How to Succeed at a New Program as a Transfer Resident

[JLElaser]

Hi all

I have fortunately been accepted for an open position and will be transferring across the country. I am a USMD and I will be an incoming PGY2 in a midtier IM program in the northeast.

It will be a completely new hospital system with 3 different EMRs, a different call and rounding structure, and I will know no one in the program. The scary thought is, I will now be responsible for the entire team as a new upper level in a setting I am unfamiliar with. I feel like I will be a Day 1 intern all over again, especially not knowing how the hospital works, working with new nursing/social work, not knowing where anything is located in the hospital. I was also told practicing medicine in the northeast may be different than where I am used to (I'm from the South).

So I expect to have a steep learning curve and may fail hard in the beginning. It doesn't help that I will be under the spotlight since I am the new person and they need to evaluate my skills. What can I do in order to make the transition more smooth?

Thanks in advance

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[gutonc]

Assuming this is really the plan, I think your new program is doing you (never mind the patients and new interns) a major disservice by starting you off as a true R2. You are appropriately concerned about your ability to function as a leader/teacher in a system that you know nothing about.

During the course of my residency, my (mid-sized, mid-tier) program took in 6 PGY2 transfers. With one notable exception, they all spent the first 6 months of the year as interns and were only promoted to R2 once they'd proven their capability. 2 of the 6 were advanced at the 6 month mark, 3 repeated the entire year as interns. One of the 2 who advanced at 6 months was not renewed at the end of PGY2 but was helped to find a new PGY2 position and ultimately completed a residency elsewhere.

The solitary exception was a person who graduated from the program's med school. Top 5 in the class. Class president. AOA president. Did his intern year at BWH and then wanted to move back for family illness reasons. He struggled despite at least somewhat knowing the system and having come from a Top tier internship, but completed residency on schedule and is a hospitalist in town.

 

[JLElaser]

They stated I will start with elective or outpatient clinic so I could get used to the system.

Would it be worth trying to do as much as mksap as possible to have a better knowledge base?

Just want to be proactive

Assuming this is really the plan, I think your new program is doing you (never mind the patients and new interns) a major disservice by starting you off as a true R2. You are appropriately concerned about your ability to function as a leader/teacher in a system that you know nothing about.

During the course of my residency, my (mid-sized, mid-tier) program took in 6 PGY2 transfers. With one notable exception, they all spent the first 6 months of the year as interns and were only promoted to R2 once they'd proven their capability. 2 of the 6 were advanced at the 6 month mark, 3 repeated the entire year as interns. One of the 2 who advanced at 6 months was not renewed at the end of PGY2 but was helped to find a new PGY2 position and ultimately completed a residency elsewhere.

The solitary exception was a person who graduated from the program's med school. Top 5 in the class. Class president. AOA president. Did his intern year at BWH and then wanted to move back for family illness reasons. He struggled despite at least somewhat knowing the system and having come from a Top tier internship, but completed residency on schedule and is a hospitalist in town.

 

[Piebaldi]

Hi all

I have fortunately been accepted for an open position and will be transferring across the country. I am a USMD and I will be an incoming PGY2 in a midtier IM program in the northeast.

It will be a completely new hospital system with 3 different EMRs, a different call and rounding structure, and I will know no one in the program. The scary thought is, I will now be responsible for the entire team as a new upper level in a setting I am unfamiliar with. I feel like I will be a Day 1 intern all over again, especially not knowing how the hospital works, working with new nursing/social work, not knowing where anything is located in the hospital. I was also told practicing medicine in the northeast may be different than where I am used to (I'm from the South).

So I expect to have a steep learning curve and may fail hard in the beginning. It doesn't help that I will be under the spotlight since I am the new person and they need to evaluate my skills. What can I do in order to make the transition more smooth?

Thanks in advance

I would say that is definitely a true statement - and depending where in the NE, it is very different from the South. All "regions" have significant variability I would say.

 

[IMreshopeful]

They stated I will start with elective or outpatient clinic so I could get used to the system.

Would it be worth trying to do as much as mksap as possible to have a better knowledge base?

Just want to be proactive

I think the one benefit of being a senior is that you have more time to adjust and think than as an intern. What will take time getting used to is the style, flow, and feel of the place. I think you’ll be fine, we’ve had a couple residents transfer in this way and they did great.

 

[evilbooyaa]

They stated I will start with elective or outpatient clinic so I could get used to the system.

Would it be worth trying to do as much as mksap as possible to have a better knowledge base?

Just want to be proactive

That's good to start with non inpatient.

I would consider spending sometime during your elective on the floors just to figure out how stuff is done here, and how that might be different from what you're used to. I don't think the knowledge base is going to be the main issue here, but rather how does the department, the floors, etc. work in a functional way. If you want X done, who do you talk to about getting it handled?

 

[SqEdSaint]

Use orientation week(s) to work on the inpatient team and get acclimated. You shouldn't need to go through HIPPA, BLS, ACLS, and other hospital policy nonsense trainings again. Aside from the EHR, consultants, and how inpatient attendings like to round, everything else should be the same.

 

[JLElaser]

I think the one benefit of being a senior is that you have more time to adjust and think than as an intern. What will take time getting used to is the style, flow, and feel of the place. I think you’ll be fine, we’ve had a couple residents transfer in this way and they did great.

That's reassuring, did those residents have a have to spend the first few months as an intern before being promoted to PGY2? Were you or other co-residents annoyed if you had to help them get used to the hospital?

 

[JLElaser]

That's good to start with non inpatient.

I would consider spending sometime during your elective on the floors just to figure out how stuff is done here, and how that might be different from what you're used to. I don't think the knowledge base is going to be the main issue here, but rather how does the department, the floors, etc. work in a functional way. If you want X done, who do you talk to about getting it handled?

Most definitely. I plan to come early and stay late just so I can get familiar with the system. Just don't want to bug my co residents too much though and annoy them

 

[JLElaser]

Use orientation week(s) to work on the inpatient team and get acclimated. You shouldn't need to go through HIPPA, BLS, ACLS, and other hospital policy nonsense trainings again. Aside from the EHR, consultants, and how inpatient attendings like to round, everything else should be the same.

Unfortunately the hospital is making me attend all the PGY1 orientations :\ Will have to go through computer training (like healthcare culture/sensitivity modules), work with HR to set up direct deposit/insurance, attend general hospital hospital policy training, getting ID badge etc.

But I will definitely find some time to get familiar and pay more attention during the EMR trainings

 

[DarkHorizon]

I know of someone who made a transition from prelim general surgery to ortho pgy2 after a research year. He showed up a month early and just shadowed for a month so he wouldn’t get destroyed taking trauma call as a junior once the start date rolled. He still struggled once he started but survived. I would say you should do the same.

 

[NotAProgDirector]

If you get an elective first, I would ask to "buddy" with a current resident on an inpatient service.

 

[DrGabyZ]

Future PGY3 that transferred as a PGY2, you'll be fine.
I was given about 6 weeks of electives to try to get used to the new system, decided to do 2 of those weeks shadowing in inpatient services, I won't lie the first day I had to ask 3 different people how to get to the place I was looking for.
The hardest thing I believe was the EMR as it was one I wasn't familiar with, but being in electives gave me time to basically trial and error with it.
Honestly I probably got comfortable around the 5 months mark (took me a while to get to know the different consultants and how the hospital worked, but it's basically fake until you make it.

 

[argama]

How do transfers happen? I know of the "my residency got shut down" reason, prelims who match an R2 position their second match, but how else do residents transfer from one program to another in the same specialty? For example, if I do my intern year then see there's a free PGY2 cat spot at like UCLA, I cannot apply to transfer for my PGY2 without my PD's blessing, and my PD would only give me his blessing for what reasons?

 

[mvenus929]

How do transfers happen? I know of the "my residency got shut down" reason, prelims who match an R2 position their second match, but how else do residents transfer from one program to another in the same specialty? For example, if I do my intern year then see there's a free PGY2 cat spot at like UCLA, I cannot apply to transfer for my PGY2 without my PD's blessing, and my PD would only give me his blessing for what reasons?

PDs generally want happy residents. If someone is miserable, they’re not going to be a good resident. I’ve seen transfers mostly to be close to family for one reason or another, though I’m sure there are other reasons.