Abstract
The social dimensions of residency are as essential as the scientific ones, particularly when starting a new program. Privileged to be the first-ever trainee in a newly accredited residency program, this reflection details the particulars defining my experience. In an attempt to balance humility with accomplishment, the following offers unique observation and insight on the many aspects we all share in training, in the aim of contributing something meaningful to them.
“Write it down so you don’t forget,” urged my assistant program director in the operating room. It was October of my intern year, and the wisdom in her advice was readily apparent—residency could be a barrage of new, exciting, and sometimes overwhelming information. Her instructions, however, were unrelated to the procedure. Our discussion that morning centered around my experience as the first-ever resident in our newly accredited otolaryngology–head and neck surgery residency program.
Such a path for ENT residency is unique. Prior to 2019, only 1 program had received accreditation in the United States in the previous 15 years. Often an intrigued peer, colleague, or friend will ask me to describe it. Rarely do I have the time to share the complexities that fully capture the experience—ever evolving and layered between personal and professional change. Thus, heeding the advice of my mentor, the following is a culmination of 3 years of insight, setbacks, and joy, written as a Frequently Asked Questions guide aimed to depict the early years as an inaugural resident in a new ENT residency program.
Q: “What is the best part?”
To start, this is the most common question. With so many unique aspects, the answer is invariably influenced by recall. Yet there is a common theme among these thoughts—the educational experience.
Resident teaching is unanimously prioritized in a new program. Our division was successfully practicing for 5 years before the program began. Through the integration of advanced practice providers, the group autonomously functions without relying on residents to complete day-to-day operations, allowing education to take precedence.
This parallels the immeasurable level of investment among our faculty. Halfway through my second year, we were unexpectedly short-staffed due to vacations and illnesses. The consult pager sang, and the workload began to amass. Recognizing my strain, our division chair huddled with me in-between cases to run the list and split remaining tasks. We individually went to drain peritonsillar abscesses before rejoining in the operating room to perform a parotidectomy. This clinically and administratively busy microvascular oncologist, let alone division chair, relegated his time to safeguard my welfare.
Our faculty’s approachability and accessibility has been integral to the experience. This is not to say my now coresidents and I are not held to strict professional standards—our assistant program director’s Russian accent becomes slightly more pronounced when we’re out of line. Such attending-level commitment has promoted intimate and effective instruction, receiving individualized feedback on everything from balancing a microscope, to controlling epistaxis, or dissecting a facial nerve.
Q: “What is the hardest part?”
The simple answer would discuss specifics intrinsic to starting any program: piloting didactics, navigating new rotations, and strenuous call schedules. But these obstacles were expected. The most challenging stresses have been the unanticipated, extrinsic ones stemming from the program’s evolution. The breadth of exposure and training directly relies on the success and prosperity of the group. Luckily, I have seen 4 new faculty members added since starting. Yet what if a new hire is a poor instructor? What if an attending leaves? How will our education be supplemented? These stresses necessitate a great deal of trust in program leadership, which I surmise is not typical for junior-level residents.
Q: “Can you compare it to anything?”
I imagine my experience is similar to being a first-born child. There is extra scrutiny, responsibility, and a self-amplified pressure to succeed as the eventual first graduate. As a younger sibling, I spent a lifetime benefiting from the trials of my older brother. I trusted him for judgment-free guidance and support. Not consistently having that relatable figure in my training, like a chief resident, highlights the significance of peer mentorship.
Q: “Who else have you learned from?”
The local programs in the region have welcomed us and encouraged our success. In particular, the University of Pennsylvania has involved our residents in all their academic activities. Often, I feel that we have 2 program coordinators (our own and UPenn’s). This collaborative model for multi-institutional scholastic efforts, championed by their department, has an undeniable role in the future of medical education.
Similarly, Temple University has played a vital role in our day-to-day learning. Their ENT and OMFS residents rotate on service, help cover our call, and provide much-needed comradery. At times, we refer to ourselves as team “OTOMax”—a homage to the diverse training experience and overlapping multidisciplinary care of our specialties.
Q: “Is it lonely?”
Everyone who goes through residency feels loneliness at one point or another. It’s ingrained in the experience and even romanticized in pop culture (Grey’s Anatomy has 18 seasons). Yes, I missed the chance to innocently gripe about an attending’s tedious preferences or another’s rounding schedule. There are less team happy hours with only 1 resident.
Fortunately, my coresidents’ affability and empathy are endless. We will forever be bonded by this unique experience. Each with a different temperament, we provide one another with balance throughout this experience.
Finally, any emotions of loneliness are relative. Our patients have endured radical surgeries and grueling recoveries during the strictest of hospital visitation policies. Despite how catastrophic the COVID-19 pandemic has been, the medical community has never been so united. The isolation we experience in residency may only be a fraction of what our patients feel.
Q: “If given the option, would you pick this path again?”
This is the easiest question to answer: without hesitation, yes.
