By AlleaBelle Bradshaw, MD
There are a lot of cliches from the interview trail, most of which are at least partially true. One of them is that residents and faculty will say something about how their residency is “like a family.” Of course, it is generally a positive thing that residents view their programs as families. I don’t mean to be the person that ruins this by taking it too seriously, but we should consider the meaning of something we have started saying almost automatically. I write to share my thoughts about what family means, how residency is like a family, and considerations for both residents and applicants when using the metaphor moving forward.
My thoughts are colored by my personal experience with family. My family was a mostly traditional one with two parents and three kids. I am the youngest with two older brothers. We loved, learned, fought, and got close to falling apart more than once. You could say we did fall part at times. My brothers taught me so much and are, at least in part, the reason I am a doctor, but they weren’t always supportive. I am thankful for all the lessons and memories, but I also have to figure out which parts of those relationships I don’t want to learn from and carry forward.
One of the definitions of family includes the descriptor of people “living together as a unit.” Even though we don’t live at the hospital, like trainees did in Halstead’s time, medical training is still called residency because of the extensive time at the hospital with our colleagues. It makes sense that the relationship dynamics start to resemble those of traditional cohabitating family members. Co-residents become like siblings with different experiences, who teach one another, give each other a hard time, and are there for one another. Given these aspects of residency and their similarities to traditional family members, it is not surprising nor unique for a residency program to be ‘like a family.’ The real question should be, what is that family is like? What are this family’s values? Are those values aspirational or realized? Is the program’s leadership respected, feared, and/or loved? Do the residents support one another? Overall, is the family a healthy one or a dysfunctional one?
Of course, no program is perfect just like no family is perfect. (In actuality, the system is imperfect, making it effectively impossible to have an ideal program, but that’s a different topic.) There are good times and bad times. There are times of mistrust, miscommunication, and mistakes. The important part of family is how they treat each other when they meet these challenges. In a healthy program, residents support one another, and leadership supports the residents, especially during adversity. There are values upheld that include well-being and a growth mindset, knowing that work ethic and progress are predicated on those two things. Those values should be apparent in the program through the decisions and actions of the program’s leaders, both upper-level residents and faculty.
When residents are telling applicants about our programs, we shouldn’t expect applicants to know what we mean when we say our program is like a family. We all have stories, examples, and more nuanced ways of describing our relationships with our co-residents and faculty; we should use them. Similarly, I would encourage applicants to ask questions when residents or faculty say they are like a family. Ask about values and the relationship dynamics between program leadership and residents, as well as between residents themselves.
The virtual nature of interviews has made it as hard as ever to get an understanding of a program from just a few hours on interview day, but being thoughtful about how we’re describing our relationships is an important part of having successful residency Matches in the future.
AlleaBelle Bradshaw, MD is a PGY-2 general surgery resident at MedStar Georgetown University Hospital and Washington Hospital Center.