The value of dedicated research time and making the most of it have been discussed in recent blog posts. But what about the agonized return from research? Returning to clinical residency is something all research residents must face, and for some, this transition may induce understandable anxiety. Thoughts of having lost clinical knowledge and surgical skills may increase as the end of one’s research time approaches. I could cite studies that analyze resident performance after the return from research, but they did not help me personally. On the contrary, the majority sowed more doubt. Instead, I’ll share my experience and some of the best advice I received prior to and following my return.
It is the end of June, and I am at our program’s graduation ceremony. Colleagues that I started intern year with are now rising chief residents starting their 5th year. I on the other hand will be returning as a PGY 3 next week. I feel nervous anticipation mixed with excitement and perhaps a twinge of yes, (I’ll be honest) even jealousy. I was extremely fortunate to have had a wonderful experience during my research years with outstanding mentorship. I spent the last 2 years in a basic science laboratory on a T32 grant. However, returning to clinical residency has been on my mind since the day I left. I asked program directors, attendings, and residents who had successfully made the transition for their advice for trainees navigating the return to clinical residency. I found this guidance most helpful:
- “You have done it once before with 2 years less experience.”
- “What surgical skills? As a PGY2, you had none!” – this thought actually eased my anxiety the most!
- “You will be rusty, but it will come back.”
- “Nobody has outlandish expectations.”
- “You are not the first and will not be the last.”
- “Many current leaders in surgery took dedicated research time during residency. They seem to be doing just fine.”
- “Don’t underestimate the sim lab.”
- “If you feel rushed during a case (you will be slow in the beginning), then express your goals for the case before starting. Today I would like to gain access to the abdomen. Today I would like to dissect the critical view of safety. Identifying parts of the case that you would like to practice and communicating this to faculty before starting may allow you to gain experience with different steps of the case without someone taking over. At some point you will be able to combine the individual steps into a complete operation.”
- “Ask for feedback. This allows for targeted intervention on your part, be it in the skills lab or reading.”
- “Don’t be afraid to communicate and call for help.”
- “Ask your faculty to elaborate on their thought process both in clinical decision making and in the OR.”
- “Don’t overthink it.”
My additional recommendations are:
- Read, read, read – can be accomplished while studying for ABSITE. Helps one maintain the clinical mindset.
- If you can, moonlight. There is nothing better than clinical activity to preserve your clinical skills. If you can, try to go to the OR during research, even if it is just to observe.
- Go to the OR as often as you can after coming back. Double scrub whenever you can and pay attention to what your seniors are doing.
- Don’t shy away from covering extra call. The more you do, the more you learn.
Fast forward to the beginning of September, and I am back in the saddle of clinical and operative management. While it was daunting in the beginning, I was surprised how quickly I felt comfortable managing patients and operating. Nonetheless, there will be challenges to overcome. For me, I was humbled by having to ask for the camera to be retracted every time I swapped instruments during a laparoscopic case so that I could find myself. Or while presenting my first consult while on-call: my presentation seemed so clear in my mind but came out disorganized and chaotic—the look on my attending’s face said it all. It isn’t easy. You will have to read more, practice more, and possibly even combat feelings of self-doubt more than your peers. Additionally, you likely will have residual projects to wrap up from your research time. In a perfect world, these would be completed prior to your return, however the majority of residents I spoke to shared the “mad dash” to the end of their research time, with projects overflowing into the clinical transition. Completing these projects will take up most of your free time while you are already tired and adjusting to the busy clinical schedule. It will be hard, but hard work pays off. If it were easy, everyone would be a surgeon scientist!