Third-Year Residents Reflect on Their Second Year

In Spring 2013, we interviewed three incoming residents: Jason Chen, MD, Surgery; Guillermo Rivell, MD, Internal Medicine; and Alex Shuster, MD, Emergency Medicine, who talked about their expectations for their residencies—their goals, fears and dreams. Last spring, they gave candid interviews about their first year. Here is an update on their second year.

Year Two

“The second year in Internal Medicine is not necessarily easier,” says Dr. Rivell. “You aren’t taking care of minutia but you definitely have more responsibility and accountability. That is hard. It's also a challenge running a team because of the fine balance between being supportive, congenial, and holding people accountable for their actions.”

Dr. Shuster agrees. “Every year is challenging in a different way. This year, we had some of the key knowledge we need, but with that knowledge comes more responsibility. The biggest challenge I’ve found in the ED is teasing out a patient’s symptoms, and differentiating between a chronic, non-life threatening problem with one that could be a very serious heart attack or pathology. It's not always as obvious as you think.”

“The second year is a big step from the first,” adds Dr. Chen. “Less paper and floor work, and more OR time. That has been enjoyable, but what is harder is more hours and responsibilities. The hours can be really long, so sleep deprivation can get to you. My eating habits have worsened and workouts have declined; the baggy clothes can hide a lot.”

“A major challenge,” he continues, “is now learning to take on more leadership roles, delegating to your juniors and teaching them what you learned your first year. Looking back, I realize how difficult I found prioritizing. You're told, ‘You need to do A, B, C right now,’ but honestly, maybe only A should be done first. This year, you also learn to work more efficiently. Last year I took 20 or 30 minutes to interview patients, when it can easily be done in 10. But you've got to go through that.”

Outside the Hospital

All three residents love Washington, D.C., and try to enjoy city life in their free time. Dr. Rivell says, “My wife and I try to venture out, but we always circle back to the same few restaurants: Cuba Libre, Umi Sushi, Beau Thai; Cava supports me during my night shift rotations.”

Dr. Chen celebrated his 30th birthday on 24-hour call at Children's National Health System, but when he does get out, his favorite restaurant is Izakaya Seki. He took his fiancée there on their first date. “They have an amazing miso-based grilled bass, and they do tempura really well; great noodle and rice dishes,” he says. He’s moved closer to the hospital, “so now my bike ride is half a mile instead of a mile. It's nice to get that extra five minutes of sleep.”

Dr. Shuster also lives nearby, in the U Street area. The commute, to the Hospital Center and Georgetown, is about 12 minutes by car in each direction. “I don't have a lot of free time,” he says, “Big things are exercise, movies and sleep. I like 14th Street a lot, great bars with some nice rooftops, like Marvin Restaurant on 14th and U.”

Year Three

“In my third year,” says Dr. Chen, “I'm looking forward to operating more and working with attendings, learning how to quickly assess and develop a plan for surgical consults. I expect to mature as a young surgeon, and develop more leadership skills.”

Dr. Shuster says, “In our third year, instead of seeing individual patients, we’ll learn how to run a department, help manage the team and prioritize studies based on cost, time and doing what's right for the patient.”

Looking Ahead

Dr. Chen has three more years as a surgical resident, while Drs. Rivell and Shuster will complete their residencies at the end of next year. Dr. Rivell plans to apply for a hematology-oncology fellowship upon graduation. Dr. Shuster says he hopes to stay in D.C. He says, “I was born and raised here, and really like the D.C. area, and there are so many great hospitals here.”

Dr. Chen says, “I have a strong sense of serving the country where it needs me most—general surgery—but am also drawn to breast oncology. You develop a strong relationship with the patients. Some surgeons prefer to operate only; I like the hand-holding. I like learning the story, what the patient’s life has been. Also, you’re collaborating with radiologists, pathologists, medical oncologists, plastic surgeons and other providers to determine the plan of care. It's very gratifying.

Advice to First Year Residents

“My advice,” says Dr. Rivell, “is that you should understand not all octogenarians should be considered comfort care patients. Find out what their lives were like before they came to the hospital.”

“Roll with the punches,” says Dr. Chen. “Some surgeons are demeaning and patronizing, but that should drive you to get better. I don't completely resent this negativity in teaching. In surgery, the wrong move can be lethal, so a harsh reprimand is sometimes necessary to learn quickly. Every day, you've got to read your surgical textbook, and ask yourself, ‘what could I do better?’”

“Being a resident can be such a humbling experience,” adds Dr. Shuster. “It's tough to compare yourself to someone who's been practicing medicine for 30 years, so you have to have an appropriate set of expectations, but only be competitive with yourself. There is so much to learn, so try to be open to feedback. The more you can listen, the faster you grow, and the better you become.”

Jason Chen, MDSurgery

30, engaged; lives in Columbia Heightsfrom San Mateo Valley, Calif.BS in Molecular Biology, University of California at BerkeleyMD, Vanderbilt Medical School, Nashville, Tenn. 

Guillermo Rivel, MDInternal Medicine

32, married; lives in Adams Morganfrom Augusta, Ga. BS in Biology, Wake Forest University, Winston Salem, N.C.MS in Biomedical Research, Colegio de Medicos, Pamplona, SpainMD, MedicalCollege of Charleston 

Alex Shuster, MDEmergency Medicine

29, single; lives in the U Street area from McLean, Va.BS in Cognitive Science, University of VirginiaMD, Georgetown University Medical School