From intern to resident

I took this photo at the end of a night shift in early April 2020. From the seventh floor I could see the long line of socially-distanced hospital staff waiting in line for pre-work infection screening.

As of a few days ago, I am officially a second-year psychiatry resident, or PGY-2 (see end of post for a quick primer on the quirks of residency year naming). When I began my intern year in June 2019 I was excited to practice medicine, but was also apprehensive about whether I would find the work fulfilling, or whether I would experience burnout.  Both turned out to be true: it was an incredible year wherein I’ve truly enjoyed [finally] getting to be a doctor, and I’ve also learned invaluable and sometimes unexpected lessons that include how to choose and adjust antipsychotic doses, but also how to more accurately recognize and then mitigate burnout.  I’ve had the enormous privilege of learning from patients, fellow interns, senior residents, attendings, nurses, technicians, social workers, nutritionists, psychologists, and occupational therapists at the VA, at San Francisco General, and at Benioff Children’s Hospital; in different specialties (psychiatry, medicine, neurology, pediatric neurology, and adolescent medicine); and in a variety of different clinical settings.

At the start of residency I had hoped, but certainly hadn’t expected, that my fellow residents might become close friends.  My fear that I would be terribly unsuccessful in making new friends turned out to be unfounded; in fact, some of the senior residents have described our residency class as notably cohesive, which bodes well for the coming years.  Our camaraderie certainly helped when, two thirds of the way through the year, we unexpectedly faced the specific challenge of working in healthcare during a pandemic with various unknowns.  From February through June I worked on the same psychiatric units at the General, and it was at turns fascinating, stressful, and educational to watch the city, our institution, and our department adapt to this public health crisis.  Amid bouts of uncertainty over whether the curve would be flattened or if we would end up with a terrible outbreak on our units (which, thankfully, did not happen), the overall consistency of my schedule during these past months gave my life structure.  Together with my colleagues I settled into the new normal of daily pre-work screening questionnaires and surgical masks all day.

Then, toward the end of the year, we all found ourselves grappling with the role of structural racism and police brutality in our communities and our medical fields, and the impacts (both acute and chronic) on our patients, colleagues, and friends.   As part of this long-overdue collective reckoning, we have had to rethink what it means to be supportive of each other, to hold each other accountable as allies, and to advocate for each other and for the patients we serve.

During orientation for the incoming interns, a classmate and I each shared a couple sentences about our cultural backgrounds and how they affected the start of our residency.  I shared that I am a Chinese-American immigrant who grew up in a relatively liberal and well-educated college town, and that while during medical school I was involved in some equity-focused advocacy efforts, it was during intern year that I finally began unpacking my intersectionality and privilege in earnest.  I believe a necessary step in becoming an anti-racist physician is understanding one’s own cultural intersectionality, that we are each at a different stage in this process, and that wherever we are is a fine place to start.  Just as this chosen career path requires that we hold space for our patients’ emotions and inner conflicts, so too do we need to hold space for our own uncomfortable truths.  And so, I am reading, listening, writing, and thinking.  

My second residency year (PGY-2, or post-graduate-year 2) will start next week with three months on consultation-liaison psychiatry at UCSF, followed by three months on adult inpatient psychiatry at UCSF, and then six months of outpatient psychiatry at the VA.  Throughout the year we take call shifts at the General, VA, and UCSF.  Each residency year brings new expectations and challenges, and just as I did a year ago, I again find myself feeling both apprehensive and excited.

***Summary of residency year naming schemes: each year, or title for a resident in that year, is often named as “Post-Graduate Year” followed by the number: PGY-1, PGY-2, etc. Another informal shorthand for residency years or residents is R1, R2. Thus, a second-year resident could be referred to as “a PGY-2” or “an R2,” and is in their PGY-2 or R2 year. The first year of residency (PGY-1) is colloquially called “intern year” because some medical specialties, such as radiology or neurology, require that their residents first complete a general medical internship (which may or may not be at the same institution) before starting specialty training in PGY-2. Psychiatry residency is one that begins in the PGY-1 year. Regardless of these differences, across specialties, the completion of the PGY-1 year is thought of as the transition from internship to residency.

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