To the Editor:
McKenna et al1 struck a resonant chord when they proposed connection as the key to resilience and wellness in medical education. So many of the forces now shaping modern medicine pull residents away from their patients and push trainees apart from each other. From duty hours policies to the electronic medical record (EMR), more and more systems seem to conspire against the formation of meaningful personal connections in medical training. Residency programs must find a way to restore these connections and combat the feeling of isolation that is all too common among trainees.
For two years I trained as an infantry officer in the Singapore Armed Forces. I was challenged and tested in ways I had never been before in the military. Yet I can say very surely that those were two of the best years of my life. How did I extract meaning and even joy from such a trying experience? Connection. The camaraderie of my peers, the guidance of my superiors, and the trust of my subordinates gave me the resilience to overcome tests both physical and psychological.
Fast forward to residency. I knew residency would demand much of me, but I was reassured by the anticipation of forming bonds as strong as those I had experienced in the military. How different could it be? Where once I had platoon-mates, I would have co-residents; in place of commanding officers, I would have attendings; and instead of having recruits under my charge, I would have patients.
My expectation was not entirely let down, but it was not entirely fulfilled either. There have been patients, attendings, and co-residents with whom I have made strong connections. But I have been dismayed at the stark loneliness of residency at times. Clearly I am not the only one who has noted this trend, and the search is on for what may be driving this insidious isolation.
Whether the culprit is duty hours, documentation, or the EMR, residency programs would do well to recall what lies at the core of the residency experience: learning, caring for patients, and joining the community of physicians. These are the joys of medicine, and they are immutable. As the practice of medicine changes, new obstacles to these rewards will inevitably arise. So long as we remember where true north is, we will know how to find our way back.
Tomi W. Jun, MD
Resident physician, Department of Medicine, Stanford University, Stanford, California; [email protected]; ORCID: http://orcid.org/0000-0002-2120-1704.
1. McKenna KM, Hashimoto DA, Maguire MS, Bynum WE 4th. The missing link: Connection is the key to resilience in medical education. Acad Med. 2016;91:11971199.