Having gone through medical school and the hoops needed to match into a residency in the US, it is easy to assume that all FMGs have a great work ethic. This is more than just doing all the work one is asked to do. It is about being honest with your colleagues, your support staff, your patients, and more importantly, yourself. Below I will prove a few suggestions. Most of these are obvious, but it is always worth pointing out a few principles and specific tasks that will set you up for success.
First, show up on time. When you round in the morning as a junior resident, there is a lot of work that needs to happen before you can start seeing patients with the team. You need to get sign out, print out lists, etc. Being late will derail your day. As a senior, being on time is extremely important, otherwise it shows lack of respect for other people’s time. Same applies for showing up at conferences, meetings, and cases.
Know your patients in and out. I used to write out small cards with the pertinent history. While not the primary thing we have to know, knowing the patient’s social history will also go a long way in helping with your patients’ disposition. Another good thing about developing this skill, is that as a senior, it will become easy to remember details about several patients.
Document as early as possible. In the era of multidisciplinary care when a patient might be taken care of by several specialties and supportive services, having your note in will help advance the patient’s care. Many people wait until they have a definitive plan from an attending. I think this is a missed opportunity, because if you wait, you will have to come back to this later and your exam/findings may no longer be accurate. It is better to put in your note with the evaluation at the time you saw the patient and addend the note once the plan has been finalized. Same applies when you start practice. As the attending of record, putting your note in early gives guidance to the other members of the patient’s care team, and will hopefully save you some phone calls if the plan is written clearly and succinctly.
Be honest about your knowledge and skillset. When you start internship, you’re not expected to know much. That said, if someone has asked you something once and you don’t know the second time around, it makes you seem uninterested. This is not a label you want, and even harder to get rid of. Always be honest. Do not make up something if you don’t really know, like having checked a lab when you didn’t. The same goes for starting treatments or doing a procedure you’re unfamiliar with. There’s a fine line between being bold and being reckless. In medicine, being the latter is highly undesirable and potentially dangerous.
Sign out on time. This stresses the importance of time management. Try not to leave any tasks that should have been addressed during the day. For example, a lab/xray that was ordered at noon, should have been followed up by you and not the person covering overnight. Same goes for calling consults and ordering next day labs/studies. It forces you to get everything done in a timely manner so you can go home at a reasonable time. As a senior, it is also imperative to ensure your team is signing out at the time the night float arrives, that way your juniors are less likely to go over duty hours. As a surgical resident, I would page the intern/junior to the operating room to run the list with me to ask questions and then have them sign out. Otherwise the juniors linger and afternoon rounds that start at 7pm become routine.
Medicine is a team sport. If there are any gaps in the call schedule and you can help cover, offer to do so. This goes a long way to show your co-residents, seniors, juniors, program directors, that you are truly a team player. This will also help if you have any requests for time off in the future.
Avoid having very specific vacation preferences, unless it is for a good reason. If you or a first-degree family member is getting married, well that’s reasonable. Otherwise try to be flexible. This helps you in the long run. As a junior, you are staying on the administrative chief resident’s good side. As you progress through training and need more time off for fellowship interviews/meetings, the program will be more amenable to grant your requests.
Never complain. We all have moments when we need to blow off some steam, but your seniors, your juniors, the support staff, your attendings, don’t usually react well to these situations and you will be labeled a complainer. That said, if there are issues that you identify that could use improvement, go through the appropriate channels to provide feedback along with possible solutions. This will label you as a problem solver.
Always show respect to the nurses. As a junior, they are an invaluable resource to help keep you out of trouble if you listen to their advice. No, they did not go to medical for several years, but they have been working with the same type of patients for a long time. Collaborating will solidify your position as an invaluable member of the team. Over time you realize that they know a lot of the ins and outs of unit they work on. If you start in a new institution, it is always a good idea to introduce yourself that way they know who you are and can help you navigate in a new environment.
Show genuine interest in every service you rotate on. You may be on a rotation in a field (i.e. subspecialty) that you won’t practice. However, there are many things you can learn that will serve you later. Furthermore, your attendings can perceive if you have no interest in that rotation and will engage less with you if that is the case.
Finally, be consistent. You want to be known as a “solid resident.” You do what you say you’re going to do when you say you’re going to do it. You are honest about your skillset and knowledge. You seem interested in the service, regardless of whether you will pursue that branch of medicine. You are respectful to your co-residents, attendings, and the rest of the staff. Having a solid work ethic is important for everyone, but particularly important for Foreign Medical Graduates that are trying to succeed in an American residency or fellowship training program.