TILIR #1: Another July 1st

Hello internet! It's been a while since we talked. Since the last time I wrote, I finished up medical school, matched into Pediatrics, moved from the Bronx to Grand Rapids, and completed my entire first year of residency. As of 0700 this morning, at the end of a long night shift, I signed out my team's patient's to the new interns and officially became a senior resident!

Sleepy me having celebratory brunch

Residency traditionally begins on July 1st, a notorious date, when every provider you meet in the hospital effectively becomes a year less experienced. For historical reasons, the first year residents are known as "interns," as opposed to senior residents, or "seniors" for short. The intern is likely the first doctor you see in a teaching hospital and also the doctor you see most often.

On the morning of June 30th each year, that doctor has been practicing for 364 days - not a whole lot by any means, but with 80 hour work weeks and only a few weeks off a year, they have gained an enormous amount of practical experience since graduating medical school. On the morning of July 1st, the first doctor you see has zero days of practical experience outside medical school. Sure, they've done some "sub-I" (sub-internship) rotations in medical school where you get to go through the motions, but they haven't so much as ordered Tylenol. This is likely their first day using a new computer system. Imagine if your first day with a new piece of technology had children's lives riding on your ability to use it effectively and efficiently. Everything is going to take at least twice as long to accomplish, even with double the supervision for the first few days.

But it's not just the new interns that are dangerous; with each new academic year there is suddenly a new group of supervisors. As an intern, you are one of many on a team. You do the grunt work of writing notes and putting in orders. But every team has a supervising senior resident. Unlike most jobs where you can either aspire to a management position or not. All doctors must lead teams during their training. And we're not all good at it.

So, on July first you have teams of newly minted doctors being lead by often first time leaders. There are, of course, very experienced attending physicians watching over everything, but they can't be everywhere at once. So, avoid the hospital, if you can, for the next few days. We're all climbing that steep learning curve, but we'll be with you shortly.

TIL: Rett syndrome is a rare genetic condition that almost exclusively affects girls and causes progressive developmental regression that can be stabilized but not reversed with symptomatic treatment. Rett syndrome is caused by mutations on the X chromosome of the MECP2 gene, but we don't know exactly how errors in this gene cause the symptoms of this disease.