Another thing I’ve noticed since being in the ER and seeing more of how medicine residents work is the different amount of responsibility surgery and medicine residents have. I used to wonder, as a medical student, why even the youngest surgeons seemed more confident than medicine interns, and even than many medicine seniors. Was it the nature of the people who chose the different specialties, or something about the training?

The major decisions about patient care seem, at least at this program, to be handed down to the medicine residents from the attending: The patient will be admitted. You will use thus-and-such medications. Whereas for the surgery residents, we’re the first to hear about and evaluate new patients. The attendings expect to get accurate and reliable information from us, and they give weight to our suggestions about whether the patient needs to come in or not, to have antibiotics or not, even to have surgery or not. I think I’ve changed more in this regard than the medicine interns have, from where we both started as students. For medical students, although you can try to figure out what the plan is going to be, you’re quite often wrong, or totally out of your depth, and it doesn’t matter much anyway. That was how I started the year. I could collect data, but then I would wait for my seniors to tell me what to do with it. They didn’t appreciate that, and pushed me to act like a doctor: don’t just say what the facts are, say what you want to do about them. Now, only six months in, I’m used to approaching a situation with the goal, not only of finding out what’s going on, but deciding what I think should be done about it. For now, I still check most of those decisions with senior residents before acting on them. But I know that in six months, I will be expected to act on a lot of things without checking with someone else. It’s a different mindset. (And this is not to say I’m getting the right answers all the time; but I’m looking for different answers than I was six months ago.)