THE ROLLERCOASTER OF MEDICAL TRAINING

Medical training is a long and winding rollercoaster ride with arduous slow ascents, perilously sharp curves, gravity-defying loops that leave us temporarily upside down, and rapid descents which can be exhilarating to some, terrifying to others. Students, residents, and fellows (SRFs) often ride this rollercoaster daily. SRFs have a safety belt securing them in place (staff supervision) and often ride this rollercoaster with others (training program). After completing training, SGIM members face similar perils on this training rollercoaster due to lifelong learning requirements. As physicians, we all ride this same rollercoaster, but maybe in different cars or at different times.

Many physicians enter medicine with a goal of helping patients by curing illnesses or treating chronic diseases. While some physicians endorse the concept of wellness and health promotion, fewer physicians learn to care more about the patient than the disease. Riding the rollercoaster of formalized education while undergoing self-discovery takes a lot of emotion and energy from individual riders.

Physicians remember specific patients that influenced their SRF training. I remember the 600 gram 25-week preemie born to a crack cocaine addicted mother with no prenatal care that I successfully intubated during training. Upon my return to the NICU four months later, I was dismayed to see the same infant still there after suffering several healthcare setbacks. More heartbreaking was to hear that “mom” never visited or called to check on her son. I remember the 22-year-old college student brought into the trauma room at Charity Hospital after a motor vehicle accident while driving under the influence. He was nearly the same age as many of the students and residents as we labored to plug the holes, stop the bleeding, and get him to surgery. After 35 minutes of unsuccessful attempted life-saving heroics, I sat with the attending and upper-level resident as we informed his parents that he had died. I remember the 44-year-old female with end-stage cirrhosis secondary to Hepatitis C as my first patient as a third-year medical student. She had come to peace with her future and selected hospice care. I naively thought there was still something that I could do to change her course and impending death. My attending told me that as her doctor (in training), the most important thing I could do was obey her wishes, make her comfortable and be there for her and her family. This was not quite the message or first patient a medical student expects transitioning from classroom to hospital.

These patient encounters were unexpected challenges in my training. There is no book training in the first two years of medical school to prepare you for these encounters. The support of colleagues and mentors at Tulane and SGIM was essential to my advancement in medicine. SRFs and early career faculty are an often-overlooked group within professional society membership. SGIM is different since SRFs are valued for their contributions: for example, they sit on SGIM Council, are Associate Editors for the Forum, and participate on the annual meeting planning committee with special emphasis on SRF programming.

In the September 2023 issue, I wrote “the SRF quarterly column will focus on scholarly articles by SRFs as well as articles for SRFs. The Forum envisions a future state where SRF trainees in Medicine view the Forum as the go-to source for articles such as preparing your CV, negotiating your first job, parenting in residency, work-life balance, etc.”¹ With this October 2023 issue, the Forum presents the SRF quarterly column as a recurring initiative to meet their needs. We invite our SRF associate members to submit articles to the Forum that address their unique challenges. We also seek articles from SGIM members who work with SRFs to highlight lessons learned or local best practices. SRF members are the pipeline of SGIM as they will advance medical education, research, patient advocacy, and clinical care throughout their careers.

In this issue, we highlight articles by several trainees. Medical student Dr. Cherian discusses the humanistic side of medicine by discussing the frequency of burnout at the individual level and defines the awareness of moral injury as an underlying component in her descriptive case. We also see the humanistic side of medicine in Dr. Fenske’s article as she describes her self-evolution during internship in understanding how communication, transparency, and humanism are essential in delivering excellent patient care. Drs. Williams and Kohli, Chair and Co-chair of the Membership Committee, discuss SGIM’s investment in SRFs by spotlighting the “Investing in GIM” initiative for fellows and the National Young Scholar in GIM (NYSGIM) offering for residents and students. Drs. Allen and Jackson describe their use of innovation and technology to increase communication through JamBoard which allows reflection on daily experiences and sharing feedback or educational pearls. Dr. Ali reminds us to define, recognize, and advocate for “true diversity” because when all voices are expressed, we can have a healthcare system as heterogeneous as our communities and SGIM. Drs. Bass and Maruthur highlight the SGIM investment in establishing an SGIM Task Force to address future collaborative efforts between SGIM and fellowship training programs. Dr. Hoque describes the benefits and challenges of shared decision making in clinical practice while Dr. Leung describes her lifelong learning within the Dutch healthcare system with the focus on life expectancy instead of code status. Dr. Gerrity describes the value of generalist’s care utilizing the 4 C model of first contact, continuity, comprehensive care, and coordination of care in an increasingly complex healthcare system. Finally, Dr. Ehrenberger pays tributes to trainees with her resident appreciation poem (applicable to all SRFs).

SGIM and the Forum are committed to the continued support and advancement of SRFs. Many SGIM members are involved in local undergraduate and graduate medical education while others are committed to less formal programs like mentoring or writing letters of recommendation. We all ride the rollercoaster together so remember that “The people closest to me determine my level of success or failure. The better they are, the better I am. And if I want to go to the highest level, I can do it only with the help of other people. We have to take each other higher.”² Be sure to ride that rollercoaster with SGIM colleagues at your side.