introduced the birth of the Personal and Professional Development groups (P&PD) that really were birthed from the desire of residents to facilitate the movement between these two spaces-- to smooth it out. After all, everybody feels the same way. What happens when we talk about our experiences? We start to resolve the two modes. . . 

Ritch ended with an excerpt from The Heroes Walk, by Anita Rau Badami on the physician-patient relationship. Listen to him read it at the end of the recording. That is what family medicine is all about, right? The most meaningful way we can bring health to people.