Speaking up for myself in residency

Before residency started, I was invited to a fancy-schmancy dinner at the faculty club to meet other residents. The club house was a beautiful old brick building with tapestries hanging on the walls between stone columns. As the silverware clinked and drinks were refilled, I, the incoming intern, half-jokingly asked for “pro tips” from the graduating residents. The woman sitting next to me, with a serious expression on her face, gave me the following advice:

“Grow a thick skin. A lot of women come into residency having succeeded by being nice, sweet, and deferential up until this point. But in residency, you will be put under a lot of pressure, and you have to stand up for yourself.”

At the time, I was stunned to get such blunt advice. But now, I’m grateful for it.

A former attending at my medical school used to say with a certain degree of gleeful malice, “The confidence of the med student seems to directly correlate with the volume at which they speak!” Thus far in residency, I have observed that my male colleagues are perceived as more confident and competent for very simple, and dumb, reasons: they are taller, louder, and more willing to interrupt.

There’s no intentional crowding out. No one has said girls are stupid or weak or cry too much. No one has implied that I should drop out if I get pregnant. But as a naturally soft-spoken girl, and a person of color, I do myself the most wrong by mumbling. I do myself the most wrong by not questioning something that I think is wrong or inappropriate because I’m afraid people will judge me. By being silent, I am not showing that I already understand concepts–I am making myself irrelevant.

This is not to say that I should be noisy or frivolous with my words. But I need to have the confidence to speak up when I want to. As Mindy Kaling writes, confidence is simply the entitlement that comes with having worked hard. And I have worked hard to make it to this point in my life.

Tips that I got as a medical student from older female attendings:

  • Take the initiative to do things on your own and make commonsense decisions about management.
  • Really own your cases and follow from start to finish if you can. If anyone asks you why you’re in the room, say, “This is MY patient.”
  • Advocate for your own education. After all, how can you advocate for your patients if you can’t even for yourself?
  • One of the most profound pieces of advice I got was “You will have to fight for yourself in your own way. Remember that assertive is not aggressive.”

Here’s another tip for those worried that if they say the wrong thing, they will be laughed at or talked about later: in residency, everyone is so preoccupied with their own survival that they don’t have time to gossip about your one dumb question from morning rounds. And if they do, they’re not the kind of people your mother would want you hanging out with anyway, right? Grow a thick skin. Know that you deserve to be part of the conversation.


About the friendly intern

Ask a question: The Friendly Intern My personal blog: Pathos and Pathology
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2 Responses to Speaking up for myself in residency

  1. mdafterphd says:

    thank you for sharing such a thoughtful advice. I have a tendency to stay away from a crowd and to do my own thing. But it is becoming clear that I can’t possibly keep up with that after second year. I will consciously try to speak up my thoughts best as I can, but i know it is going to be a challenge.

  2. Pingback: Speaking up for myself in residency | MD after PhD

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