The Resident’s Dilemma: Strategies and Attitudes for Balancing Learning and Service

The challenge of balancing teaching and service has been on my mind since medical school. From my interactions with residents and the way that residency was described throughout, my medical school class in Hamilton, Ontario was more than aware of the large role of service in residency: to put it simply, the resident is no longer just a learner but also an employee. I have begun my internal medicine residency with three relatively busy rotations, both from a teaching and from service perspective: cardiology, infectious diseases and internal medicine. To continue to grow while being on these sometimes challenging rotations, I have had to find ways to integrate teaching and service.

1. Looking for the learning within the service: While this point does sound cliché, there is an enhanced degree of learning that comes from providing patient care and acts as a learning possibility. Every learner on their medicine rotation has certainly sat through noontime lectures on electrolyte abnormalities to varying degrees of interest or excitement. But when they are in the emergency department and encounter a patient with a sodium of 105 and seizing, their drive to understand and learn around the case is magnified by the case in front of them. Neuroscience backs this idea: we know that increased limbic system activation is key to memory consolidation and thus to learning. Even if there is no obvious new content to be discerned from the case, every patient interaction has their own flavour and thus opportunity to work on being patient-centered as communicators.
2. Manage service requirements to allow downtime for personal study and relaxation: It goes without saying but residency can be a challenging journey. Not all dimensions of service can be a learning opportunity: renewing analgesic and sleep medication orders can only teach so much. Finding ways to be more efficient and get extra rest: be it doing “tuck-in” rounds with the nursing team, becoming better at using ConnectCare or delegating tasks well to the rest of the team, gives us the opportunity to rest, recharge and reflect upon what we learn from service..
3. Being a self-advocate when it comes to learning opportunities: A classmate of mine and present surgical resident once said “ask and you shall receive” and I am truly learning the importance of that now as a resident. The best person to advocate for your learning is yourself and actively seeking opportunities for learning is almost always respected if not commended. I certainly find that the weeks where my learning on service is better, is when I have a particular plan in mind, such as an EPA I want to work on filling or a procedure I want to do.

Having said all of this, it is an ongoing challenge to truly understand what specific aspect of training allows us to grow as residents. To some extent, the learning is picking up the intangibles through being immersed in the hospital environment. Sometimes, I find that the same clinical pearl needs to be frustratingly re-taught over and over to fully integrate into my thinking. In the end, it’s all about staying curious, embracing the grind and knowing that every small lesson stacks up over time, even when it doesn’t feel like it.

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Dr. Aubrey Maltz is a Core Internal Medicine resident physician at the University of Alberta.

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