 So as I'm making of this episode, I'm officially just one week away from graduating internal medicine residency. If you're not familiar, residency is essentially the process after medical school. And for me, it was three years of essentially working for a fraction of a doctor's salary and super long hours and just grinding. But I enjoyed the process so much. And this is really just my heartfelt collection and documentation of what the process is and sharing my lessons. Hopefully you guys on the other side, they're going through this experience yourself can find some benefits and lessons that you can take away too. So let's get into it. Number one, focus on making a difference and not necessarily a mark. I feel like in my training, I found two kind of groups of people, some who just wanted to coast and get through the process and not necessarily feel like they had to be memorable to their patients, their colleagues, et cetera, to the program. And on the other side, I found people who just feel like they necessarily needed to do the next biggest thing during their training and during the process of residency. But one of the biggest things that I've learned over the past three years is like, no, you don't actually have to focus on making a mark where people remember your name. That shouldn't be your goal. You should be focused on making a difference, a difference for your patients, a different for the colleagues around you. I feel like it's a personal failure. If there's things that I know I do well, for example, I know I'm efficient. I know I have a calm demeanor and overall, I think I have a good patient report. Those are skills that I built throughout medical school and residency. But I think it's a personal failure if I don't focus on teaching my interns, my medical students and other residents how I do this. I don't necessarily need to make other trainees do things like I do. But if I found those important aspects of medicine easier because of things that I've learned, things that I've experienced, then it's important for me to pass it on. So make sure you're focused on making a difference for your patients, your trainees, your attendings, your co-residents throughout the process, because you're going to learn things and behave in certain aspects where other people just wish that they could be like you. There are people that can do procedures just so confidently and so calmly that I wish that I could have that level of composure. And so again, I need to have them rub off on me. Ideally, I need to make a difference in other people's lives, the things that I do well. So again, you don't have to make a mark, but do focus on making a difference. Number two, your best friendships will come out of residency. I think every step of the way, whether you're going through high school or college or medical school, you think that that group of friends is going to be the one that is going to be like different. You know, when you go through high school, you're like, this is my crew. And then you get through high school and you rarely talk to your high school classmates. You go through college and you're like, this is going to be my crew. And then you get to medical school and saying, those people have nothing to the camaraderie that I have with my medical school classmates. When you get into residency, you are essentially working the gauntlet and grinding with the same people for three years. Imagine as you are studying for step one or any board exam, essentially for three years continuously, working long hours, taking care of patients, really putting other people in front of yourself and your own preservation, particularly now in the time of COVID, those people become your bread and butter of who you want to spend time with all the time. And without a doubt, the people that have impacted my life the most have easily come in these past three years of residency. So when you go through the process yourself, remember that, understand it and try to make those relationships as strong as possible. Number three, you begin to love what you're good at. Now, often there's a question of, I don't know what I should be doing in medicine. The same question comes across in medical school where you're not served with specialty to go into. And then once you pick a specialty like internal medicine, you may have other choices. If you do ortho, you're not sure if you do spine or hand or plastics. If you do internal medicine, you may want to do cards or GI or go to hospital as general medicine. There's so many choices. And people are always asking early on, how do I make that decision? But really from personal experience, I feel like the decision of what things I should go into just kind of come by themselves. And the reason is that you tend to start liking the things that you become good at. So for example, if we take a person that is thinking about going into cardiology, you may ask them like, did you always want to go into this field? They may say yes, but really what actually happened to this person is they may have taken care of a patient with a cardiology problem, such as heart failure or like an arrhythmia. And they didn't know what to do at first, but then they looked it up or somebody taught them and it made sense. But the next time they saw the patient with the same problem, they already knew the first two or three things to do. Maybe they forgot a thing here too, but they felt confidence that, cool, this is a problem I can take care of. Now the third, fourth, fifth, sixth time, and somebody with heart failure or an arrhythmia comes around, that person is going to feel excited. One, because they think they're interested in the field, which they will be, but mainly it's because I'm good at this. You know, we get excited for doing things that we're good at and scared for the things that we're terrified or don't have too much experience. So if you're thinking about what should I go into, you will find those problems that you will admit at 2 a.m. And some of them you're gonna be like, cirrhosis again. And that's because maybe you just haven't taken care of enough of those patients, but you're gonna say something like, oh arrhythmia, a-fit, I love this. I've seen it so many times. I'm down, it's 2 a.m. admission, but I got it, it's gonna be easy. Those are really what help you make decisions on what specialty you go into. So don't get too focused on making a decision of what the right specialty for you is. Often, again, those decisions will find you because you will find that you'll start loving the things that you get good at as more experience and repetition happen. Number four, and this is a lesson that I wish I took to heart a little bit better, but key forcing yourself to learn even if it's at a slow rate. I'm a big believer, especially after three years of residency there, there are still topics that I wish I could have mastered and really the difference is I just didn't give myself enough time or actually any time to dedicate to them. But if I had just focused on saying, let's find a few articles or topics that you struggle with and looking at them on a daily basis, even if it meant reading an article that took me four days because I was really busy, but now saying, cool, I have learned something about this topic. Next time I take a patient with that, I feel more confident. There's a reason that those attendings I've been practicing for 10, 15, 20, 30 years are so brilliant and so smart is that some of them have still devoted their lives to learning something on a daily basis. I have some attendings that read 10 articles a day. Now I'm not telling you that you have to do that, but picking a slow pace where you can say, the goal of Ms. Career is to get better every time I go to take care of a patient. Find those things that you're struggling with or you have no idea what it's about or the things that may be interesting in like a new research study and just read those through a slow pace. Even if it's going through an article every two weeks, whatever that pace is for you, you're going to make progress compared to the other version of you that may not have done anything at all. Lesson number five and listen up because this is really what makes a good doctor, but pattern recognition is the art of being an excellent physician. When you're going through medical school, you're exposed to so much information that you feel like the smartest doctors are the ones that can retain that the best, but really the best doctors are the ones that can see patterns in a patient's presentations in their labs, the clinical findings in their stories and saying, given all this, this is the likely answer. This is the likely diagnosis and then also using pattern recognition of what management will lead to the most optimal outcome for that patient. When you're first starting as a brand new doctor, when I was first starting as a brand new intern, there were so many pages and with so many questions that I had no idea how to answer. But as I got through residency, it wasn't that I became smarter or I was easily memorizing things that I didn't memorize before. I just had a better ability of saying, okay, I see A, B, and C. When I've seen that last 10 times, it tends to be this. And my interns can't pick that up because they just haven't had that level of repetition. But once you have enough repetition, certain problems that a patient may have, just feel like clockwork on how to answer and manage them. You're just going to subconsciously know what to do. That's just because you've seen it so many times. But on the flip side, in going back to learning at a slow pace, the best way to improve your pattern recognition and thus your ability of being a great clinician is to identify patterns that you don't know the answers to or finding questions that you don't even know what patterns to look for. So some of my favorite ways of doing this is reading new articles on clinical cases and understanding like, oh, I missed how these could be related and could ultimately lead to this possible diagnosis or using free apps like the Human DX app or doctors across the world or sharing interesting patients and then asking you if you can figure out their diagnosis based off the information they give you. But I'll tell you from experience that my memory is not that grave and my ability to do repetition and focus on the lessons from each repetition is pretty strong and thus become a much better doctor starting over the past three years. And lesson number six that you don't remember the scores but you definitely remember the people. The nice thing about residency is that there's pretty much no scoring system. Aside from step three, you don't really take any exam that you compare yourself to your peers. The beauty of that is that now you can go through each day, focus on really just two things. Try to be a better doctor, try to take care of your patients. And the process of doing that is again, by learning but also being inspired and learning through the people that are around you, your peers as well as your attendings and your mentors and finding the aspects of medicine that they're better at than you are and trying to pick up just a little bit of nugget here and there and trying to use that in the future and ideally passing them down by the line. Now to end this episode, I really wanted to share a few things that are done differently in residency and hopefully you can learn from my mistakes because in addition to just documenting my journey and looking back at this a few years to see what type of things I picked up, there are things that I already know that I would have done differently. Number one, I would have spent more time with my colleague. Even though we spent a lot of time together and developed a lot of great friendships, I'm already nostalgic and reminiscing because in just a few short weeks, my wife and I are gonna be moving to a brand new city and may not see any of these people for quite some time. And so with hindsight being 2020, I wish I had cherished and found those extra opportunities to hang out with these people that will forever be lifelong friends. Number two, I wish I prioritized my fitness more. Now this is something I definitely started to do as my 30 year residency as I ran both a marathon and a half marathon over the past six months. But during my first two years, even though I was somebody who considered to be overly fit, I definitely let myself go in terms of not being as fit as I used to, particularly in medical school where things were honestly a lot busier. But if I had to do it all over again, I would have created some kind of routine even if it was at home workouts that would have made me a little bit more fit throughout the process because honestly, as a resident, you're typically sitting, writing notes, saying patience, not really moving very much. And then you're eating a bunch of hospital food that's not the most nutritious, not getting the most optimal sleep. So I would have focused on my mental health, my fitness a little bit better than I did, but that looks like it's changing over the past few months. But it's something that I've changed as I've transitioned more into running as I ran my first marathon. So hopefully as an attending, I'll have even more time to dedicate on those things. Number three, as we talked about, I would have read some kind of medical topic daily, either having a big kind of database of things that I wanted to read next, whether it be an article or review article, a video, and just going through the next thing on my list. You know, one tool that I use often is Notion. And if I had to do it all over again, I'd have probably just collected a big database of all the journals, all the videos, all the research articles I may have wanted to read. And then just taken 10 minutes on a daily basis and moved to the next one or finished the article that I was already working on. Cause again, a little bit, even if it's a slow pace, will improve your knowledge base, your pattern recognition and ultimately becoming a better doctor. And then finally, number four, I would have used my days off a little bit better instead of just focusing on getting more sleep and recovery, which is important. I would have made more personal progress in those other elements of my life as well as working on side projects which thankfully the MD journey has been one of them. But if there's one thing that surprised me about residency is that I had a decent amount of time on particularly in my second and third year, I wish I had used that time a little bit better to develop both my academic career as well as working on things such as my fitness and other side projects. But those guys are some of my biggest takeaways from residency, three years, absolutely crazy that is all over. I know some of you guys have been with me since I've been making these videos and these podcast episodes since medical school. So the fact that here now we're essentially at the finish line where in just a month I'm going to be a full-time attending. Just absolutely insane. But as always, hopefully these lessons and these takeaways help you on your journey. If you enjoy this one, you'll probably enjoy this episode on how to succeed in residency here, as well as feel free to check out our med school handbook which includes 30 tips that will actually just make medical school and residency process so much easier. That'll be linked down below. But as always, my friends, thanks for being a part of my crazy long journey. Residency is basically over. Hopefully I was a little help to you guys on your journey and I will see you guys in the next one. Peace.