• Shyam Murali

Reflection on the First Day of Residency - E Chin Mak, MB BCh BAO

Updated: 5 days ago

Our newest interns have hit the ground running on their various rotations in the hospital. They have surprised the senior residents and attendings by learning quickly and showing immense compassion for our patients. E Chin Mak, PGY-1, describes her experience on her first day working in the Extended Treatment Unit (ETU, AKA Obs Unit). Check it out!

-Shyam Murali, MD, Editor-in-Chief


I’m not going to sugar coat my first day and say it went smoothly, or as expected even. It was tough. I constantly felt like I was suffering from pulmonary edema – I was drowning and overwhelmed by how new everything was. Everyone seemed to have it together, while I felt like I was constantly playing catch up.


To put things in context, I studied medicine in Ireland, and anyone who has studied in Ireland/UK will tell you that the social hierarchy of medicine is a steep one. As a medical student, I did not exist in the clinical arena – I was banished to the corner of the room to “learn” how it was done. I was invisible. My only job was to take histories, perform physical exams, and present them to a senior, who would then correct me on how to take better H&Ps and present my findings more clearly. I was never involved in the management patient care. If I had questions, they would be directed to someone senior to me, but never EVER the attending (or consultants as we call them there). I would not speak to, look at, or even breathe in the direction of the attending. As you can tell, this became confusing as I began residency in the United States, where not only is the culture of medicine a polar opposite, but I was also having to start formulating management plans and making clinical decisions for my patients.


My first shift was in the Extended Treatment Unit (AKA observation unit), in essence a floor medicine service – a rotation in which I have never had any actual experience in (surprising right? I wouldn’t count passive participation as actual experience). The work-flow was especially confusing for me, as the only real experience I have had was in the emergency department. I had absolutely no idea what my role was on the team and what I needed to do for my patients. I was reluctant to ask for help because of the culture of medicine I worked in as a student and for fear that my program leadership will wonder why on earth they hired me. After rounds, my attending asked if I was handling my work alright, to which I responded “yes”, as in my mind, “no” was an unacceptable answer. Later that day, he overheard me asking my senior resident for help and was surprised I hadn’t brought it up with him earlier. I was taken aback, as it had never occurred to me how different the culture of medicine was here. You mean, I can ask an attending for help? You mean, attendings will sit down and go through my charting with me? You mean, senior residents will take time off to guide us on our shifts? Unheard of – I would never dream about getting this much support in the past.


My point is, it was a rough shift and Day 1 will probably be rough no matter where you start, but having people who are willing to help made it much easier and much less anxiety-inducing. I suppose the feeling of being ashamed to ask for help will be a habit I need to unlearn, and I need to be patient with my learning curve. However, I’m so excited to get better at my job, I’m so excited to get my footing right, and I’m so excited to work around people in an environment that is supportive and encouraging. It’s going to be ok!



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