Insights on Residency Training

Dr. Al-abcha is a Chief Resident in Internal Medicne at Michigan State University.

The Beginning of Fellowship

I was driving from Lansing, Michigan to Rochester, Minnesota and the view of green mountains overlooking the lake was so breathtaking it made me forget the hard work of packing my entire apartment away to begin again, elsewhere. It was something I had never seen before. I was eager to see Minnesota for the first time, just as I had been to see Michigan for the first time. I had heard about the cold weather of both, but my level of excitement was not diminished either time — my goal was much bigger than worrying about the weather. The first move, to Michigan, was for my internal medicine residency, and the second move, to Minnesota, was for my cardiology fellowship. My love of medicine and cardiology dictated that wherever I ended up, which ever state, I would be just as excited to begin my training. As similar as both experiences sound as I describe them, each beginning has been completely different. First, I’d like to begin by thanking whoever came up with the idea of starting training years on July 1st. There is nothing more beautiful than a new beginning in the summer time — it makes me think of how impossible it would be to navigate these changes if we started in December.

The Beginning of Residency

I moved from Houston, Texas, to Lansing, Michigan, for residency. Having already moved from Amman, Jordan, each place was a world apart. My first day of residency in Michigan started at 6 AM in scrubs on an ICU shift. I was given a pager, and I wasn’t exactly sure what would happen after that. An entire new system, and a job that’s actually training instead of school. I felt like I had some of the medical knowledge I needed, but I had to learn to apply it to a new system. In contrast, on the first day of my fellowship, at 6 AM I am dressed in a suit and ready to begin. It feels much slower, and I feel like a beginner again (although an older and more mature beginner). Having completed my residency in a similar setting, I am very well aware of the system and culture of a hospital in the U.S., but I’m am navigating new waters when it comes to knowledge.

When you start residency, you’re learning medicine while figuring out if you enjoy practicing general medicine or whether you’re more interested in a specialty. I was excited about every rotation as a resident. I believe it’s really important to stay open and to welcome every specialty as though could be your favorite. With repetition, you’ll determine what you want to do for the rest of your life. For me, it was cardiology — it had everything I wanted in one profession. The clinical knowledge, the hands-on application, the daily application of hemodynamics, and the long-term patient relationships that I enjoyed from my clinic days. I knew it combined everything I wanted for practice and research and was not just a superficial interest that would wear off.

Combining Beginnings into a Career

It’s very similar in fellowship. Even though we’ve been exposed to the different specialties as residents, the depth of knowledge that you explore as a fellow is astounding. My understanding of an echocardiogram this time last year is a world away from what an echocardiogram means to me today. What’s so interesting about fellowship is that, although you’re at a more advanced level, although it is a stage after completing internal medicine training, you’re a complete beginner when it comes to the science. In residency, I learned how to put a puzzle together, but now I’m learning what each puzzle piece is made up of chemically and physically and the spatial arrangement it requires to create the  picture. It has pushed me to go back and refresh my knowledge about basic concepts in physics! I meant it when I said I was navigating completely new waters.

Although the beginnings of medical school, residency, and fellowship are completely different, what’s important is to be excited and interested in each beginning. To invest time and energy and to enjoy them. We get hung up on mastering anything new, and we want to fast-forward until we achieve that mastery —  we forget to enjoy the learning process. The beginnings are the most important steps. They are what everything is built upon, so enjoy building a solid base, and don’t rush!