Ep. 23 - Hot Takes from the Call Room (Strong Opinions, Weak Evidence)

Every physician has opinions they usually save for post-call brunch. In this episode, we bring ours to the mic. From schedule chaos at the end of the year to the surprising joys of chief year, we unpack the residency hot takes we’re willing to defend — and invite listeners to decide where they stand.

Transcript

SPEAKER_00 0:03

Hi, I'm Kyla. And I'm Mary. And you're listening to the Long Call. This podcast delves into the complexities, lessons, and triumphs of residency. Through candid conversations, we want to explore how meaning and connection can emerge from the challenges, chaos, and unexpected moments along the way. It's about discovering the purpose and sometimes even magic woven into the everyday work of being a physician.

SPEAKER_01 0:26

The views, thoughts, and opinions expressed in this podcast are solely our own and do not reflect the policies or positions of any institution, organization, or employer. This podcast is for informational and reflective purposes only, and is not affiliated with, endorsed by, or representative of any official entity. And while we are both doctors, we are not your doctors, and we are not providing any medical advice on this podcast.

SPEAKER_00 0:50

We're excited to unpack the mask, meaning, and magic of residency with you.

SPEAKER_01 0:54

Stay tuned for more.

SPEAKER_02 0:56

Hello and welcome everyone. Today, Kyla and I have a bit of spice to add to the podcast. We're recording later on a Friday afternoon, so we wanted to add a little bit of levity into our recording. So what are we talking about today, Kyla?

SPEAKER_00 1:12

Yes. So today we wanted to take some time to talk about strong hot takes or maybe not so hot takes. Yes, but different opinions that we may or may not have or have heard about residency training.

SPEAKER_02 1:28

Yeah, so I base some of these on things that I have heard a lot of people say the opposite, but I feel deep in my core the other way about them. And I think we might ignite some debate as we go along. We might, but that's healthy. Very good. And then we'd be very curious to hear from you all if you have any opinions about our hot takes or have any hot takes of your own. All right, so first one, Kyla, that I thought of. This is top of my mind right now. I often hear, you know, attendees, trainees alike talk about how they love the end of the academic year like we're in right now, because you know, everyone knows what they're doing, it's smooth sailing. But I think the end of the academic year is my least favorite time in our academic calendar.

SPEAKER_00 2:10

Yes, I think that this is the first point where we will disagree right away. Right away. I do think that the beginning of the year is the best time, but I'm curious as to why you think it's the worst. Well, I didn't say the beginning of the year, I said the end of the year. Right. I think that the beginning is the best.

SPEAKER_02 2:31

Oh, okay, but you don't think this is the worst. Yeah. Okay, gotcha. What's the worst to you?

SPEAKER_00 2:35

The winter.

SPEAKER_02 2:36

Okay, that's we've had a whole podcast episode about that. In fact, I'm I think that's a close second. But this is just, I don't know. I don't think I have gone one day in the past month without feeling like my hair was on fire, to be honest. I mean, there's lots of demands for the new schedules. I'm constantly cross-referencing two schedules. Our chiefs both have senioritis and are feeling emotional about leaving. I'm emotional that they're leaving after I got to spend four years with them.

SPEAKER_00 3:04

So I might say that probably every resident is experiencing senioritis by the end of Really. Yeah, I think there's some level of like senioritis about your current role. That's fair. And that's why, like at the beginning of the year, it is kind of nice to be like, okay, like I made it past that step. Now I'm in this new role. There's something new, there's something fresh. So yeah, that's an interesting one.

SPEAKER_02 3:31

Yeah.

SPEAKER_00 3:32

I do agree with you that the beginning of the academic year is my favorite time, though. It's you know, so much positive energy. Yeah. I think some people may argue though that that may be their worst in contrast to you, only because it's just a little bit more chaotic sometimes with everybody coming into new roles and trying to just kind of adjust and like figure out your place. So all right.

SPEAKER_02 3:55

Well, I'm curious what everyone else thinks.

SPEAKER_00 3:57

All right, do you have one, Kyla? Yeah, so something that I was thinking about is how everyone thinks that it's so important to understand like the formal curriculum of whatever specialty you're in, whether that's like content or like logistics of how to get things done. But I would argue that the hidden curriculum of medicine is just as important as the formal curriculum. Ooh, it's hard to hear as the PD, I must say. Yeah, so maybe like the less tangible things that you learn in your day-to-day in residency, but the things that you know we've covered in this podcast that kind of help you survive the day-to-day or even know what sort of things to anticipate with each stage of your career. I think it's crucial to know that information.

SPEAKER_02 4:40

Yeah, well, I guess I have to agree with this one because that's kind of the whole reason for starting the podcast, right?

SPEAKER_00 4:45

Yeah. I think like a funny example that I tell my mentees to make them feel a little bit better about like not knowing everything that comes with being a doctor is that I had no idea what the step exams were, even as I was applying for medical school. And so I still had in-person medical school interviews, and I remember traveling to an interview, and everybody was like, Well, what's your step one pass rate? And I had no idea what anybody was talking about. I couldn't even like ask an educated question about it because I didn't know. So I went on a break in the bathroom and Googled on my phone what step was. And then I was like, Oh boy, it's like another MCAT. And I was like, Well, I guess that makes sense that you have to do that in med school. And then once I got into med school, I remember we had a small group session with one of our deans, and he was like, Yes, we'll get you through step one, and then you'll you'll take step two, and then you know, later step three. And your jaw dropped a cut. I was so flabbergasted. I was like, What you sign up for? I well, I clearly didn't know, and that's why we're sitting here today. Very all that to say, hidden curriculum is very important.

SPEAKER_02 5:58

Yeah, that's interesting to think about, you know, as you're as people are thinking about what residency or fellowship program they want to go to. It's obviously much easier to think about or see what the formal curriculum is when you're doing these interviews than the hidden curriculum. So yeah, it's tricky. All right, here's a hot take that I have: a hospital should be able to function without residents. You know, while we value our trainees so much and they're super important, and you all provide so much value to our patients. I think fundamentally the attendees should be able to care for all of the patients in the hospital.

SPEAKER_00 6:31

Yes. Well, fundamentally, I agree with you with an exclamation point. I don't know if this is actually true in practice all the time. Uh-oh. One of your concerns. I think that, and you know, this may also be a hot take too. We'll see what people have to say. But I think that like the way that medicine has progressed as far as like the administrative tasks and things being so high-tech and largely electronic-based that it can be a huge adjustment for attendings to be able to keep up with like all of the minutia that like residents have to do. They're of course able to take care of patients and things are documented, but there's so much of like the extra clicks and like the double documenting and all of these extra things that like I think sometimes attendings don't realize how much we have to do.

SPEAKER_02 7:22

Hmm. Do you think that's like they kind of weaponize that sometimes? Like, it's I mean, these are smart people who have figured out a lot in their lives. Do you think they could figure it out if they had to? And it's just absolutely potentially easier to ask the residents to do all of it.

SPEAKER_00 7:37

100%. That is the case. They're fully capable. Thank you. Yes, another one is the hardest part of residency is rarely medicine.

SPEAKER_02 7:49

Hmm.

SPEAKER_00 7:50

I mean, the medicine can be hard. The medicine is hard, but I think that's sort of the difference, right? Between medical school and residency. And sometimes I joke about it with med students that are working with me when I kind of have to pause and teaching with them or like going to see a patient because I have to do like admin stuff that I'm doing. Like I'm like so sorry, they don't tell you about this in med school, but this is like the other large part of your job. But you you genuinely have no idea when you're in med school. And so I think if all I had to do was focus on like the medicine, taking care of patients, understanding differential diagnosis and treatment plans, like I think that I would be probably light years beyond what I am now, like clinically. I really do. And I actually was just talking about this with one of our interns in clinic because she hasn't had lots of clinic this year, like her clinic blocks are at the end of the year. And so, of course, that's like very like stressful and a little bit disheartening in a way because you think you've made like so much progress at the end of the year, which she has, she's excellent, but you feel like this huge setback. But I told her I was like, You're feeling stressed because of all of the logistics of running a clinic, right? Which are very specific to this clinic, and there's no possible way that you could have known before you started the clinic. But I feel like the logistics part is the hard part of being athletic.

SPEAKER_02 9:14

So I think unfortunately those non-medicine parts of being a resident also stick around through fellowship at attending hood. So they are important to launch skills. Yes. Still a lot of logistical challenges or learning curves in attending hood. So I think it's important that it starts in residency at least.

SPEAKER_00 9:32

Yeah, I do wish that one day there would be some way to like improve the administrative burden of being a doctor, because I honestly think that's where a lot of burnout comes from, is the admin and not so much. I think people think it's from like the patient care, and like especially if you have like challenging patients or like things that are like pulling on you, like emotionally, and also I mean, there's a lot of physical demand of being a doctor, especially if you're also in the operating room. But I feel like if I were to actually break down what are the things that give me the most like neck tension, it's really it's more of the admin.

SPEAKER_02 10:06

Well, you know, that actually segues very nicely into my next hot tank. So I'm in my role, right, as PD, the amount of administrative time I have for the residency is actually mandated by the ACGME, right? So it depends on the specialty and then also the number of residents you have in your program. So for me and our size of program, I have 50% administrative time and 50% clinical time. And I would posit that seeing patients is way easier than my administrative work. And I would rather spend an entire day seeing patients in an overbooked clinic, which my clinic usually is, than a day of administrative work.

SPEAKER_00 10:44

Yeah, no, I agree with you. We're on the same page here. That's a hot take I can get behind. Again, this is part of like unveiling the hidden curriculum because it's like that's what you go into medicine to do is to like help patients, see patients, and kind of all of the behind-the-scenes work is not really something that you were thinking about. So no, I agree. The easier part is the patients.

SPEAKER_02 11:09

Right. And I think that's why uh it can be important to like focus on getting really good at that first. So then as you kind of maybe accumulate responsibilities later on in your career, that's solid and you have that to fall back on no matter what.

SPEAKER_00 11:22

For sure. Another one that comes up a lot. We'll see what you think about this, Mary. But that chief year is the best year of training.

SPEAKER_02 11:31

100% agree. Although I think that is an unpopular opinion in OBTYN because I tell this to our rising chiefs every year, and they all give me a side eye and tell me, well, not all of them. There's probably one out of eight a year who agree with me.

SPEAKER_00 11:45

Okay, so just do not agree. Just for some context, I'm currently giving Mary a side eye as a rising chief. I mean, who knows how I will feel this time next year, but I just I'm not sure I buy it. What are you concerned about? I mean, I just feel like Chief here, we're talking about all of the administrative tasks. Like Chief Year is the admin on steroids. I do think maybe pros to throw out are that I will feel hopefully more comfortable and like my patient care and counseling and being able and find it rewarding to be able to walk junior residents through things. Exactly. Okay, yes, that's fine. We agree on that part, but I think some of the admin stuff is the part that I've been most nervous about and balancing that would still, you know, even though I'll be a chief, like there's still so much that I have to learn and get and get better at, and so being able to balance the two.

SPEAKER_02 12:42

Maybe it aligns with your Myers-Briggs type, which year of residency you like best, you know, because I feel that all of that autonomy and that ability to know what you're doing far outweighs any of the administrative tasks. Yeah. Oh, that's so interesting. I'd be curious to see if that if that lines up. That's a funny point. I think the ability to kind of shape the residency and take that true leadership role and have everyone looking to you, and you can kind of make what you want out of it, is another really cool thing about Chief Year.

SPEAKER_00 13:10

That's true. Unless, I don't know, I feel like I've tried to find ways to shape the residency prior. So I think maybe it's like personality dependent. Because now I feel more like, you know what? I've done well. I'll probably have more ideas, but let me take a backseat and let others like.

SPEAKER_02 13:27

Yeah, yeah, that's a good point. Maybe you uh you peaked on your max.

SPEAKER_00 13:32

I peaked on my culture. No, no, no. No, I did a lot, but that's funny. Yeah, I think so.

SPEAKER_02 13:42

I think so. So maybe, Chief, you're simultaneously the best and the worst. Yeah, I can buy that. All right, Kyla, I think you have an important to share with our to share with our listeners that you haven't mentioned before today. Yeah, sure.

SPEAKER_00 13:57

Maybe I've been withholding from them, but the truth of the matter is on my regular day-to-day life, I do not listen to podcasts.

SPEAKER_02 14:06

Oh, geez. Sorry. Podcaster.

SPEAKER_00 14:09

That's a bad one. Yeah, now I have it on my resume that I am a professional podcaster, which I think we are. But it is, it's not because I've been listening to podcasts regularly and then decided to take up the mantle, unfortunately.

SPEAKER_02 14:24

Yeah, I guess that was my role in this relationship. I am an avid podcast listener. So if you have any that you would recommend, I would love to hear your suggestions, but you can send them directly to me, not to Kyla. That's fair. Any other hot takes that you have, Kyla? Oh, I have one. I almost forgot this one. Okay. The best postcall meal is ice cream in bed.

SPEAKER_00 14:48

Okay. So I would say my best post-call meal is a hot breakfast.

SPEAKER_02 14:53

I just feel like that's gonna take a lot of time to obtain or make. How do you usually go about getting this hot breakfast?

SPEAKER_00 14:59

Yeah, no, I do make it. And it does take time because you're like semi-delirious, but it's always worth it. Like I normally, I mean, I already have the grocery, so I'm not gonna if I have to stop and go grocery shopping, it's not gonna happen. But I normally will have like scrambled eggs and bacon and grits. Wow. And maybe like a biscuit.

SPEAKER_02 15:18

That's pretty amazing. Next time we're on a shift together, can I come to eat? Yeah, come to my house because I will certainly be having a hot breakfast. Yeah. And you've never like burned yourself in your delirium.

unknown 15:29

No.

SPEAKER_02 15:29

I'd be worried.

SPEAKER_00 15:31

So it always works out just well, and then I go to bed. But I always have to eat before I go to bed because I will wake up within two or three hours. Some people can just go straight to sleep, but I can't do it. No, no, I can wake up and hungry.

SPEAKER_02 15:42

Yeah. That's why I have to have the ice cream because it's fast, but it's very calorie dense and it's delicious. So then hold meat. I fall asleep and I can sleep the whole way through.

SPEAKER_00 15:51

So that's perfect. Maybe I'll do my hot breakfast within like a little dessert. Side of ice cream. Yeah, that I mean, I could get behind that. That sounds good.

SPEAKER_02 15:59

Try it out. All right. Any magical moments that came up for you this week, Kyla?

SPEAKER_00 16:04

Yes. So this week I have been planning for Mother's Day. What a good daughter. And so I surprised my mom with movie tickets to see Devil Wars Prada 2. Nice. Is it good? I think it's going to be good. The first one. That's a good question. In my residency state, it very well could have been out for the last like two weeks and I didn't know about it. But to me, it's brand new. Fair enough.

SPEAKER_02 16:30

Fair enough. It will be to you.

SPEAKER_00 16:31

Fresh out. Yeah. She has like read the book, and then I can't even tell you how many times I've seen the first one because she loves it so much. So it'll be a fun activity for us to do together. That's great. It is a good movie, but it's very old.

SPEAKER_02 16:44

Yeah, it's like over 20 years old. And they're making a new one.

unknown 16:47

Huh.

SPEAKER_02 16:48

Wild. You gotta check it out. I will. Maybe I should read the book. I've been trying to read more books lately. So I have suggestions, but none of them are educational. All right, we'll save that forever stop recording then.

SPEAKER_00 16:58

What's your magical moment?

SPEAKER_02 17:00

My magical moment is that we are in semi-annual meeting season. So it's a really exciting time of year for me, despite all of the harriedness of my administrative tasks that forces me to sit down with residents individually, go over their progress, think about how I individually and we as a program can support them in kind of the next steps in their growth. So I've really been enjoying that. I got to do a couple today and we'll continue over the next next several weeks. Excellent. Well, please be sure to email us in your hot takes. If there are any that are particularly hot and spicy, we will share them in a future episode.

SPEAKER_00 17:40

Thanks for listening.

SPEAKER_01 17:42

If you have comments, questions, or ideas for a future episode, please reach out to us via email at longcallpodcast at gmail.com.

SPEAKER_00 17:50

Catch you on call next time.