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July: Joy and Dread

Every July, as a family medicine teacher, I greet the year with a combination of excitement, anticipation and dread. Who will they be, these young doctors who are my charges and companions for the next two years? I haven’t met this year’s cohort yet, and none of them are students that I remember teaching during their clerkships. Yet, I stare at their names and email addresses. Are they all McGill grads? Or, like past years, have they come from Université de Montréal, young francophones who are eager for the challenge and adventure of residency at McGill. The names reflect McGill’s commitment to attracting students from multicultural communities, and I anticipate that I will be watching many interactions where I cannot understand a word being said.

Who are these young people? What kind of doctors will they become? Who do they want to be when they grow up?

Watching residents develop into fully formed docs is one of my joys. My R1’s from last year have graduated from their tentative baby steps and the long-winded, overly inclusive histories and physicals of their first days. A few weeks ago, I watched Leila deal with her extremely complex diabetic, hypertensive patient with a personality disorder and possible dementia. Why, I thought, does she end up with the most challenging cases? Probably because Leila can handle them, I concluded.  I was impressed as she martialed help from the family, called the consultant, and spoke to the pharmacist. A year ago, she would have been drowning with this case. Indeed many experienced family docs would find this man overwhelming. Leila, however, handled this with grace and aplomb needing only the slightest suggestions from me. It just warmed my heart to see how effective and kind she was.

As for the dread, I am always very vigilant in these first months of residency. The jump from med student to resident is a big one, and now with this COVID cohort, I am worried that their actual hands-on clinical skills have suffered. A medical student I taught this year did not really know how to put on a blood pressure cuff until I showed him. Many of this year’s students have sounded more awkward than usual as they see patients in real life.

But the real anxiety every year is that there is a resident who will be a problem. I am very aware of what they call the “dual responsibility” of the clinical supervisor in Med Ed jargon: I must help the resident advance their skills and allow them to go to the very edge of what they can do. At the same time, I am there to ensure that the patients are protected and appropriately treated. There is also the third level of responsibility. We want to encourage young doctors to fulfill the community’s needs. I am not so worried if the residents need a little extra buffing and shining, some tutoring, or attention to reach their potential. In fact, I enjoy that. What worries me most of all is the uninterested resident, or worse, the dangerous resident with inappropriate self-esteem!

So tonight, I wrestle with my anxieties, look forward to the joys of opening the real world of medicine for eager learners. Who are these new residents? Soon I will know because tomorrow the adventure begins!