Preparing for July 1

July is known mostly for the loud and colorful celebration we call  Independence Day; yet those of us intimately involved as medical educators know that the most important day in July is the first day of the month.


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Because that is when the newly minted physicians (M.D.’s and D.O.’s) begin the sometimes long but always arduous journey to becoming independent practitioners in their chosen specialty field.

It is a day that nurses fear;

A day that patients worry about;

And a day that the attending physicians anticipate with both excitement and trepidation.

On July 1, all of our trainees get promoted. Those who were recently interns (the first year following medical school graduation) are now in a supervisory position, and those who were supervisory but still junior will become “senior” residents with a lot more responsibility and autonomy. A new class of “senior” residents will be practicing the skills they have learned thus far, in preparation to begin their autonomous career in an office or hospital, or to go on to even more specialized training in a fellowship designed to teach them how to care for the most complex of all patients with particular organ system problems, as well as how to become superb medical educators and/or researchers.

For our pediatric residency, here at the Carilion Clinic Children’s Hospital, we have welcomed our third group of “first years” and will experience for the first time a full cadre of resident trainees, as the inaugural group begins their third and final year of mandatory training.

This is an exciting time, a heady time for us, as we see our “babies” growing up.

But how, exactly do we prepare for July 1?

Prep starts long before the new interns arrive. It begins during the time we review their applications, and bring them in for interviews. We strive to choose the “right” people, who will fit in well with our other residents, and the rest of the program. We have reviewed all aspects of the curriculum, and made changes from prior years based on feedback from current residents as well as faculty. And finally, we are ready to be there, to teach them and hold their hand as they walk through the door, as they develop further the skills they learned in medical school.

No one should fear July 1.

In the “old days”, when trainees were often left to fend for themselves, even on their first day, there was probably reason to fear. Today, appropriate supervision is built into our systems.  A first year resident (intern) is never left alone. They always have a supervisor immediately available. They will not be making decisions without consulting someone with more experience. They will not do a procedure without an attending or upper level resident standing by their side to instruct them properly in necessary steps and techniques.

There will be new names and faces for the nurses and other staff to learn. There will be moments of confusion when it is not clear what to do this moment, but help is always within reach. Our new interns have just completed two full weeks of orientation to the hospital, the electronic medical record, and to their roles and responsibilities. They have been certified in various components of advanced life support. They have been through simulations. They know who they can go to for further assistance. They are bright, motivated and humble people, who care about their patients and will push themselves to learn more, do more and be more than they ever imagined. Their attending physicians will be hovering over them, offering guidance, holding their hands, and offering encouragement as they walk along this road, that all of us have had to travel.

I will spend this next week as the attending for our inpatient unit; I will have the honor to work with several of our interns and residents as they assume roles that are new to them. I am looking forward to it. I have observed before how rapidly they develop their skills, and I am eagerly anticipating watching this developmental process occur again.


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I would love to hear any comments or thoughts you might have about July 1 in a medical system. Good, bad or otherwise. Any experiences you may have had as a provider, a staff member, or as a patient. Please add your comments in the space below.

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About Dr. Ackerman

Alice Ackerman, MD, MBA, FAAP, FCCM is the Chair of the Department of Pediatrics at Carilion Clinic and Professor and Founding Chair of Pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care.

She has been at Carilion Clinic since June of 2007. Her primary goals are to enhance the health care of children in the Roanoke Valley and Southwest Virginia, and is actively working to do this both as physician in chief of the children's hospital, as well as through involvement with many state-wide initiatives.

Close to home links

Carilion Clinic Children’s Hospital
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The AAP website for parents
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