Resident Spotlight: A Family Medicine Resident’s Perspective

Medical students and new interns most burning questions to residents of every specialty.

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Paulius Mui – Resident Spotlight: A Family Medicine Resident’s Perspective (#001) statnote

Today’s guest is a family medicine resident about to finish his internship in the middle of a pandemic. He is passionate about rural medicine and medical education. He is also the co-founder of Table Rounds, a card game to discover hidden connections in medicine. Find the episode highlights and notes here. This episode is sponsored by Chartnote – Expedite your Medical Documentation. — Send in a voice message: https://anchor.fm/statnote/message
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Paulius Mui

Family medicine resident, Co-Founder of @tablerounds, passionate about #MedEd.

Find him on Twitter @pauliusmui

What is a typical day like as a family medicine resident?

Variety in many forms is a constant in residency, but there certainly is a rhythm to the routine. The following is based on my experience as a first year resident and applies to most days of the week.

Inpatient rotations start with signout at 6am followed by a morning didactic session, then rounding on patients, presenting or listening to lecture at an afternoon didactic session, and finishing the day with admissions and floor coverage until signout at 6pm. 

My longitudinal outpatient family medicine clinic is on Wednesday afternoons where I see patients for acute complaints, new patient appointments, and follow-up visits. 

While the structure to the day is somewhat predictable, each day feels truly unique because the breadth of our training requires us to see patients of all ages with any imaginable complaint. A day can include doing a lumbar puncture on an infant for a sepsis work-up, discharging a cancer patient to hospice, adjusting anti-depression medications for a pregnant patient, and doing a sports physical for a teenager. 

As family physicians, we may not be the clinicians who ultimately “fix” somebody by irradiating their cancer or removing their inflamed gallbladder, but we will be the constant person in our patients’ medical journeys. By choice, we don’t have the luxury of not paying attention to a health concern because no body system or organ is outside of our scope. I love that part about my training. Our depth of knowledge is not like that of the specialist colleagues, but we certainly have the depth of relationships with each patient. Every patient has a story, and I am lucky to be part of it.

What should a medical student look for in a residency program?

Finding where you will fit in is the most important and difficult part of choosing a residency program. As we go through medical school, and as we go through life, we get to know ourselves better. I think those students who have dedicated time to reflect on what matters to them will be able to recognize the “gut” feeling when a program feels right. 

Spending some time with future co-residents is invaluable and can fill the gaps of knowledge about things that are not posted on residency websites. To me, it’s the things in between the lines that make all the difference. 

I also think many people choose programs based on the location so figuring out whether an urban, suburban, or a rural location feels more like home is a good starting point.

What daily practice have you developed to consolidate and develop your clinical skills and knowledge?

My patients are my guides to what I read about. I use their chief complaints and past medical histories as inspiration for what to review and learn about. I like to look for review articles on PubMed for whatever topic I’m looking up. If I need something less in depth, UpToDate is a good starting point. I make sure to pay attention to guidelines from different society organizations as some of the information on UpToDate is expert opinion and not absolute truth. 

I am a fan of medical podcasts like Curbsiders to get a detailed take on one topic. To my surprise, Twitter has been a rich source of multimedia case presentation and interacting with other learners.

What are the things you wished someone told you before starting residency?

I think that any residency program will teach you how to become a decent physician. I like to emphasize that it’s up to us to find a way to work on nurturing our humanity, curiosity, and all the stuff that matters in life outside of standardized curricula. My take is that if we don’t put effort into it, it’s not really going to be handed to us. 

What residency life hacks and tips can you share with med students and new interns?

I would recommend prioritizing your wellness because miserable residents make miserable doctors. Definitely suggest creating time to pursue things that excite you to get energy from them. It’s counterintuitive that exercising or working on a passion project during an already busy time can actually benefit you. Don’t these things require energy and time that’s so scarce? True, but I believe that the emotional satisfaction you receive from those activities fuels you for the next day and propels you forward.

Any EHR or medical documentation hacks?

I have been using Chartnote to fine tune my templates for common medical conditions. It’s an incredible tool, especially with the newly developed voice recognition features. I am also excited about being part of a collaborative community to share templates and dot phrases not only to become more efficient but also to learn from other colleagues. The assessment and plan templates actually can teach you a great deal about how other experts go about counseling and documentation for similar patients. I think the potential for this community is only limited by our own imagination. 

Somebody also recommended looking up templates in our EMR from other subspecialists as they tend to have great work-up templates for most things we consult them for. Lastly, I have not used Stepwise yet but it seems like an interesting tool to speed up placing orders and writing notes through algorithms. 

What books, apps and resources would you recommend for med students and interns?

I think the best resources are the ones that work for you. You’ll have to experiment with what sticks and what your program might have available in your team room. One of my aspirations is for every resident lounge and medical student team room to have a copy of Table Rounds.

Disclaimer: I am 100% biased towards your wellness and that’s why I created this game with my medical school friends. 

It’s a card game that allows you to discover medical knowledge by playing with your peers and faculty. If you’re curious and want to know more, check out my interview on The Short Coat Podcast where I explain the “why” and demonstrate how the game works on air.

I highly recommend the following apps to family medicine residents:

  • USPSTF for health maintenance; 
  • AAFP Shots for immunizations;
  • ASCVD Plus risk calculator for cardiovascular health risk stratification;
  • WikiEM is great for a simple reference, especially when working in the Emergency Department; 
  • Sanford Antibiotic Guide has an interactive antibacterial spectrum;
  • GoodRx to get a sense of drug pricing locally;
  • MDCalc to help with medical decisions through lots of medical calculators;
  • Not an app, but BiliTool website for peds.

For reference books, I mostly used The Harriet Lane Handbook and The Red Book on my pediatrics blocks.

I am into podcasts and here are my top 5 recommendations:

Bonus: for EM content, I loved listening to EM Clerkship to brush up on acute care.

Believe it or not, I think Twitter can be a fantastic resource that gives you the “social media” dopamine rush. Make your neurochemistry work you and learn stuff along the way! Explore popular hashtags like #MedEd #MedTwitter #NeuroTwitter #Twitter #NephroTwitter #DermTwitter to find incredible educators that you can learn from. I also suggest following these accounts: @MedTweetorials @TableRounds @rabihmgeha @tony_breu @medrants

How did the COVID-19 pandemic affect you and your residency experience?

I think finding time to socialize in residency is already difficult at baseline and not being able to hang out and get to know my co-residents outside of work has been the most challenging part. We’re all together in this and I’m hopefully that things will change for the better in the coming year. 

It’s also somewhat surreal caring for patients with COVID because as a medical student I was not allowed to be on clinical rotations during the height of the pandemic so it always felt like it was “on the other side.” Now I’m on the same side as people who are suffering from its very real impact and sequelae. 

What has been the most challenging part of residency so far?

Way more paperwork than I did as a medical student. My least favorite part has been to chart in front of patients as it’s often the only solution to being efficient in the clinic and not having to stay after hours. Having time limits on visits is a fact of real-world medicine, but it’s still challenging. Especially when significant decisions that can literally alter a person’s well-being need to be made under a time crunch. I’m still learning how to adapt to this mindset.

Another challenging experience is learning about the side of medicine that I had little exposure to as a medical student. For example, seeing patients get discharged from the practice for reasons beyond my control and not being able to care for them after forging a common bond. It’s heartbreaking and not a pleasant part of medicine, but it exists and finding a way to cope with it is challenging.  

What are your plans after residency?

I am drawn to places where medicine is scarce and that is one of my motivations for pursuing family medicine because it prepares physicians to tackle most of the acute and chronic illnesses. I will likely find a new home in a rural community that needs a doctor but does not have one. 

At the very beginning of my medical training, I published a paper about the impact on rural area residents when their local physician leaves. As I advance through my career, I hope that my experiences inform the flip side of this issue: the impact of having a new physician in a community without one. I can’t quite foresee all of the details, but It’s an exciting journey ahead!

One possibility is exploring locum tenens opportunities across different parts of the country and to be able to work in different types of practice models to discover what I would ultimately enjoy. 

Besides my clinical responsibilities, I enjoy academic medicine and research and hope to stay connected to medical students and residents no matter what I do. I’ve been lucky to have had amazing mentors that have shaped my career and it would be a privilege to pay it forward.

Lastly, I am curious to see how my interest in entrepreneurship will complement what I will be doing. There are so many aspects of the medical world that could be improved, anything from our current medical education paradigm to the way patients receive care. In my opinion, creating something that not only fills an unmet need, but carries longevity through sustainability in the marketplace is a cool goal to pursue.

Interested in sharing your story? We are looking for NPs, PAs, residents and practicing physicians from different specialties who want to tell us more about how they thrive in their professional lives. Reach out for more info.

Discover Chartnote – We are passionate about preventing physician burnout by decreasing the burden of medical documentation.

About Chartnote

Chartnote is revolutionizing medical documentation one note at a time by making voice-recognition and thousands of templates available to any clinician. We know first-hand that completing notes while treating patients is time-consuming and an epic challenge. Chartnote was developed as a complementary EHR solution to write your SOAP notes faster. Focus on what matters most. Sign up for a free account: chartnote.com

Posted on: May 5, 2021, by :

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