We, like many programs, send our senior residents on a retreat during the last few months of training. It allows them to share some special time with the small group of people that has become their comrades in arms. The theme for the retreat is “Transition to Practice,” and 14 years ago this became the cornerstone of our strategy to educate them on the realities of life after residency.
Looking back, older faculty members were skeptical from the outset about this. They didn't experience anything like it, and some felt the department was spoiling the residents. Every hospital wants to cut the flow of cash to these activities when constrained by falling revenues, but we have persisted by patching together an amalgam of funding sources to keep it going.
The retreat is always at the same mountain resort about three hours from Columbia. It's a beautiful historic place, and the staff arranges wonderful meals for the entire group. The resort also has an amazing spa, and I usually encourage the residents to consider going there a day before the retreat if they can afford the extra night.
Kids These Days
This year, however, I got a very interesting question from one of the residents who was considering arriving early: “Are the massages paid for?” I was a bit perplexed by this and wondered how it got to the point where a resident felt comfortable asking me about having the program pay for a massage.
It is common for the media and older folks to criticize young adults about their self-absorbed lifestyles. People enthusiastically scorn the arrogance of Justin Bieber, the Kardashians, and the affluenza teen as components of society's unsustainable addiction to materialism and overconsumption. I have two teenagers at home, and I remind them from time to time about how they have so much more than I did growing up in a lower middle-class household.
I am, however, reminded of a famous quote, “The children now love luxury. They have bad manners, contempt for authority; they show disrespect for elders and love chatter in place of exercise.” You would think this came from a recent op-ed column in Time magazine, but it comes from a guy named Socrates. One of the oldest civilizations in history apparently had the same generational conflicts that we do now.
The reality is that there has always been a disconnect between generations. Teens and young adults can never fathom the experiences of their parents and workplace supervisors, particularly in light of today's exponential growth in technology. Most residents today, for example, have few memories of life without a smartphone. This sounds even more incredible when you consider the iPhone came out in 2007. That thing that you do nearly everything with is less than 10 years old. How can a resident relate to a time when mobile phones were science fiction?
We're Partly to Blame
To be fair, the residents I work with occasionally have unjustified expectations, but they are also some of the most amazing people I have met. All of them have been involved in community service during medical school, and nearly all participate in global health missions during their time with us. They intimately know the soft underbelly of society and handle numerous difficult situations each shift with relative ease.
Trying to get what one wants is an unrelenting human trait, and we are not genetically wired to be content with what we have. Our species is successful because we can manipulate our environment. With rising living standards will come increasing desire. How can a program teach residents balance between aspiration and humility?
They should instill in residents that their profession grew from humble origins. Many do not even know why they are called residents. They have no idea that physicians-in-training actually used to live in dorms attached to the hospital until the late 1960s. They did not receive a salary. Emergency medicine was born from significant patient needs, but established specialties looked down on it for many years. Residents today should understand the hardships of their predecessors.
But it is the responsibility of the training programs to help residents stay grounded about their future professional and personal expectations. Few residents at this point think their future will involve recurrent frustration at work along with arthritis, sleep deprivation, baldness, and perpetual weight gain. I often feel justified as a program director to harshly correct resident ignorance, but most of the time it is not their fault; it's my own.
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