The Peaks and Troughs of Residency: A Kinetics Metaphor for My Experience as a Resident
When I started residency, I was full of excitement and confidence that I would be able to conquer the chaotic nature of my PGY1 year. As a full-time pharmacy student, I had worked over 20 hours every week while maintaining a social life, so I felt I had a good foundation for the chaotic schedule and all the projects residents must juggle. However, despite this preparation, I did not expect to struggle with the shocking highs and lows of the residency year and the toll it took on my mental health. To compare my experience with pharmacokinetics, my peaks and troughs measured my confidence and self-worth. Throughout the year, they fluctuated, leaving me unable to achieve a steady state of mental health before I realized how much they were affecting me and the care I gave to my patients.
The Loading Dose
Within the first month of residency, I was doing pharmacy consults independently. This was one of the most rewarding experiences at the beginning of the year – it felt like graduating from a pharmacy intern to an actual pharmacist. The experience and independence boosted my confidence and self-worth. However, even though this “loading dose” of confidence carried me for a while, it was only a temporary bandage that helped me get through my first rotation of internal medicine before turmoil and self-doubt began to sprout inside me. These feelings and low points are what they don’t prepare you for as a pharmacy student going into a residency. As residents, our knowledge grows so much, but we don’t always consider the toll it takes on our mental health or the mental toughness we have to bring or foster quickly to make it emotionally through residency. Many of us as residents struggle with negative self-talk and imposter syndrome. We learn about these things in school but never stop to think about how they could affect our early careers as pharmacists.
I began to be incredibly hard on myself when I was unsure of or did not know something. I stopped providing recommendations to rounding providers and medical residents for fear of being wrong, even though they were appropriate care plans. Thoughts of self doubt such as “Why did I do this?” and “I am not smart enough to do this” ran through my head at least weekly. Some weeks, it happened daily if I felt I was not achieving the goals of the rotation to my preceptors’ liking or felt as if I had disappointed them with outcomes during my rounds. When preceptors identified drug therapy problems and recommendations that I had missed on rounds, instead of using it as a learning opportunity and an area of improvement and growth, I was hard on myself for missing things, directly comparing myself with preceptors with years of experience. I began to develop symptoms of imposter syndrome, thinking I matched with my program by luck and everyone was just trying to be nice to me when they complimented any work I did or said I was doing great. I began to feel undeserving of the residency experience and a burden to my preceptors. My confidence and self-worth trough were undetectable. My small victories were overshadowed by negative thoughts. As the year progressed, I early-committed to a PGY2 program in emergency medicine, but felt as if the group of preceptors I interviewed with must have pitied me and that this was the only reason I got the position.
I did not realize how poor my negative thoughts and mental health had gotten until my critical care preceptor pointed out to me, “You can’t know all this – you are a brand new pharmacist; I have several years of experience on you. You are exactly where you should be.” At this very moment, I finally realized that all those negative thoughts were just that – negative thoughts. I began to speak with my co-resident and other friends completing residency, and they all could recall similar experiences, whether they were as bad as or worse than mine. I was no longer alone, but it was going to take more than that realization to achieve my steady state of mental health.
After this revelation in my preceptor’s office, I began to realize that I needed to be kinder to myself and stop comparing myself with others. This is a daunting task because pharmacists often identify as type A perfectionists, competitive in nature. I began to build back my confidence and get excited when I made recommendations, no matter how small. The way I viewed my learning and education in residency changed tremendously. Rather than always needing to know the answer to every question, I just needed to know where to look for it. Every recommendation or question my preceptors posed to me that I did not know the answer to was for my benefit and growth, not for belittling me. I worked to minimize the time that negative thoughts sat on my mind and began reflecting on how much I had grown over the past year. Slowly, the “peaks” of my residency year became more apparent, and my mental health grew in positivity. The negative thoughts and feelings at times were still there, but I knew that’s all they were – thoughts and feelings. No matter what happens, there will be low points in residency training; however, they are part of the growth process – not meant to discourage you from doing and growing in something you love.
To conclude, here are the main things to note. (1) Comparing your knowledge with that of your preceptors will be discouraging, so look to them to identify areas of growth and opportunity. (2) Residency is a year of experiences and exponential learning that inevitably come with stressful times. While asking your preceptors and coworkers to give you feedback to improve your performance, you can also ask for supplemental doses of things they think you are doing well. This will help with your own internal monologue and view of yourself and may also help keep those imposter syndrome–type thoughts from creeping in. (3) Finally, and most importantly, other residents also feel they are struggling. You are not alone in the feeling, even if you don’t feel like anyone else is there alongside you in this.
About the Author:
Emily Griffith recently completed a PGY1 pharmacy residency at MercyOne Medical Center and is now a PGY2 emergency medicine resident at MercyOne in Des Moines, Iowa. Emily received her Pharm.D. degree in 2021 from the University of Iowa. Her clinical interests include emergency medicine, critical care, and toxicology. She enjoys traveling, listening to podcasts, and shopping.
Disclaimer: The thoughts, views, and opinions expressed in these articles are solely those of the author(s), and do not necessarily reflect the views or opinions of the American College of Clinical Pharmacy (ACCP). These articles are provided for informational purposes only, and should not be construed as medical, legal, or financial advice. This information is intended for a clinical pharmacy audience, but is not a substitute for professional judgment. ACCP disclaims all liability regarding any actions taken or not taken based on this information, including impact on patient care and the decisions made by the individual providing care. Reliance on any information provided on this site or any linked website is solely at your own risk.