Lessons of residency extend beyond the technical

Urology Times JournalVol. 46 No. 04
Volume 46
Issue 04

"In order to complete our transformation into urologists, we must learn to understand and respect the multifaceted importance of responsibility for our patients, our teachers, and our mentees," writes Nirmish Singla, MD.

Nirmish Singla, MDDr. Singla is chief resident of urology at the University of Texas Southwestern Medical Center, Dallas. Urology Times blogs present opinions, advice, and news from urologists and other urology professionals. Opinions expressed by bloggers are their own, and do not necessarily reflect the views of Urology Times or its parent company, UBM Medica. Please let your voice be heard by joining the conversation in the comments section of each post.


The shift that occurs during medical school from the classroom to the clinical setting undoubtedly marks an important transition. The radical change in the learning environment is perhaps most apparent in that we no longer rely solely on textbooks and lectures to acquire knowledge, but rather contextualize the clinical questions that we encounter daily and integrate the dynamically evolving body of literature into the care of patients.

Beyond redefining the approach to learning, this transition also symbolizes a shift in our primary focus from ourselves (the student) to the patient. No longer is our education simply centered on passing examinations and advancing to the next career stage, but rather on improving outcomes for the patients we encounter and treat.

Also by Dr. Singla - Life after residency: Is a fellowship in your future?

While medical school serves as a transition point, residency is a transformation. In the 5-6 demanding years that it takes to become a board-eligible urologist, we learn the foundational knowledge of a unique specialty, how to answer consults effectively, how to counsel patients based on the latest research in our field, and how to operate as surgeons and perform procedures skillfully. In short, we learn the skills needed to become a practicing urologist.

The value of responsibility

Aside from the technical aspects of training, residency offers many lessons along the way. There is a particular maturity that develops throughout residency that extends beyond the curriculum.

Now in the final year of my own residency training, perhaps the most important lesson I have learned is the value of responsibility. This may seem obvious at first glance, as patient care sits at the core of shared responsibility for the health care team.

As a chief resident, though, I have come to appreciate that responsibility assumes many forms and should not be underestimated. Understanding the meaning of responsibility is crucial to effectively transition from a trainee to a urologic surgeon.

In the context of patient accountability, it is worthwhile to revisit one of the basic tenets of medical ethics frequently cited: Primum non nocere, or first, do no harm. As surgeons, and particularly as surgical trainees, we must respect the privilege that we have been granted by our patients. They entrust their lives to us and surrender their bodies to allow us to operate on them to our discretion.

As trainees, we are indebted to these patients for supporting our surgical education and enabling us to learn from them. We must further respect the legal liability that our attending surgeons are willing to risk for their patients in order to provide us with education and train the next generation of urologists.

In return, we owe it to both our patients and our teachers to assume full ownership for our patients’ care and well-being. This means not only reading about, practicing, and preparing for operative cases, but also ensuring medical optimization for the operating room, paying attention to details in postoperative management (eg, intravenous fluids, thromboembolic chemoprophylaxis, social issues) and feeling a sense of personal accountability when complications arise.

In hospital settings where immediate supervision is less direct, resident autonomy may be celebrated but comes with even greater responsibility. In such settings, perhaps more important than learning how to operate is recognizing when not to operate in the interest of upholding the principle of non-maleficence during the evaluation and counseling of patients.

Next - Promotion to chief resident: Paying it forward


Promotion to chief resident: Paying it forward

Promotion to the chief resident year comes with yet another form of responsibility, in that we inherently become responsible for our junior residents and medical students. We assume the guise of leaders and role models for our mentees and transition into teachers-in conferences, in the clinic, on rounds, and in the operating room. I have gained an increasing appreciation for the patience that my own mentors and attending surgeons have demonstrated for me, and now I have the opportunity to pay the debt forward.

Read: Visiting professorships offer unique benefit to residents

By assuming the administrative responsibility of distributing operative case assignments among residents and dictating the content of educational conferences, I share the responsibility of ensuring that junior residents are progressing appropriately in their training.

Indeed, the journey to become a urologist has taught me several valuable lessons that extend beyond the curriculum found in our textbooks. Certainly, the knowledge and technical skills that we learn as trainees are imperative for clinical practice. However, we must also learn to appreciate the privilege that we are gifted as physicians and surgeons. In order to complete our transformation into urologists, we must learn to understand and respect the multifaceted importance of responsibility for our patients, our teachers, and our mentees.

More from Urology Times:

How to command patient trust while building experience

Consider Choice E: Effective learning during residency

Quality improvement: Why residents should get involved

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