PGY-2 Internal Medicine – McMaster University
I’m Laura Dawson, PGY-2 in Internal Medicine at McMaster University’s Waterloo Regional Campus (WRC) Campus. I’m from Kingston, Ontario, and previously completed a Bachelor of Arts, with a double major in Psychology and English
Why I chose Internal Medicine
In pre-clerkship, all of the content and culture of medicine that I found most interesting was linked to Internal Medicine: my favourite areas of study were Cardiology, Renal, Gastroenterology (GI), Neurology, Host Defense/Interpreting Lab Values, Professional Competencies (Pro Comp), and variations in patient acuity.
In clerkship, my keenness for the subject matter was added on to by a love for teaching (especially learning about the mechanisms of action) and rounds. I also found I really enjoyed providing symptom management and answers for patients on a daily basis that make significant differences in their lives and care – even if little can be done about their prognosis.
I found I continued to feel energized each day as I encountered more complex patients during my core rotation in Internal Medicine and routinely did not want to go home at the end of the day.
What kinds of rotations are required in your program?
Internal Medicine has mandatory rotations, as well as electives/selectives. The mandatory component of first year primarily includes:
- Clinical Teaching Unit (CTU) x 4 months/year
- Intensive Care Unit (ICU) x 2 months/year
- Cardiology x 2 months
- General Internal Medicine Rapid Assessment Clinic (GIMRAC)
- Neurology x 2 weeks
- Palliative Care x 2 weeks
The research requirement is one fairly large research project completed within the three years on a topic of your choosing, under a supervisor within Internal Medicine or within a subspecialty of Internal Medicine.
Which of your personality characteristics are particularly helpful in your field?
I am a very social person and gain energy from encouraging my team, bringing in snacks/coffee, providing answers to patients, and problem-solving as a team during multi-disciplinary rounds.
I like to be constantly mentally engaged, during the workday I enjoy that there is always something meaningful I can do in terms of problem solving, speaking with a patient/family, organizing a note, teaching medical students, or doing a procedure.
What are the best aspects of your residency?
The best aspects of my residency program are:
- We are very close-knit; being on a small campus with three new residents per year. We have become very good friends and supports for each other over the past two years.
- There is a plethora of opportunities to complete procedures and staff are always willing to supervise you and provide you with opportunities in the Clinical Teaching Unit (CTU) and ICU.
- The Internal Medicine and subspecialty staff we have here at the WRC campus are some of the nicest people I have ever met. When they ask me a question it is out of their genuine interest to teach me something, and not just to put me on the spot.
- This hospital community itself is quite close-knit. Residents’ names and faces are well known throughout Grand River and St. Mary’s hospitals, and are well respected.
What are the most challenging aspects of your current role?
I think for me personally the most challenging aspect of residency was having to work in Hamilton at the beginning of residency, where I was not familiar with the electronic medical records (EMR) or hospital processes.
In retrospect, (if COVID had allowed), I would have done more electives in Hamilton as a medical student to better familiarize myself with the hospital processes. This was truly the most stressful part of residency so far. We are required to work in Hamilton approximately 2–2.5 months per year in CTU.
I like to be constantly mentally engaged… I enjoy that there is always something meaningful I can do in terms of problem solving, speaking with a patient/family… teaching medical students, or doing a procedure.”
What is one question you’re often asked about your decision to pursue a non-clinical career?
“Would you recommend your residency program?”
If you are looking for a close-knit, hands-on program in Internal Medicine – this is your place! If you are looking for something in a particular niche subspecialty in which ‘showing your face’ is incredibly important in a particular location/discipline, make sure the campus you choose provides those opportunities. WRC does not have a subspecialty program in Kitchener/Waterloo for CaRMS 2.0, but their match rate for CaRMS 2.0 is phenomenal (including for subspecialties)!
Can you describe the transition from clerkship to residency?
Residents often say the learning curve is vertical from clerkship to residency. For the first four months of residency, I would have to agree. To be honest, it was much more mentally strenuous than even I had imagined.
Since I had started on my CTU core x 2 months there was a large focus on proving your knowledge and a tangible feeling of urgency to prove ourselves. However, this eased off quite dramatically as soon as those cores were over.
I think it was a combination of everyone’s imposter syndrome and desire to prove that we all deserved to be there. I cannot say that it was at all easy, but I made some amazing life-long friends in the other residents during that time.
What are your future practice plans?
Right now I am strongly considering a career in General Internal Medicine. I’m very fond of the practice, patient population, team environment, and the lifestyle. I like to be “on” when I’m at work and “off” on my days off. I enjoy writing consult notes and digging into histories.
So far, I have not found a subspecialty of Internal Medicine that grips my interest during the day as much as General Internal Medicine. I always think to myself, “I have found a job where I truly enjoy the work and environment, and I don’t watch the clock for the day to end”. I couldn’t ask for a better job than that!
What are your fellow residents like, how do you interact with each other?
I absolutely love my fellow residents. Whether it is meeting up with them in the park for a picnic, lecture during academic half-day, or going for post-call waffles with some of the Hamilton residents while I am there – I could not have wished for better friends or more compassionate colleagues.
We have small group chats between us where we connect daily to bemoan our lack of sleep, talk about ways to investigate or treat a certain condition, send memes, and share holiday pictures.
What are your academic interests?
My primary passion is making sure that medical students and junior residents feel well supported, have practical resources for the wards, and get enough sleep!
I’ve been working on creating hundreds of PowerPoints presentations for this since medical school and get great pleasure sharing them with any students or residents to help them succeed while they are on the wards. Everything from how to treat hypertension or delirium on-call, to what to do if someone has a stroke in front of you. It also helps me learn the material when I get to make it to teach to other people.
In terms of research I have mostly focused on COVID research and a quality improvement study on time to patient discharge.
What is your work-life balance like, and how do you achieve this?
It completely depends which rotation I am on. On CTU, my work-life balance is limited by the increased work hours, so I make sure to go for post-call brunches, coffee, and catch up with friends once a week, often over dinner.
My interests primarily lie in ‘the little things’ in life. I really enjoy going for walks with my husband, visiting family, going for coffee, painting rocks (free canvases!), and reading fantasy books.
I would be remiss not to mention I have an absolutely amazing husband who is similarly hard-working in the tech industry, and so we encourage each other to achieve our goals and rest when we need it. The best resiliency strategy I have is listening to my body when I need sleep, hugging my husband, and having a good group chat to check in on each other as residents. I also bought a fish.
Impact of COVID-19
RDoC recognizes the ongoing impact COVID-19 has had on residency. We wish to raise awareness of its effects on residents’ day-to-day lives.
How has COVID-19 impacted your required rotations (clinical, research)?
As all residents have faced similar challenges, I do not feel that mine are particularly unique. However, COVID has definitely limited our patient contact in terms of being able to participate fully in protected code blues, connect with our classmates and mentors, and stay well during our rotations.
I have a number of classmates who have had to take leaves due to COVID and I am certain they worry constantly about falling behind in the program.
Due to COVID-19, what are the biggest changes you’ve experienced compared to previous years in clerkship and/or residency?
The code blue situation has certainly been the largest change: where only a limited number of individuals are meant to be involved in the room during the code. I would also say that the burn-out rate from cross-call coverage for staff, residents, and nursing colleagues has been extensive and definitely shows on the wards.
It has also forced us to abandon a lot of the bedside teaching we would otherwise receive and provide.
How has COVID-19 impacted your work-life balance?
COVID has definitely changed the ways in which I spend my free time outside of work. I used to be a very fidgety person in that if I stayed inside for more than a day or two I would feel the overwhelming sense of urgency to leave the house/go outside/go grocery shopping, or just have a change of environment.
Since COVID I – and many other people – have been forced to gain contentment with indoor activities. Thankfully for myself, I have finally found a sense of peace with indoor activities.
However, I do terribly miss the large group BBQs, family gatherings, and holiday parties which used to be routine in our lives. My husband and I are slowly re-discovering what it is like to sit in a restaurant, enjoy a patio, and see friends again. It all feels strangely new, and I am certain we are not unique in sharing these sentiments.