Ep. 24 - Generational Differences

Residency training is constantly evolving...but is it getting better? In this episode, we explore generational differences in medical training through a conversation between a current resident (Dr. Sanjana Satish) and an attending physician (Dr. Uduak Andy) over a decade removed from residency. Together, they discuss how duty hours, technology, wellness initiatives, supervision, autonomy, and work-life balance have changed over time, along with the advantages and tradeoffs of each era of training. Whether you're a trainee, educator, or simply curious about how medicine has evolved, we offer a thoughtful look at what has changed — and what has stayed the same.

Transcript

SPEAKER_00 0:02

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_04 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 mess, meaning, and magic of residency with you.

SPEAKER_04 0:54

Stay tuned for more.

SPEAKER_05 0:57

Welcome everyone to another episode. This is Mary. I'm very excited today to have two guests on with me, and our focus today will be on generational shifts. So I have two folks who are kind of at different time points in their careers, and I'll let them both introduce themselves. All right. I am Uruwak Andy. I am a Eurogyology attending. Wonderful. Do you want to tell us a little bit about when you trained? You don't have to train around.

SPEAKER_01 1:25

I'm happy to when you graduated, but maybe arranged. I had to, I know I'm happy to say I had to actually look this up. So I did residency from 2007 to 2011, and I did fellowship right after from 2011 to 2014. And I have been on the faculty since, and so I've been at this job for a while.

SPEAKER_05 1:42

Very good. All right, and we have a somewhat returning guest as well.

SPEAKER_03 1:47

Hi, I'm Sanja Satish. I'm a second year in OBGYN residency right now. Great. So what year will you graduate? I will graduate in 2028. Okay. So what's the difference on that? Did anyone do the math? Oh almost 20 years. Oh no, no, no.

SPEAKER_01 2:02

2028, minus when I finished 2011. 17 years. That is almost 20 years. Okay, wonderful.

SPEAKER_05 2:09

Wonderful. All right, so just to start off, what is one word you would each use to describe your residency experience?

SPEAKER_01 2:18

We'll see how they compare. The word I thought about was intense. I remember thinking three months after residency, like, I don't think I can do that again. So, you know, yeah, that was my word.

SPEAKER_03 2:32

Fair. I think my word is fulfilling. A little corny, but you know, I think about like where I started, even though it's only been two years, and you know, I think it's been great in a lot of ways. Obviously challenging as well, but overall fulfilling.

SPEAKER_05 2:46

All right. Well, I guess to be fair, you're only about halfway through. So maybe, maybe it can actually go back to you, Udawak, and think about what did a typical week look like for you in residency, maybe in terms of, you know, when you were arriving, when you were leaving, total number of hours, and then we can contrast that. Or maybe it's very similar to a song to those experience.

SPEAKER_01 3:12

Yeah, I was thinking about would it be that different? I was the post-80 hour work rule. So I think we tried to stay within those confines. I mean, um, weren't always successful. And from a long days, you got in early, you know, before five to six hours, you know, to pre-round and get ready, and you were here until the work was done. And depending a little bit on what rotation you were on, right? If you were operating and you were in the OR, you stayed till the cases were done, and you know, labor flow was a little more controlled because they're sign out and they're sort of an end time. And so I think we mostly stayed under 80 hours, or maybe we just didn't report when it was over 80 hours.

SPEAKER_05 3:49

Okay, fair enough. So you were recording work hours. We were how would you record those?

SPEAKER_01 3:55

We would, you know, trying, I was trying to think. We didn't do it in real time. We were always behind. And I know as a program director, if I get this a lot, we would get a lot of like, put in your hours and we'd put in hours at the end of whatever time period. And so it was always sort of a slur. It's a recall bias in our in our hours.

SPEAKER_05 4:16

And you said you got in before 5 a.m.

SPEAKER_01 4:19

We got it around the 5 to 6 a.m. hour. Okay. Yeah, so pre-round and and get ready for the hour.

SPEAKER_05 4:25

And do you have a sense of what your average hours were?

SPEAKER_01 4:29

I don't know if you got a report out or anything. I don't remember. I mean, I think I I I would say we we stayed close to 80. Oh. I mean, I think, you know, that's probably what we reported mostly was in the 70 to 80 range, and that was probably accurate.

SPEAKER_03 4:44

All right, fair enough. What about you these days, son? Yeah, I think similarly, like like record starts at a set time, so that's kind of set. I think as an intern, certainly you do get here at between the five to six hour. But I think after that, I feel like very rarely you get in before six, even if you have to pre-round, because typically you're rounding like after six, I think. And then I think in contrast, I feel like my average hours are probably like in the 60 to 70 range because we have a lot of like, especially as a second year, subspecialty rotations where our hours like are in the 40s, and then nights, of course, our hours are in closer to the 80 mark. And otherwise, I think to the point about like staying in the OR until the case finishes, I think that's typically the case, you know. Except I think sometimes with benign GYN, we if the night person can, we do try to like tap each other out if possible, but you know, it is not always possible. So yeah, I think a little bit fewer hours, but I think the culture of like staying until the case finishes is definitely still present.

SPEAKER_05 5:48

Yeah, I think that kind of speaks to the the next question, which is about you know, do you think hours worked translates to clinical competence? Uh obviously you now are an educator, Udwak, so you see the residents coming through and what their surgical skill set looks like to some extent. Yeah. Do you think there has been a trade-off there? Obviously, there are a lot of benefits to the 80-hour work week and maybe even being below that. But what do you think for your perspective?

SPEAKER_01 6:15

I mean, I I think the truth is the people who I think people self-select on what they want to do. And I think people who are going to go into surgical sub-specialties will, you know, appropriately put in the hours. And so you'll see those skills still there. So I I wonder if we looked at that, and like you know, it sounds like people still don't trade off as much and and leaving the operating room. I think, you know, we're a surgical specialty, and then for me as a Eurogand, I'm a you know, a sub-specialist who does surgery. So I think like the people who end up wanting to do surgical sub-specialties are going to operate and put in the time in an OR. So I don't know that that has changed. At least I haven't noticed that that has changed much.

SPEAKER_05 6:52

Yeah, yeah.

SPEAKER_01 6:53

Yeah.

SPEAKER_05 6:53

Do you feel at all, Santana, that um trying to come in under hours because I don't ISPD do hound you all if you're putting if you're accumulating too many hours? Do you ever feel like that's been detrimental to your education?

SPEAKER_03 7:07

Not really. I think it's hard to absorb and learn after a certain number of hours working. I think when I, you know, what I think that I we learned what we need to in the time that we have, like in 80 hours, I think that's plenty of time. But I think that the surgical, like, you know, people who want to do surgical subspecialties, I totally agree. Like, will sign up to do extra surgery, like whether that's like holiday block or like option, you know, certain times where they like offer to do that. I think the experience comes, and I think it's just with time as well. But I don't I don't feel limited by work hours at all. And I actually think I was I was reflecting on this, I actually think it probably makes me more invested and present in the surgeries that I am in because I have more capacity to do that.

SPEAKER_05 7:54

Yeah, that makes sense. And I'll just put in a plug that I think sometimes our our generalists are the ones who need the most surgical training and residency. So I think those folks it also behooves them to put in the time. So thinking about how you spent those 80 hours then. I know currently in our program there's you know a lot of expectation to, you know, not only get the clinical experience, but also to get you know leadership experience, research experience. How do you feel like that all shakes out or fits or doesn't fit in your work week, Santana?

SPEAKER_03 8:29

Totally. I think that is a huge part of our our work week. I think in general, especially like in general with fellowship as well as like generalists, just our expectations for research and leadership certainly takes a lot more time. So even if I like my average work hours are 60 hours, like most of the time I'm spending 10 to 15 at least like additional hours on the like weeks where it's later, doing like admin stuff, things that we need to like do for residency, including like the research and leadership. So I do think that overall, you know, it does come close to like that 70 to 80 hour mark, but just doing other things that isn't necessarily like direct political work. Yeah, fair enough. How does that react?

SPEAKER_01 9:09

I I thought that that was interesting because some of the questions that we're we're thinking about in research and where this fits in. And I thought, you know, when I was a resident, like if research was definitely done on nights and weekends, that was not part of your 80 hours. Like your 80 hours was political work and running around, and uh, you know, I I definitely think that, which I think is a good thing because I think it's important. And and you know, sitting on my end where I get to see, you know, fellowship applicants and our residents trying to get into fellowship, I think the requirements for those things are high. And the the research output that's expected of our residents are definitely, you know, more than what we we went through. So they need the time and the ability to deal with and to connect with you know attendings during the day who are not gonna do it with your night of nights of weekends. So I think it's important that they have that time. And so that is a difference I've seen is that maybe they have a little more time to do some of that during the day. Uh I'm able to meet with them more than I think I ever had the ability to meet with my attending, so which is good. Yeah, it's a good thing.

SPEAKER_05 10:08

Yeah, I think that's a positive thing. What about learning? And obviously, there is on the job learning, a lot of the learning in residency is clinical, but there's also all right, the phenomenon of protected, more or less didactic time. What did that look like for you in residency, Udoa?

SPEAKER_01 10:27

I was thinking about the you know question about like how did we learn? And you know, we did a lot of like practice bulletin reading and like you know, we would do like didactic sessions. I think that was there was some expectation of like, you know, the more senior residents sitting around and like learning with the junior residents. And I'm not sure what it looks like now, but you know, label floor when things got maybe a little quiet. We'll go through practice bulletins and do a lot of like didactic learning then. So I think that's how we did it. I I wonder if you know, sort of the access that our our trainees now have to like more electronic tools and quicker ways of reading, right? Changes that for them, that they don't need to do as much of that didactic reading and and learning. But we certainly I feel like that's how we learned.

SPEAKER_05 11:07

Yeah. And did you have protected time carved out during the week where attendees would come and give lectures, anything like that, or it was more they were teaching you in the moment?

SPEAKER_01 11:16

I think it was a lot of in the moment teaching, which happens a lot on labor fly, I'm sure it still does. I mean, there was always some protected time on Thursdays, which I think you guys still have some time, but that was variable. It might still be as a resident. I think going to that was very dependent on sort of the benevolence of your older, like the older residents and and and being let out. I I do think when I've given the lectures more recently, the the attendance I feel like is better. So you can clarify.

SPEAKER_03 11:44

So no, I think that's so interesting because I think actually the culture has shifted to be the opposite, where I think junior residents are prioritized for like attending didactic sessions, and I think it's really helpful that way because they're probably who needs like the most kind of like building blocks as far as learning goes. And so, like our chiefs, like even when I was an intern, would pick up the pager for us so that we could attend Thursday Didactics, and it's like totally protected where no one holds the pager. I mean, as an intern, I think you still get messaged sometimes, but I think after that, it's you know, I think very much like no one is contacting you during that time, and I find it to be really helpful for boards as well because we have like dedicated sessions leading up to Kriyogs about like specific topics that are very like board focused, and then I think on your point about like how we learn, I think for me, I'm definitely like a very like question-based learner, and so we use like a lot of like question banks now, and I think I think it's good in some ways because it's easy access, you can do it really quickly. Whereas like I think sometimes for me, like sitting down to read a practice bulletin like takes a lot of mental effort, and that might be the TikTok riding my brain, but so like questions feel more accessible, but I think like we do still try to do some of that practice bulletin learning, and I find that like is a lot more helpful in like solidifying concepts rather than just like memorizing questions. I think are helpful for like memorizing, but the practice bulletin like puts everything together, so I think we do a combination, but definitely like for me at least, I think I do more questions probably than reading.

SPEAKER_05 13:22

So, yeah, fair. You both kind of spoke about relationships with your chief or senior residents and the answer to that question. How would you describe like hierarchy and residency, either within different levels of residence and or with fellows and attendees when you trained in?

SPEAKER_01 13:41

Yeah, no, I I was reflecting on this question and thought there was a lot of hierarchy, and I see it differently now. So I'll tell you something in my day as a junior, you were you know reported to your chief who then reported to the attending. And you know, I've been I am on the other end where I still take some night calls where I call at the residents on GYN calls, and there was definitely a progression over the years of where the second year would never call the attending, right? As a trainee, you went through your chief and then your chief presented, and and now you know the second year's call. And you know, I thought both ways. There's something good about as an attending, I get to meet my second year's and talk to them and help them sort of think through the consults. I think something's lost, though. I do think that that like inter-class teaching that would happen where you would have to learn to present to your chief, your chief would then really even think about it and then present to attending, and it's sort of this different levels of teaching that would happen. I don't know how much of that happens, and it may happen even before they call me, but that's like an actual sort of example of a shift I've seen over the years of sort of the breakdown of hierarchy of who talks to be attending about a patient and how you know it is just more, we get it more from the junior residents now. It's an interesting shift.

SPEAKER_05 14:50

Yeah. Do you remember when you were a resident, maybe as an intern or a PGY2, how you perceived your attendees?

SPEAKER_01 14:57

Oh, we're afraid of attending. You'd be so scared. I remember even on the labor floor, like when the attendant would help and everybody would start shaking their boots, and like your job was to like avoid them, talk to the chief. We were done, talk to the attending, and so alright, I don't know that that was helpful for anyone. I think that sort of this ability to communicate with different people is good. And I don't think it's helpful when anyone is part of the team is afraid of talking to anyone, right? But but I do think something about like the I and it might still be, and there might still be ways this happens, but like the level of responsibility the chief felt about this service and really owning it and sort of owning their juniors and really making sure that they I I wonder if something's lost there.

SPEAKER_05 15:39

No, no, that's a good point. Are you afraid of anyone's gonna? No, I was just thinking that I I definitely not mean or clearly not.

SPEAKER_03 15:50

No, I was just thinking, I was like, I don't think there's any attending that I'm fearful of. And in fact, I think maybe the ventrum is slung in the opposite direction, where sometimes I'll be telling my mom who works in HR about like certain things that I've told attendings, and she's like, You told your attending that. And so I think you know, but I I definitely think it makes me feel more comfortable when you know, when in surgery, like I think when you're scared and nervous to work with someone, I think that for me at least definitely affects like my performance, and I think I'm not doing as well as if I feel comfortable with that person, and like and even with presentations, I think it just like makes the relationship and the a lot better as far even the working relationship because it's a lot more like collaborative, which I think is helpful. And then I guess presenting to the chief, I think you know, being a second year now doing night call and UI on call, we never really the expectation isn't really there to like tell our chiefs about all the consults. I think there are certain ones for me. It's like if it's more complicated and I want to have like a sounding board before presenting to the attending, you know, in that case, then I will kind of like run it by the chief just to like see what their thoughts are. But I think sometimes it's just also the acuity, like there's they're just not available to do that, and like sometimes the GYN patients like need more immediate, like senior attending like yeah, exactly, where I'm like, this is beyond what I can do myself, and so I think yeah, but I think that when I do talk with my seniors to your point, I think there's a lot to be learned, and they kind of think about it differently than even I or the attending I'm working with would. So I think that there's a lot to be learned and like running more of the more complicated patients by senior attendings, and certainly like we have a conversation and like they try to kind of like teach as much as possible in that moment as well. And I think during days, like when that they're the GYN chief, I feel like there's a lot more like ownership over the patients who are inpatient as well as the consults. I think typically like they're at least aware of all the consults. If they're in the OR, they may not hear like all the details about all the consults, but I think there is that like responsibility when you're like the GYN chief on D's, whereas like when you're the ninth chief, you have to manage like both OB and GYN, which is a bit more challenging.

SPEAKER_05 18:08

Yeah, yeah. I think you both bring up a lot of pros and cons. I think you know, certainly the the clinical busyness has increased over the years, is at least my perception, um, over the time I've been here. And then I also think sometimes there's good parts about learning from your chief, but there are sometimes like where some not so good habits or uh steps can get passed on that maybe we as the attendees would prefer not that for the junior residents to learn. So yeah, interesting. I guess Santana, let's start with you. How like when uh when a junior resident makes a mistake, how is that handled? And I'm wondering if that's the same or different from you know 17 years ago.

SPEAKER_03 18:49

Yeah, I think most of the time, you know, the direct whoever was there at the moment will try to like pull you aside to give you that feedback. I think it's never in like a public space, which or like in front of a lot of people or in a tone that I feel like is like that is portrayed on TV or that I've seen on Red Grace Anatomy before. You know, where it's like it's very different. And I think you know, in my experience, people try to like focus on the tangible things that you can change and do differently the next time. And I think it's also easy to I don't know, it's never like I felt I feel like I've never actually received real like mean feedback, and people are very like good about offering that. I also think it's just normalized like to provide and receive feedback, so it's not like a whoa, I'm getting feedback. It's kind of like this is expected for a thing for like my day-to-day, so it's never like a shock or I feel like uncomfortable about it because it's expected and you know, within the culture of our program.

SPEAKER_05 19:49

So yeah, we certainly try to uh make it so you expect to get feedback at every step along the way. Yeah.

SPEAKER_01 19:56

Yeah, I think that sounds great because I think that's that's an active culture that we've sort of tried to change. I remember, you know, before the current safety net system, which is what we call our recording platform for for near misses, it was called the the port system. We hear for ports, ports would be the same thing. It was an electronic system to record like near misses. And I remember it being a little more punitive, where we're like, you know, if you did something like I'm gonna port you, and it was like people would say that, people would say that. You know, I was like, that that's not what you want. That doesn't really seem to help us. No, but it's good to hear that um that it's it's a little less, you know. I think I think the truth that it was always, you know, people want to do things better, and I think there was always sort of like coming from that, that sort of sense of how can we improve things. But I, you know, I think pointing out like publicly correcting people for it happened more than than it does now. And I, you know, I kind of test it as an attending instead of how we give feedback. I think on labor floor, you know, you would get publicly, you would get public, very public loud feedback if something I don't know, if that's that might still happen. I don't do labor floor, thankfully. But um sorry. But um, but I it sounds like it's it's less less public and less, you know.

SPEAKER_05 21:12

Yeah. I'm sure it still happens from time to time, but I think that's certainly not the norm and not where not the culture we're trying to perpetuate. What about if, Udovak, you noticed something you thought was a safety issue or a concern, you know, before you were the chief resident or the fellow or the attendee, and how would how do you remember handling that in residency?

SPEAKER_01 21:33

I mean, I think I think at the end of the day it was always still, you know, we gotta keep a patient safe. And so we would, we would, we would bring it up and you know, they it would sort of go through the process. Again, I probably would approach my chief my chief, like a resident above me before going directly to an attending or or try to try to go that way. But I think there was always a sense of, you know, we make errors in medicine and so we should make it bring those to light and we should learn from them. So I think you always brought it up and you know you were. Word, you know, but you always write up and you'll talk to your chief first, who would then take it up the hierarchy, but then would sort of figure out how to make sure it didn't happen again.

SPEAKER_05 22:08

Yeah, that's definitely reassuring to hear what do you think it's similar? I know we talk about like flattening the hierarchy, but it is still there for all of our, you know, efforts to to make it better.

SPEAKER_03 22:18

Do it do you handle things similarly? I think so. I mean, I think in some ways it's a little different in that like we don't I don't feel like I never I never don't always have to like escalate to a chief and we just kind of submit safety nets if something happens. And I think that's also something that's just normalized, it's not really like a punitive or you know, uh like you're trying to like catch somebody or find out. Yeah, exactly. So you know, even like medical students place safety nets, and so I think it's very normal to like report something that you see, and even now I think with core and some of the more, you know, the more like professionalism, things like that, I think it it feels more normalized to submit those things. And there's a lot of avenues to submit different kind of concerns that you have.

SPEAKER_01 23:04

So do you think it's it's so great. I mean, I think as you know, as someone who as an attending, but you know, in my leadership position, at Breving and stuff, like that is the culture we want. We want people to like we want people submitting. I'm always like, if we don't have safe enough safety nets, that that's the problem, right? Things are happening because that's just the nature of the work we do. And so if if our safety nets, we look at the number of safety nets and if that's going down, that's a problem. We're not reporting. We need to report, you need to enter them. So I I I think I'm reassured that that's you know, that's a real culture change that's happened. I think that's a good thing.

SPEAKER_05 23:35

Do you think there's any downsides to the flattening of hierarchy?

SPEAKER_01 23:38

I guess I think I think what I mentioned about this sort of like opportunity for like senior residents to teach, I do think something is lost when you're I don't know. I think I think it's helpful. And I think as much as we try to flatten the curve, right? Like a 17-year difference is a real difference, right? Like, you know, your teams who are a little bit closer to you, like, you know, have different perspectives, remember more like nitty-gritty detail than I do, right? I think even when, you know, even beyond like your team, like my fellows, I always say the things my fellows will teach you that I just have forgotten or don't think I'm important anymore. And I think it's important to have those like closer teachers. And I it's like I do, I think that can be useful. And I try to encourage it. Like even the OR when we're operating, I you know, I have a fellow because you know, I have a Eurogand fellow with me, and I don't see that they they teach different things, they see things differently, they're they're closer to learning it for the first time, and so they can remember, like, oh, they're placed it this way, and I'm like, of course you place it that way. Like, I've been doing it that way for 20 years, of course. But you know, like you know, the learners are learning, and so they can pick those things up easier. So I think there's utility that I really do. I think that I think that the different levels, uh, the different things to learn from different levels of people. So that's I hope we can maintain some of that.

SPEAKER_02 24:51

Yeah, that's great.

SPEAKER_05 24:52

All right, well, I'd like to turn to wellness next. Something that was discussed by your program director in your residency program.

SPEAKER_01 25:04

Ah, it's a great question. Definitely not like it is today. What did the wellness, like the word wellness? I don't think they're about a residency doing it. I was like, yeah, of course you're well. I I think clearly our language has suffered, which I actually think is a great thing. I think it's great for everyone, right? I think that, you know, the question about like, you know, how how does this help people? I think just the recognition that we're human, right? And then you have lives outside of medicine, I think it's a good thing. I do. I'm not I'm not one of those people who are like, oh, this residence is so soft because you're so well with this. I think it's good. You should be well. Like, I don't you can't actually do this work if you're not well. So it certainly was not something that was discussed a lot during my residency. I think we just expected, you know, you'd be well and you do it. But it was there wasn't this sort of like, let's really think about are we well and what does that mean? And I think, I think on balance it's been a good thing to include for that language to be included in work here.

SPEAKER_05 25:57

Do you think you or your co-residents ever experienced burnout during residency?

unknown 26:01

Yeah, of course.

SPEAKER_01 26:03

I think like, how did burnout show up? I you know, I I I thought about an example once of uh a senior resident who got really angry because the intern, like, was a beast on the busy day on labor floor, and the intern found some food and was eating and no one else had eaten. And she was just so and I was like, She was really just tired of burnout. And like, like, there should be no question about if anybody can find food and eat, they should eat it, right? And and I I I was laughing about that example. It seemed so silly and so, but like that's how burnout showed out, right? That people got like just angry and bitter, and you know, you punch down, right? And so then you take it out of people who are, you know, especially when there's a real hierarchy, take it out of people who are younger than you. So I think I I definitely think people burned down, that's how it showed up. Um yeah, yeah. So so I I think it's a good thing we're moving beyond that line.

SPEAKER_05 26:53

Sounds like there wasn't a great mechanism per se for addressing it when you noticed that in a co-resident, or yeah.

SPEAKER_01 26:59

I mean, I think that, you know, again, because of the hierarchy took like maybe having their pairs, so having another cheese saying, hey, not a take a beat, right? Like that, you know, and and sort of reflecting that to them, right? Like there's some distance, right? Like get off the label floor, like it's okay. Like people should eat. This is not, this is not a question done. But you know, I say that I I think and I think it's still possible for that to happen, but I think it's this idea of wellness, or at least like being in tune to how you're feeling is important, so that you know when you're getting to the point where then you know you're gonna become not pleasant. Yeah, yeah.

SPEAKER_05 27:33

That's fair. Because I think certainly burnout still happens, it's a real thing for our residents despite our kind of focus on wellness. Do you um have any reflections on Dana on how residents deal with burnout these days?

SPEAKER_03 27:46

Or yeah, I mean, I think definitely, you know, like Dr. Andy already mentioned, there's definitely more of a priority, which makes it easier. I think, like, I when I start feeling it, you know, you kind of can take a personal day, or like, you know, you have vacations that are scheduled, and so that definitely makes it a lot easier. I think like how we deal with burnout, I think that we are very like, you know, especially like my class, like, I feel like we have a lot of like events that we organize within our class, and so you know, there's a camaraderie between our class to your point about like it usually takes a peer, like a direct peer, to kind of notice that, and so like it's easier to kind of pick up on that with like people within your own class, and so we have a lot of events to help foster that. And then I think even like the culture between like senior residents and junior residents, even now, like I think every year we make improvements and strides in that. Like, like this year now, you know, when the intern goes to the OR or C section, we like hold the postpartum major and answer like patient calls. And if we know that they're gonna be there for a while, sometimes we'll also like sign into anti-partum or postpartum, which is even a change from when I was an intern a year ago. And I think all of these things contribute to better patient care and people feeling more well, like and less kind of like overwhelmed after you're you come out and you see all of these things. So I think there are structural level changes and like more like personal, intrapersonal things that we do to kind of address burnout.

SPEAKER_05 29:12

Yeah, that's great. I think a big point of tension I think about a lot as a program director, and something I've seen shift even in the past five years, right, is kind of autonomy that residents have, you know, both in the OR and outside of the OR, thinking about how much a resident would take on on their own versus being directly supervised by an attendant. And I think we've made a lot of changes in the name of patient safety, which is obviously a good thing, but I do worry that something is lost in terms of our residents feeling prepared for independent practice. I don't know if you have any.

SPEAKER_01 29:48

No, I I I was thinking about that. You know, how much how much autonomy do you get and and when do you do it? I mean, I think again, as a surgical specialist, right? You gotta know how to operate until when I am seeing res I'm seeing them like my goal is at the end of this, if I'm sending you out in the world, I want to make sure you know how to operate. And and we want to supervise there's a tension. I that's I think that's exactly the right word. I I haven't found the balance, and it's it's constantly evolving about like when do you let them, you know, I think of something very concrete like sitting on the robot and doing a robotic case, right? When do you let them keep going and let them struggle a little bit versus not just safety for complications? You can watch for that closely, but then you're looking at the time and you're like, you know, the time for the patient anesthesia, but also the time we need to get to the next case, and that is a constant tension, which I don't know that there's an easy way to get rid of that, but but there's a tension there, and I think recognizing it, having communicating about it openly to residents and instead of having everyone understand that we're on the same page and there's training here, but you know, there's also a patient. So I I've I've always found that let's have that discussion because I don't want the residents feeling like I'm taking things away from them, you know, but just making sure we're all on the same page, I think is it.

SPEAKER_05 30:59

Do you ever feel overly managed or micromanaged, overly supervised?

SPEAKER_03 31:04

Um, no, I feel like there's appropriate supervision. Certainly, like I have situations where I'm in the OR and I'm like, am I ever gonna be able to like do this myself? Because of like, you know, there are like other things for like patient safety reasons that we don't like always have like all the autonomy to just do things by ourselves, which I think is totally appropriate. But I think you know, to Dr. Andy's point, I think like I oftentimes like the expectations are set before cases, like, hey, you're gonna do this part of the case, which I think makes it easier to be like, okay, right now at this stage of training, I'm gonna do this, but the goal is to ultimately ultimately keep progressing throughout my like PGY years, so I find solace in that. But certainly I have the fear, like you know, when I am like in a case and I don't do much during the whole case, it's kind of like, okay, well, am I ever gonna learn this? And I definitely like have that thought, but I think overall, like it like especially even just like in two years, there's a lot of progression, and even in second year, like you know, I did my like guy knock rotation first versus like now like your own guy and last, and kind of like how much autonomy you're given even progresses in the year, and so I find solace in that, but definitely there's a fear about like being ready for independent practice, so yeah, I don't think that makes sense.

SPEAKER_05 32:19

I think you both alluded to this earlier in terms of uh incorporation of technology and learning and patient care. Can you reflect back on what technology you used in your day-to-day life as a resident?

SPEAKER_01 32:32

Yes, it's hilarious. We should share with the listeners that when we came in here, I had written notes on a printed-out sheet of paper. And Staginarian Lily had notes on her phone, and we thought that was really funny. That's hilarious. I mean, I think we used some technology, but I was pre-EMR. I remember when Epic started, right? I remember the change in our in our um in our outpatient clinic when we used to have the charts and you roll it up for the weekend up to like, you know, the VC and sort of that change. So I mean technology enhances it helps, right? And and so we once you get over the learning curve, like it can only make things better. And I think you know, the the more technology I'm using now is all these AI tools that we have, it just makes us faster and better. I think I think it's great. I do, I do. I think I think you just have to it helps you be more efficient. So I think it's a good thing. But but I you know, they're differences and they're real. You have to be patient with people who train a little bit, you know, some of my written notes, you know. That's it.

SPEAKER_05 33:28

To that point, Paj, have you noticed any tensions in how you and your co-residents interact with the EMR pieces of technology and your some of your attendees?

SPEAKER_03 33:38

Yeah, I mean, sometimes when you're watching someone do something and they're like, oh, I could do it so much faster, it's actually painful. I think that's the only thing. And the other thing is there was an epic blackout for the whole day where we had to use paper charts when I was an intern. And it's pretty early on. Uh actually it was like six months in, and I remember when I was walking home, my mom still talks about this. I was like, I don't think I could be a doctor 30 years ago. Like, this is so hard. You have to like go hand orders to the nurses, like on cheese of paper. I was like, oh my god, like you can't just like message them on secure chat, you have to like call them for everything. It's so it was so different, and I felt like it was so much harder, and everything took way longer. Like admissions, everything. It was just like, it's like, oh my gosh, this is painful.

SPEAKER_02 34:26

I don't know how people did it.

SPEAKER_05 34:29

Yeah, absolutely. I realized I think during that blackout that our residents have no idea how to write or decipher a written prescription, you know, how like the dots and the hashes, the total loss of art. I mean, it's fine, it's just funny to think about it. All right, we're gonna do some rapid fire about what you think generations get wrong about each other. Okay, so what's a misconception about our current residents that you think is unfair?

SPEAKER_01 34:57

You know, I I think I think my my peers, and people are a little older than me, can can look at our residents and say, because they prioritize balance and have a life outside of medicine, they don't care about patients. And I I there's nothing farther from the truth. I think these residents care. I mean, I I work with them, I see they care, they do things differently, right? And they, you know, they have plans at 6 o'clock, which I never would have had the balls to have plans at 6 o'clock because I'm like, I'll never get out of time. But, you know, so there are differences in how they prioritize their lives, but I think at the end of the day, they care deeply about patients. You see that in their interactions and the way they go above and beyond the patients. So I I think because I I would hope we would realize just because they're doing it differently, because they are sort of finding a better balance in within their work and like their lives outside of medicine doesn't mean they care any less. Truly.

SPEAKER_05 35:50

Absolutely. Sanjay know, what's a misconception that you think about your generation might have about us older physicians?

SPEAKER_03 35:58

I think that maybe possibly people may think that some of like the older physicians are kind of like stuck in their way of doing it like a certain way. And of course, like you know, like things like surgery or things that are very protocolized, you aren't gonna do it a certain way. And I think that's definitely appropriate. But I think people don't realize like how much things have changed, and I think like having this conversation has made me realize that, and like looking ahead, like you know, 20 years from now, if there's a new EMR, like how much that takes to adapt and like learn and kind of change. And I think inherently to being in medicine, you have to like have the attitude of being a lifelong learner, and I think that there is a lot that people in the older generation have already adapted to that you know, I feel like maybe we don't give them enough credit for.

SPEAKER_05 36:44

It's very kind. On the flip side, then Santa, what's one thing you wish older physicians understood about your generation?

SPEAKER_03 36:54

Yeah, I think it's I think Dr. Andy really just touched on it. I think that you know, having that balance makes us able to care and invest in patients more because we're we one have the time, but also like the emotional bandwidth and the mental bandwidth to invest in patient care and like do the extra step and coordinate like all the care because you know it's part of like our our our training, but also just like we we want to do it, and I think yeah, you know, I I think that thinking about the question from your perspective, I feel like maybe some older generation physicians think that maybe like we're lazy, but I think it just manifests in different ways and how we like learn and train and go through residency.

SPEAKER_05 37:38

Yeah, and then Udov back to you. What's something you wish Sanji appreciate about your generation of session?

SPEAKER_01 37:46

I was thinking about this question, and I you know, it it I heard her say about talk about feedback earlier, which which made me happy to hear. But I think sometimes when from our perspective, we can feel like I want the younger residents to not see some of the feedback we give as criticism because sometimes it's not coached in the like wellness language, and we don't spend the time sort of like making sure we're not in a private setting and doing all these things, and sometimes like how we train it, we're like, we're just gonna give you the feedback, how do we not come across as and I think realizing the gift of feedback is something that like in training, and I actually think as you progress through training, you've you start realizing how like if anyone gives you feedback, like you know, and you get deciphered, you know, decipher it and and and take what's good, but it's such a gift, right? Because it means the person has stopped and is thinking about you and trying to make you better. And so I think to receive feedback from the older generation that spirit, even when it's not it's not couched in the very sort of like nice, you know, nice terms that like I think some of our younger trainees have gotten accustomed to. Because I think what it then lets people do is one, give you more feedback, which only makes you better, right? And and and I think I do think a real thing that I've heard from some of my peers and olders that you know I worry about being seen as a mean attending if I give people like you know what might be considered true or harsh feedback. So then I'm just not gonna do, like, do it, which I think is a loss. Why do you want to learn? Why do you want to get the feedback? And so I think my younger residents can just, you know, if it truly is feedback, take it in the spirit of they want me to be better. We're here because we like training and teaching, and and no one's here to make anyone feel bad. It's really to make people better. And if you take it in that spirit, I think it's helpful.

SPEAKER_05 39:29

Yeah, I think that's a great one. All right, well, reflecting on this conversation, that's just so great. Thank you both so much. Any takeaways that you got hearing from each other and thinking about, you know, what an ideal you know residency experience should look like, whether it's something that you know we've lost that we should reincorporate or things that we should highlight even more moving forward.

SPEAKER_03 39:52

I think, you know, to Dr. Andy's point about like not reinstating the hierarchy, but like, you know, learning from people in different stages, I think reflecting on this conversation, there are certainly so many different things to be learned from people at different stages. And so I think that's definitely something that I'll take away. I'm just kind of like kind of leaning on the people like immediately above me a little bit more, without like you know, creating this like only like the chief can talk to the attending kind of situation. And then I think like as far as the other changes, like the EMR, the work hours, all of that, I feel overall has been, and I think maybe you would agree as well, overall very positive and has helped us a lot in kind of like making strides in the field.

SPEAKER_01 40:33

So I mean, I think I I I truly I'm not saying this to you know flat as I learn from our residents every day. I think this this idea that like you should have a life house out of medicine, like imagine that. Like, you know, I think it makes you better. And I and I wasn't being fatitious when I said the the language out around wellness is good for everyone. I think we should I I think that that change has been a good thing. I you know, no one goes into medicine who doesn't want to help people. Like we're you know, like we're doing this because we, you know, we're altruistic, we want to help patients, but I think that if we're not well, they can't help people. And I and I I appreciate our trainees reminding us of that every day. It's that it's important to take the time and make sure you're well so so that you can do this for the long run. We need us to stay in the game for a long time, and that's how to stay in the game. So, so I think that's something that's been good, and that's uh that's a thing I learned from them daily. So, like how to really set boundaries and and make sure you're well so you can do this job well. Completely agree.

SPEAKER_05 41:30

I should have warned you at the start, but here we are. We do always ask our guests for a magical moment from the week. So something in your work that brought you joy or really, you know, re-sparked the magic of being a physician for you.

SPEAKER_03 41:48

I was on a call this weekend at night, and you know, someone has been like trying to flag me down in the ED. I'm always like very like, you know, one track mind, going to see a consul. And the person was someone I had taken care of, my interneer, who was just very grateful for the care that I provided, and you know, it's talked about how like they felt that I was like a really great advocate for them, and it was just a very touching moment. We hugged in the ED, it was very uh, very cute, and I think it just reminded me of like even though I was an intern and like really all I did was just listen to her concerns, and that's that's really it. I think it was just great to like get that feedback, and especially in like times when you're a little bit more stressed to kind of get that feedback is great.

SPEAKER_05 42:31

That's so lovely.

SPEAKER_01 42:33

That is lovely. I'll think of last week. I had a post-up coming. This is when we've done surgery. It's been this was must have been her first post-up because until maybe five, six weeks ago, we did a vaginal hysterectomy. She had fibroids that were quite bigger than we thought they were, but we persisted and we got them out, and then we did a coppectomy, which is one of my favorite surgeries, closing a vagina, and she came back and she was just so happy. I mean, she brought me like a huge first thing, and she brought things for my office staff, and you know, this is why I like surgery. This is you know, I I took this woman who had like a whole thing hanging out of her, and now the vagina's closed and she's so happy. And I I left feeling like this is the good work I'm doing in the world. It's making women's lives better, which you know brings me joy.

SPEAKER_05 43:18

That's awesome. Well, thank you so much, both of you, for your time. I know we've been trying to schedule this for a while, and I'm so happy that it that it did work out.

SPEAKER_04 43:27

Thanks for listening. 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 43:37

Catch you on call next time.