Transitioning from Trainee to Attending: Tips for Navigating Your First Year in Practice

Transitioning from Trainee to Attending: Tips for Navigating Your First Year in Practice

Miriam Knoll, MD

Aug 28, 2017

It’s the moment you’ve been waiting for: after getting through more than 10 years of college, medical school, and training, you’re finally an attending! Many people feel that this transition is harder than starting internship, because all of a sudden, you—and only you—are calling the shots. You now bear all of the responsibility of caring for your patients.

Here are some tips I’ve learned over the last year that may help you with these next steps.

Plan Ahead

In your last year of training, try to imagine what your new position will be like. How will your role change? Yes, you’re absolutely taking care of patients while you’re in training, yet you still have your attendings to rely on. Next year, you will need to make more decisions by yourself.  I encourage senior residents/fellows to imagine themselves being fully in charge of every patient they see, especially in their final year of training. When you see a new consult, ask yourself, “How should I treat this patient?”

In addition, pay attention to the resources you often utilize for patient care decision-making. Are there guidelines that your hospital uses? Textbooks you refer to? Notes and PowerPoint slides from lectures that are helpful? Start acquiring and compiling these materials in the months before you complete your training, so that you can continue to access them when you start your first job. Are there institution-specific policies and procedures related to patient care that you take for granted? Pay attention to these things so that you can replicate them in your new clinical setting.

Utilize Your Colleagues and Coworkers

Every work environment has its own culture; medicine is no different. Each hospital, office, or clinic runs a certain way. What you’re used to from your training is likely not the only way to do things. In your new job, if you notice the workflow is different, ask your new colleagues how things are done there. You may eventually try to influence the practice and implement strategies you prefer, but I recommend first taking the time to learn how things are usually done. You may be pleasantly surprised and learn to favor the new institutional policies. Learn to ask, “How is this normally performed/scheduled/done?”

Some of the culture may be related to treatment, such as chemotherapy regimens or radiation fractionation. Other times, the philosophy that’s new to you will be related to ancillary staff or scheduling. Remember that you have an opportunity to continue to develop your skills throughout your career; learning doesn’t end when your training does.

Don’t Expect to Know It All

You may have completed your training, but don’t expect to know everything! If you have questions, make sure to reach out to your resources. Here are some suggestions:

  • Ask senior colleagues in your practice for advice
  • Look at consensus guidelines
  • Research the topic on PubMed and UpToDate
  • Review active research protocols
  • Consider sending a patient for a second opinion
  • Present at a tumor board
  • Contact experts in the field

If you are a woman, join the Facebook group “Hematology & Oncology Women Physician Group”*! Members of this group include women from all fields of oncology, including trainees and attendings. This is an amazing resource for all kinds of support, including clinical questions and career advice.

I hope you find these tips helpful for your own transition to an attending. To all the new graduates, I wish you much success in your careers. If I can help in any way, tweet me @MKnoll_MD!

*This Facebook group is designated as “secret” by Facebook. Similar to the Physician Mom Group, this group is not searchable. New members must be Facebook friends of current members and approved by the administrators of the group. Permission was obtained from the administrators to post information about the group for this article.


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