Reflections on Endings and Beginnings: Navigating the Academic Year Transition
Is the end of the academic year beginning already? For me, it's been sneaking in the past couple of weeks. First, it was a warm and sunny day here and there. Then, our graduating fellows started counting down their "lasts": the last revision before their manuscript was accepted for publication, the final shift with a specific attending or charge nurse. A couple of days ago, the inarguable evidence that the end of the academic year was near came as an email from my department; it was time to schedule my year-end evaluation with my division head.
If you want strategies for maximizing the benefit of the yearly sit-down with your division chief, see my blog from last year at about this time: https://www.burningbrightmd.com/blog/preparing-for-your-yearly-evaluation. This piece will not be that because today, I'm feeling nostalgic. I remember my own "lasts" when I graduated eleven years ago from my pediatric critical care medicine and clinical ethics fellowships. When I was getting ready to graduate, I remember being much more torn about calling my attending for help than I'd been a year earlier when I knew so much less. As a second-year fellow, I solidly knew what I needed help with and what I didn't. A year later, getting ready to graduate, I panicked to find that there were still things I needed help with but that nobody would be responsible for helping me in a few short weeks. I remember our graduation ceremony. My fellowship director called my name and handed me my diploma. While my friends were clapping enthusiastically for me, he and I both had our hands on my diploma for a split second, and a thought echoed through my brain. "Great. I feel like I now know enough to be a mediocre first-year fellow. But somehow, I'm…done?"
On (literal) paper, I was done. But it took me 4.25 years to get my attending sea legs under me, which was precisely when I found that while I still didn't know everything, I could handle whatever came in the door until somebody more competent than me came in to relieve me.
Though it may be a bit early for those of you embarking on a new path for the upcoming academic year, I thought I'd rattle off the little bits and bobs that I've learned between taking that diploma securely in my own two hands and now living the dream as a junior-senior faculty member. Some of these may land, some may not. No worries.
1) Your attendings mean it when they tell you to call the attending phone if you need help, even after you've graduated and left the institution. The same is true for those of you in pager-based specialties. Somebody's carrying the darn thing 24 hours a day, and we know there's comfort in asking somebody you've known for years to think through something with you.
2) Patients are getting more complicated, both physiologically and socio-emotionally. You won't know the right thing to do right away a lot of the time. But that's okay because you will know what to do for the things that really do need quick action. For the things that don't need quick action? By definition, you've got time to figure out what you want to do. Many things that feel time-pressured in medicine actually aren't. Notably, many of them cannot be figured out quickly anyway, so get comfortable being uncomfortable. In working through these complicated cases, just keep moving. Progress is better than perfection.
3) Let's talk about perfection. Objectively, we know perfection does not exist. However, getting through training requires us to function as close to "perfect" as humanly possible. However, the habits that get us through training will be different from the habits that will help us be successful attendings. And it's because the pace required of us in training is not sustainable for a 20- or 30-year-long faculty career. Getting out of the habits that served you well in training but start to fail you as an attending will be uncomfortable. Sometimes, it'll be downright painful.
4) Let's talk about discomfort and pain. To do that, we'll talk about growth. After I was comfortable as an attending, I started having the (very unconscious) thought, "I should be done doing hard things." (I didn't figure that out alone; life coaching helped me uncover it.) That subconscious thought was limiting what I was able to achieve not only professionally but also personally. Whenever something got hard, be it writing a manuscript, creating an educational curriculum, or losing weight, my brain would tell me, "I should be done doing hard things." And then I'd quit doing the hard thing. It then became a self-fulfilling prophecy that I shouldn't be doing hard things because I had become incapable of pushing myself. And that was fine until my status quo became unacceptable to me. I had to acknowledge that though I'd accomplished a lot, I still wanted more. Growth is uncomfortable. And sometimes, growth is painful. And nothing is wrong when we are uncomfortable or even when we're in pain. It comes down to choosing which "hard" we want: being dissatisfied with the status quo or pushing ourselves to grow.
There are definitely other lessons. If the thought even crosses your mind to consult ethics, child abuse, and/or palliative care, just do it. If you think, "I wonder if Risk Management should know about this?" They should. If you ask yourself whether the sick kid should get an LP, get the consent, glove up, and handle it. And don't get greedy. (That last one goes for mechanical ventilator weans and goals of care conversations.)
This is a fun time in academic medicine but also a bittersweet one. We get to see how much our trainees have grown and are becoming the extraordinary attending physicians we knew they'd be when they matched with us. But then, our trainees have become friends, and they're getting ready to leave us. They're leaving for bigger and better things, but it always hurts to be the person who's being left behind (even if you're happy where you are). But we recognize the sweetness because we've experienced the bitterness. We have lessons to teach because we were once the ones accepting our diplomas while thinking, "But somehow… I'm done?"
I'll be the first to congratulate the Class of 2024. You'll be amazing. But you won't know it for approximately another 4.25 years.