The Attending-Resident Relationship

Paul J Kim, DPM Assistant Professor, Arizona Podiatric Medicine Program, Midwestern University College of Health Sciences Glendale, Arizona

There are multiple reasons why the attending-resident relationship is important. The primary reason for this relationship is to train the next generation of physicians/ surgeons in the practice of medicine and surgery.  This involves teaching/learning surgical techniques as well as managing patients perioperatively.  This relationship allows for the transfer of knowledge and experience from the attending to the resident.  Ultimately, the sum knowledge and skills from all of the attendings are integrated into the resident prior to the completion of their training. 

The cornerstone of this relationship is "trust".  The attending trusts the resident to make prudent medical and surgical decisions on the care of their patients.  The resident, in turn trusts the attending to deliver their knowledge and experience in an environment that is conducive to learning.  When this trust is compromised, the relationship no longer fosters the transfer of skills and knowledge.  In this context, the attending and the resident both feel undervalued and underappreciated and the relationship dissolves with bad feelings.

Since it has not been very long since I was a resident and now work as an attending, I have gained some insight into the attending-resident relationship.  My perspective as a resident about my attendings is still fresh in my mind and I held some strong feelings regarding them.  Now that I am the attending and have residents working with me, my sentiments have changed somewhat.  I have always had the intention of working with residents, but the reality of the situation has modified my views, both positive and negative.  I have colleagues who have chosen not to work with residents as well as those who seek them out.  By the nature of where I work, resident training is a natural extension of my professional obligations.  Hence, by default, and maybe not by choice, I have trained residents the last couple of years.  Below are some of my thoughts and observations as seen through the eyes of a resident and an attending.

Resident Perspective "I am here to learn as much as I can from whoever will take the time to teach me.  I am capable of learning new skills and listen to the knowledge conveyed to me by my attendings.  However, I sometimes feel intimidated, treated disrespectfully, and overworked.  When I feel bullied or intimidated in the operating room, I do not perform at my best.  This gives the impression that I am not competent, but I am competent if provided the environment to showcase what I can do.  Although I have a lot to learn, I already know a lot, sometimes more than some of my attendings.  Give me the freedom to make mistakes and don’t hold it against me when I do make mistakes.  I will learn from these mistakes and this will make me a better physician.  Hire a surgical assistant if you want someone to retract for you, don’t waste my time if you don’t want to teach me.  Don’t make me do all the scut work because I am free labor.  I especially don’t like it when you demean me in front of others to make yourself look good.  What am I supposed to learn from this?  Overall, respect how hard I work for you and once in a while a thank-you would be nice." Attending Perspective “I am here to teach.  I have a lot of real world experience, knowledge and skills to convey.  You may be up on the literature, but this does not mean that my methods are outdated.  I have learned through experience, which you do not have.  These are my patients, hence I am ultimately responsible for them.  If you make a mistake, this may be just bad day for you, but this can negatively affect my livelihood.  I have to explain your mistakes to my patients and their families.  Therefore, don’t get bent out of shape in the OR if I take over the case because I see you doing something wrong.  There is value to learning things that may seem mundane or routine to you like, retracting tissue, dictating operative reports, and post-operative management.  I have the benefit of perspective hence realize that these skills are of value and need to be ingrained.  Further, if I am taking the time to teach you, don’t show up 5 minutes before the case unprepared and expect to take the lead on the surgical case.  I know much more about the patient and I feel no obligation to allow you to do the case if you don’t have the professionalism of being prepared.  Overall, you don’t have to like me, but respect me for my experience."

 

There is an underlying written or understood contract that the attending will teach and the resident will learn.  This paradigm has been utilized in medicine and all skill related trades for thousands of years, hence has stood the test of time.  Often, the relationship evolves to a mentor-mentee relationship that endures beyond the completion of training.  I have been blessed by having attendings that have honed my surgical skills and shaped my clinical acumen.  I still keep in touch with some of my attendings, although the relationship has changed, my respect for them has not.  As a resident, I thrived on the attending encouragement and patience which propelled me to work harder and to be more committed.  I credit select attendings for my daily effort at being a better attending.  I hope that I can make a small impact on the attitudes, skills, and knowledge of the residents that I have the privilege of training.  My wish is that this diatribe gives some perspective on the attending-resident relationship and that each comes to a better understanding of the other.

###

 

Please write in with your thoughts and comments on Dr. Kim's editorial. Don't forget to visit eTalk on PRESENT Podiatry and start or get in on the discussion....we'll see you next week. Best wishes!

John Steinberg, DPM
PRESENT Editor
Assistant Professor,
Department of Plastic Surgery
Georgetown University School of Medicine
[email protected]

 

---

GRAND SPONSOR

MAJOR SPONSORS