Every July, medical students become new interns, interns become second-year
residents, senior residents become fellows, and fellows become attendings.
The summer is a time of transition, a progression of the natural life cycle
of hospitals, clinics, and residency programs. Each stage feeds naturally into
the next, each phase of training builds upon the foundation of the previous
I remember starting as a pediatrics intern five years ago. I was so nervous
and unsure of myself as a doctor. I couldn't even dose Tylenol without looking
it up, and I practiced running codes on pretend patients. Then, when I had
become comfortable treating children with physical illness, I became a
resident in adult psychiatry.
While I could treat sepsis in a 3-month-old infant, I was lost with the
five men over 50 with schizophrenia whom I was supposed to be helping. Two
years later, when I had finally grown comfortable treating adults with
psychiatric illness, I became a first-year child psychiatry fellow. Many of
the medications I used were the same ones I had used to treat adult patients,
but in microscopic doses. My patients were so tiny, and their problems were so
big. Their parents looked to me for answers and advice, but it was a long time
before I felt competent to give them.
This past year, my first as a child psychiatry fellow, I spent most of my
time in the outpatient clinic. I had gotten to know all of my patients and
their families over the course of the year, and by June I felt comfortable
with and confident in the treatment that I was providing them.
But July 1 came around much faster than I anticipated, and suddenly I was a
second-year fellow, working on the inpatient unit. I was no longer comfortable
or confident, but instead unsure and somewhat confused. I was starting over.
It is exhausting to start over so many times. I feel a bit like Sisyphus,
pushing the boulder up the mountain, only to have it roll back down, again and
again. Every few years, as soon as I feel as though I actually know what I am
doing, my professional identity shifts and becomes something different,
something unfamiliar and foreign. This is not to say that it isn't
exciting—it is actually thrilling to move from one level of training to
the next, to feel more senior, even if only in title. I have to admit, I still
get a little rush every time I say, "I am Dr. Donovan, a child
Last weekend, I was "Dr. Donovan, child psychiatry fellow on
call," covering three different hospitals. I was paged multiple times,
by multiple people, all asking questions about small children. I amazed myself
by actually having answers. It felt almost instinctual, the answers just came
rolling out of my mouth before I could even stop to think about what I was
saying. I was surprised to realize that my brain had been storing information
I didn't know I had. I felt confident in my decisions and sure of myself as"
the child psychiatry fellow on call."
As a child psychiatry fellow, I am asked to play many different
roles—therapist, psychopharmacologist, pediatrician, parent guidance
counselor. Now in the last year of my training, I can look back at each phase
of internship, residency, and fellowship and understand how they all
collectively prepared me for this career.
I can see how each shift in professional identity was necessary to give me
the broad foundation I need to provide comprehensive treatment to children and
their families. And I am thankful that I was pushed to continue growing as a
doctor each year.
I understand now that as residents, we don't actually start over each July,
not from the beginning. We retain the knowledge and skills we learn over time
and build upon them. We assume new roles in July, a little big at first, but
we grow into them quickly. The boulder doesn't actually roll back downhill; it
is just a long hill to climb. ▪