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Letter to a Fourth-Year Medical Student, by Pam Sansoucy, MD


Here you are: the place that you have been attempting to achieve for many years. At this point, I am sure you have heard a lot of advice regarding your future. Many of those ahead of you have probably given you the ubiquitous “Enjoy fourth year!” advice before you enter the trenches that are residency. You likely have heard unsolicited advice pertaining to the career path you have chosen and maybe even tidbits on “how to survive residency.” This letter is not intended to scare or intimidate you as others have previously attempted. I won’t sugarcoat things: residency is hard. It is an extremely condensed period of three to seven years during which time you have to become proficient in your field — proficient enough to teach others, care for patients and, eventually, have your own practice. Residency is full of long hours and stress. Sure, there are work-hour restrictions, but you will still have nights (or mornings) during which you make it home and fall asleep while trying to eat a meal. The emotional exhaustion of giving everything you have just to care for your patients will take its toll at some point during your residency. But, like I said, this letter is not meant to scare you.

You have chosen to enter this field. Maybe chosen isn’t the correct word. You were called and felt the undeniable urge to enter medicine. Nothing anyone said would have dissuaded you from applying to and entering medical school. This is extremely important to remember. There is a reason in all of us that caused us to pursue this choice despite the daunting odds and strenuous work. You have already hurdled barriers to reach this point in your career. You will reach and surpass more obstacles in the future. Shortly, you will leave your medical school classmates whom you have grown to know over the past four years. Together, you have made it through anatomy lab and passed Step 1 and Step 2. You have each helped each other, studied together, aided and supported each other while being pimped and shared snacks on rounds (which seemed to last for an eternity). As a medical student, sometimes the residents may have seemed unstoppable: they worked constantly; their signatures directly affected lives; their knowledge sometimes was more practical or expansive than your own. You have been working hard to keep up with these residents over the past couple years, and in just a few weeks following graduation, you will be one.

Here is my secret to thriving in residency: your colleagues. It may sound corny or overrated, but I challenge you to ask any resident what helps them through the tough days, those days in which patients are dying, complaining or crying, in which nurses are stressed or attendings are irritated.

I have interviewed many medical students for a position in my current residency program and have taught many medical students who have come through our clinic on third- and fourth-year rotations. My unsolicited advice is always the same when it comes to residency interviews: go with your gut. If you are not sure you would socialize with the residents you meet on the residency interview day, it probably isn’t the right program for you. Every program essentially has the same number of electives and distribution of rotations. You will get used to where you live, whether it is urban or rural, a large state or a small one. There are great faculty members at every program — they wouldn’t stick around in academia if they weren’t. A hospital is a hospital. You will spend plenty of hours there. It doesn’t matter if it is brand new or slightly more worn, the medicine is the same. I always found it comical on residency tours that the call rooms were a highlight. I can guarantee that the bed you may get to rest your eyes in for a bit will not drastically affect your residency experience. All of these other things will even out in the end, except one thing.

If you feel comfortable with your soon-to-be colleagues and can have easy conversations with them, that’s a huge gold star for that program. Yes, residency is difficult, but you have two options: (1.) attending a residency with no one to lean on, talk to or complain to because you don’t get along with your co-residents or (2.) going through your daily residency grind with friends by your side (in my opinion, the much better option). These people will not only know you as the doctor into whom you are developing, but also as the person you are and have been.

I have had the distinct benefit of working with a group of people whom I respect, admire and truly like. I am approaching the end of my residency now. I have gained many friends, people with whom I will remain in contact for years to come. These are the people who can understand what life is like for you because they lived through it with you. We know the names of each other’s significant others, children and pets. We met each other’s parents. These individuals were there for me on days that no one outside of my program would understand. They were there for me when life completely unrelated to residency became complicated. My colleagues were there for me when my father-in-law died during my intern year, something you really don’t expect to happen when your husband is 28 and his father is 57. They stood beside me through my personal trials — protecting, supporting and caring for me.

So, read what you will about residency, and talk to those who are going through it currently. Try not to dwell on the negative, the anticipation or dread. Instead, open your eyes to the wonder of medicine and human interaction around you. You will hear plenty about how you will grow into a knowledgeable and capable physician. Prepare yourself for an intense, hands-on learning experience in your field of choice. But also look forward to the friendships bonded in fire, those that will persist even when residency is a distant memory. Remember that it will all come to an end somewhere in the three- to seven-year span for which you have signed up. Yes, you will develop memories and a lot of knowledge and skill. But, in the end, you will not remember the details; most of it will become a series of “Well, back in my day…” statements. However, if you focus on the relationships you develop with both colleagues and patients, you will truly succeed in residency. The details of those moments will be grafted into your heart and soul. You will find that, for what you are willing to put out there, you will get that back tenfold. If you are a human with patients, they will put their lives in your hands. If you are open with your co-residents, they will become some of the best friends you will ever have. Be vulnerable and enjoy.

Pamela Sansoucy (1 Posts)

Guest Writer

University of Massachusetts Family Medicine Residency


I am a recent graduate from the UMass Family Medicine Residency Program. My interests include whole person care of all ages. I will be joining a practice in Westminster, MA to continue outpatient family medicine.