People often ask what kind of person I consider to be the ideal resident. This question usually conjures up memories of residents with whom nearly all program directors actually did not spend a lot of time during their training. They are the residents who complete every assignment on the first request, do not end up on any delinquency lists, complete their scholarly projects before the last six months of training, do not make special scheduling requests, quietly volunteer to help interview medical students, show up early for shifts, look like a professional, and are more action than words. In fact, they are the kind of residents that the program director often forgets about because they fly below the radar.
Of course, some residents require a lot more maintenance. A quick Google search on high-maintenance employees turns up websites with lists of character flaws at different levels, from the average office worker to the CEO. But anyone working within a training program will recognize that many of these items can be applied to high-maintenance residents.
They Have Urgent “Needs”
This character trait is often displayed in three ways: lots of schedule requests, appeals for exceptions to program policies, and quick shift checkouts to get out of the hospital for personal issues (usually with more handovers than the other residents).
They Have a Sense of Entitlement
Often seen with interns who are demanding with the nursing staff, beware of the resident who utters the phrase “because I am the doctor.” Fortunately, this behavior is usually crushed by EM nurses. If you are a resident who thinks you deserve special treatment, think again. EM is a team sport.
They Aren't Self-Sufficient
All interns need a lot of support and nurturing, but at some point residents have to become self-sufficient. It means creating solutions and not always asking everyone else for the answer. This is often the critical point in a resident's training at which everyone in the program recognizes that he “gets it.” It's fine to ask your support staff to help carry out your plans, but you need to be the one who makes the plans.
They Cling to Personal Wrongs
Relatively small slights in picking up charts, procedures, administrative duties, nurse staffing, nursing home “dumps,” consultants, borderlines, and a number of other variables go on their running tab of “why my life is harder.” Yes, complaining about patients who do nothing except complain is understandable. But it will wear down everyone else around you if you are always listing grievances about your job and life.
They Are Seldom Satisfied
Residents deserve to be treated equally, but one or two in each class always dissects every schedule to see which residents might be getting an advantage over them. They use this as leverage to pursue what they want and subsequently ask for fewer clinical hours and night shifts and as many weekends off as possible. All of this becomes readily transparent not only to the chief residents who make the schedule but also to everyone else in the program. Complaining about schedules is a quick way to get noticed by all of your peers (but not for the right reasons).
By now you might be thinking that I consider a lot of residents to be whiners. But as a group, they are the most wonderful people I have ever met. I am grateful to work with them, and I have at one time or another exhibited all of the character flaws I listed. In the end, a program's staff have to remember that new residents are glorified graduate students with little experience in real-life issues. After years of competing with their classmates, they must now work with a small peer group in a highly intense environment. It's not easy, and everyone will be selfish and high-maintenance at some point during residency. It is the attendings, nursing staff, and older peers who must force each resident really to see himself, warts and all.
No one likes to be criticized, but this is part of residency training and life as a physician. Patients, nurses, administrators, peers, and consultants will take swipes at you behind you back, online, and to your face. It's natural to deny or justify your actions. But once in a while, try to reflect on the idea that some of the criticisms may be true. It stings a little, but it will make you a more reasonable person and help you avoid the high-maintenance tag.