EM Mindset:  Physician Wellness – A Resident’s Perspective on Surviving in the ED

Authors: Michael J. Burla, DO (EM Resident, Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI) and Danielle E. Turner-Lawrence, MD (Oakland University, Department of Emergency Medicine, William Beaumont School of Medicine, Rochester, MI) // Editors: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)


After graduating from medical school, I don’t think you truly know what to expect as you embark on residency.  Sure, you have spent countless hours studying, taking tests, completing clinical rotations, and grasp that your medical training is a marathon and not a sprint.  Once you start residency reality kicks in, and your responsibilities exponentially increase and it feels a bit like you are out of breath.  This transition is difficult because there is no weekend retreat to prepare you, and there are no medical school courses that truly emulate residency.  This isn’t a knock on medical schools or preparation; I just think it isn’t something you can completely prepare for.  In order to be successful, you must be immersed in it.  You must be in the thick of it to know how you function under stress, or when you are sleep-deprived, or when you have discovered gaps in your medical knowledge during a critical situation.  If one is unable to adapt to the strain of residency, it can affect one’s wellness, and ultimately, affect the development into a functioning physician.

It’s important to focus on your own wellness early, especially during the rigors of residency.  Even the American College of Emergency Physicians (ACEP), among other professional organizations, has made steps to recognize the high level of burnout in our specialty, and the need for wellness promotion.  I can only speak on my own observations that have contributed to my wellness and success in residency, but perhaps sharing these may be informative to others.

Expectations and Work Environment

As an intern in your first few months of residency, you are just trying to stay afloat.  You are trying to juggle studying, shift work, family, exercise, and social life.  It’s a challenging adjustment; the whole dynamic of your day has changed.  For example, how do you work a night shift, attend morning grand rounds, and then switch back to mornings or evenings?  Finding time to sleep can be difficult, but is certainly necessary to function successfully.  Not only has lack of sleep been shown to have a negative impact on our own wellness1, it has a negative impact on how we perform as residents2.  During residency, I have always made getting the sleep I need a priority, which has contributed to my overall wellness.  Early in my career, I began to schedule and plan for my sleep, timing out how much I would need to feel refreshed and effective.  If I still felt overly tired, I would allow myself to sleep, as simple as that.

Saying that expectations dramatically increase once you become a resident would be an understatement.  Shouldering the responsibilities of being a patient’s provider, learning to assume real ownership of your patients, and talking about difficult topics or breaking difficult news are skills that are acquired through practice, but expected early on.  On a daily basis we deal with stressful situations, for which we need to be cognizant about how we adjust our mental well-being.  Just like planning for sleep, you need to have planned for how you will decompress after a stressful shift. It is important to have a form of metacognition, when approaching how we function in and out of the ED.  It is increasing more common that residency programs have an orientation month to help integrate new residents3, but developing healthy mental habits individually extends beyond this, and quite frankly isn’t fully realized until after a single introductory month.

I think the key to true wellness as an EM resident is to allow yourself to be positive and to practice resiliency.  To not let others, whom may or may not be having a bad day, affect you, and if they do, figuring out how you can quickly bounce back. Choosing to be positive and relaxed is a mindset that, for many of us, requires a purposeful decision.  A great example of this might be how you can positively interact with a rude patient.  Recognizing that you cannot control who that person is or what they have been through, but knowing you can control how you feel about your interaction with them is important.  I know it is easier said than done, but LEARNING to depersonalize these types of interactions goes a long way.  Their actions are not a reflection of you, but rather of their own situation or persona.  This applies to interactions with drug-seeking patients, demanding patients, difficult staff, or consults.  These entities could affect your work environment if you let them, but they don’t have too.

Despite your best efforts, sometimes you won’t be able to avoid these types of stressors or feelings. A great way to decompress if some of these stressors start affecting your mood is to take five minutes to yourself.  If able, take a walk out of the ED, or even just your area, to clear your mind and refocus on what is important.  On a granular level, I often will grab a cup of coffee, focus on the taste, or even step outside and get some fresh air to gain my center.  Focusing on simple sensations such as soothing smell or a cool breeze is a form of meditation, and can help clear your mind.  Clearing your mind on a daily basis can help improve your overall focus with daily activities, and ultimately improve your well-being.

Life Outside of the ED

Even though you attempt to embrace wellness during residency, the time and mental commitment can encroach on your personal life.  Recognizing this factor is an important aspect of managing expectations.  One phrase that my wife (who also happens to be a resident) and I like to say is, “I can do anything for a month,” which I think resonates with a resident lifestyle.  Some rotations are difficult, some are easier, but all of them only last a month.  A good way to approach these ups and downs is to expect them, remembering that expectation management is key.  I like to think of residency as a “physician boot camp,” where our time needs to be mostly dedicated to training to become a competent physician.  I think accepting this reality allows one to put priorities in perspective.

Getting better at planning helps.  Getting into the habit of knowing when your free time may happen and scheduling your plans helps.  Free time is a precious commodity during residency, and the more one is organized about one’s time, the more efficiently time gets utilized.  For me, even utilizing my electronic calendar on my phone has helped with planning.  Not only did I plan in concrete events such as shifts and meetings, I section of specific time to take care of tasks that I would potentially forget about or not make time for innately.  Another great resource for improving time management is asking your senior residents and faculty for advice.  These are the people who have or are currently going through the wringer with you, and probably have the best insight on how to balance your personal and professional life.

Lastly, one key factor that I cannot stress enough is the development of comradery with your fellow residents.  Many residency programs promote this agenda4, 5, however I think it is essential that the resident body puts effort into this.  By making an effort to hang out after a shift, plan a time to go out, or even just lunch after lectures, I’m contributing to building a framework of coworkers and friends that are moving through the same obstacles.  Any opportunity to connect with your fellow resident and share similar experiences or angst about residency can help.  When you all have a common goal in mind, to successfully thrive in residency, you tend to support each other during difficult times.

Final Thoughts

Overall, wellness is a state of mind.  As I sit here writing, I have just a few weeks before graduating.  While residency was by no means easy, I reflect positively on my experiences. Adaptability and expectation management was a huge part of why I had a positive experience and learned to be resilient.  My biggest take away is that you need to purposefully have a positive outlook and the mentality that you are in control of your wellness.  The more one practices this mind set, the more effortless it becomes.  Being happy, for the most part, is a choice we make.


References/Further Reading:

  1. Min AA, Sbarra DA and Keim SM. Sleep disturbances predict prospective declines in resident physicians’ psychological well-being. Med Educ Online. 2015;20:28530.
  2. Papp KK, Stoller EP, Sage P, Aikens JE, Owens J, Avidan A, Phillips B, Rosen R and Strohl KP. The effects of sleep loss and fatigue on resident-physicians: a multi-institutional, mixed-method study. Acad Med. 2004;79:394-406.
  3. McGrath J, Barrie M and Way DP. Emergency Medicine Resident Orientation: How Training Programs Get Their Residents Started. West J Emerg Med. 2017;18:97-104.
  4. Schmitz GR, Clark M, Heron S, Sanson T, Kuhn G, Bourne C, Guth T, Cordover M and Coomes J. Strategies for coping with stress in emergency medicine: Early education is vital. J Emerg Trauma Shock. 2012;5:64-9.
  5. Lefebvre DC. Perspective: Resident physician wellness: a new hope. Acad Med. 2012;87:598-602.


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