The other day a tweet caught my attention from @JasonYoungMD who stated "My Five Foundations of Felling Fine: Food, Fitness, Friends & Family, Falling Asleep, Fulfillment." This seemed like the best advice I had heard for the newbie interns taking teaching hospitals by storm as well as the rising third year medical students who are about to be unleashed on the wards (if they haven't already). It also is a great starting point for program directors who are wondering how to ensure that their residents are "Fit for duty" according to the new ACGME rules.
Food While this is basic part of sustenance, finding food sometimes in the hospital can be challenging, especially at odd hours. Fortunately, this has gotten better, but the choices may not be healthier. In my own hospital, I've seen the front lobby transform from a small coffee kiosk (Java Coast which was celebrated when it arrived) to a full-fledged Au Bon Pain (ABP as we affectionately refer to it). While ABP was a welcome addition, it is easy to consume a lot of empty calories eating muffins or breakfast sandwiches! To make matters worse, research from one of our very own sleep research gurus has shown that the more sleep deprived you are, the worse food choices you make! Therefore, the thing you will reach for after a night shift is going to be the carbohydrate loaded Danish. Residency programs must know this and usually have morning reports full of this type of food. So, consider how you will make healthy food choices, whether that be bringing your own food, or finding out where the healthy options are. Lastly, don't forget about the empty calories that come with beverages, especially coffee-related drinks. For you Starbucks fans, there is an app for that, and I guarantee you may change your choices.
Fitness Like food, fitness can be hard to come by. Interestingly, working in the hospital can actually be a way to get exercise. For example, some studies demonstrate that residents walk as much as 6 miles on call! However, it's also just as easy to sit behind a computer and take a "mission control" approach to your call night where you are monitoring all your iPatients. So, think about this and consider wearing a pedometer and most importantly getting into a routine. When time is of the essence, find a way to work fitness into your day like taking the stairs in lieu of the elevator, or parking farther away. If you join a gym, you have to make sure you go, and one easy way of doing this is to make sure your gym is on your way home from work and that is your first stop. During residency, I actually switched to a gym that was directly on my route home that had a parking lot so I literally had no excuse and actually felt guilty while I drove by and did not stop there. Others opted for 24-hour gym craze that that could work for anyone's schedule. Lastly, exercising with a friend will likely lead to greater results than the solo work out.
Friends & Family Speaking of friends and family, this is the support system that gets interns through residency. Fortunately, another omnipresent F can be helpful here: Facebook. Busy interns or students can at least get reminders to electronically wish your friends happy birthday or log in on that random Monday off to reconnect with friends. It's also important to set appropriate expectations with your friends and family, for example when you are starting on a time intensive rotation that can be demanding. Because of the intense nature of working in the hospital, some of you will form fast friendships with your co-interns and residents, which can be helpful to get you through. However, even your closest friends (including those at work) will ask you to choose between them and sleep, which can be very tough when you are running low on sleep.
Falling asleep So, speaking of sleep, my first question was where do I sleep? Sounds silly I know, but I actually did not know where the call rooms were or did not have the call room key for my first call night ( I actually can't remember which) so I ended up going to sleep for an hour in an unoccupied hospital bed. So, this may not be possible today for two reasons: (1) interns are not likely sleeping when working the jam packed 16-hour shifts; and (2) hospital beds are nearly always filled! Still the challenge for today's interns is getting sleep when working odd hours, especially if starting night shifts on night float or night medicine as programs are evolving to include more night rotations. If this means you have to invest in window treatments or wear an eyeshade at night, just do it. There is nothing better than sleep for a resident and the more the better. While your sleep at home may be limited regardless due to your other family obligations, it's important to know your limits and set aside nights where you will recover.
Fulfillment Last but not least, it's important to figure out how to keep yourself happy and fulfilled during your residency. In some cases, that is a particular hobby or loved one that you need to stay in touch with. In other cases, fulfillment is more complex. It is not uncommon to have doubts about your future career as you stand by the fax waiting for outside hospital records, wait on the phone to schedule a follow up appointment for a discharged patient, or even transport a sick patient to get a needed test. While many are working on ways to reduce the burden of this largely administrative work, interns and medical students are still straddled with a large amount of scut which can be demoralizing. So, where do you find the fulfillment in your work? Well, you will find it when you least expect it, in the words of a patient who is eternally grateful. In other cases, you will meet a mentor or role model who shares your passion and interest in medicine, whatever that may be, and can inspire you to keep you going. Whatever it is, find it and hang on to it for dear life during your darkest hours and it will pull you through.
I do need to add one more F to this fine list. Provided that you are keeping up with the first 5 F's, the best thing is that being in the hospital, learning medicine, and caring for patients is actually FUN! So, don't forget to pause and enjoy it. These tips will also serve you will in the FUTURE!
Vineet Arora, MD, is a Fellow of the American College of Physicians. She is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist, supervising internal medicine residents and students caring for general medicine patients, and serves as a career advisor and mentor for several medical students and residents, and directs the NIH-sponsored Training Early Achievers for Careers in Health (TEACH) Research program, which prepares and inspires talented diverse Chicago high school students to enter medical research careers. This post originally appeared on her blog, FutureDocs.