We've almost made it.

Long gone are the purgatory stints of library study, slaving to solve esoteric problems relating to planks and pulleys. Innumerable several-day exams have been conquered and tucked far away in our memories, hopefully never to haunt us again. The last of our forced smiles and faux-eager nods have been displayed toward ambivalent instructors and medical teams during the throes of our student rotations.

Post-graduate training is also nearing its end. Intern year, the greatest growing pains in our medical education, came and went like a stubborn baby tooth. Becoming a junior resident felt like re-attaching training wheels when we thought we were two-wheeling. Now, deep into our final year of medical training, we can see the end of our formal medical education in sight and must prepare, yet again, for uncharted territory.

There are myriad tales out there describing the roller coaster ride of medical school. Intern year has been portrayed in medical blockbusters such as Samuel Shem's The House of God (and also highlighted in previous pieces that I wrote, seen here and here).

But what can be said for those of us finishing our medical training? What are our accomplishments, expectations and challenges?

Top of the training totem pole

Like anyone going through early career development, working as a medical resident gets infinitely more exciting as we become more senior in our level of training. Fact.

The physical aspect of our medical education is much easier at a senior position than at any previous level of training. We know our hospitals' electronic medical records inside out. Workflow has become much more seamless now that we have several years of shared experience with the faculty and staff of our respective hospitals. Hardworking, eager interns and students assist us in direct patient care and documentation.

The cognitive aspect of medical training has become more engaging. More time is allotted in our job descriptions to think of the "big picture" in patient care. Senior trainee positions include the well-earned responsibility of managing complicated and acute illness in a relatively unsupervised fashion.

Now is the peak time, where most physicians in training finally get to practice what we've been preached. And for the most part, we do it well.

Bottom of the professional barrel

Despite the varsity-jacket bravado that many of us feel as we finish up our final year of medical training, we can't avoid the trepidation that comes with becoming a newly minted, board-certified physician.

Training isn't over after residency or fellowship. We'd like to think we all know everything there is to know about our respective medical fields as we move on professionally, but we all know that this is certainly not the case. Our "relatively unsupervised work" is a large indicator of our readiness to practice independently, but we truly must be ready to practice on our own. Where an attending physician can quickly answer an urgent question during our medical training, busy professional colleagues and academic resources act as our only lifelines for the rest of our careers.

Do we recall those various health care-related buzzwords and acronyms? RVUs, ICD coding and P4P metrics were commonly settled between the hospital administration and our attending physicians and largely escaped our core medical education. Now more than ever must this red tape and bureaucracy of clinical medicine be learned, and fast.

Like the several other marked transitions in medical training, we must prepare to rebrand ourselves again as young and eager apprentices, learn from experience and mentorship and have faith that we will be fully functional in our upcoming roles, this time as independent practitioners.

Take home point

Like most lifetime goals, the rigors and duration of traditional medical education seem infinite as one struggles through it, but are highly appreciated as it comes to an end.
So what does it mean to be a young board-certified physician? I'll let you know when I get there.

Originally written for LeadDoc
Brian Secemsky, M.D.

Medical writing for patients, students
and practitioners.

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