By Shikha Jain, MD

Each July 1, hospitals around the country are flooded with eager newly minted physicians. New interns are learning how to be doctors. New residents are learning how to take on a more senior role and teach their interns while leading a team. New fellows are learning how to see the big picture while also learning the intricacies of their specialty. New attendings are learning how to put everything together and take on the ultimate responsibility of being the final decision makers with their patients. It is an exciting time!

With a significant increase in physician engagement on social media, physicians on Twitter created the hashtag #TipsForNewDocs to give advice to new physicians as they embarked on their careers. With the hashtag physicians are able to virtually give advice from many times zones away. New physicians are able to access advice from international thought leaders and influencers with a simple swipe through their Twitter feed. These brief 140-character words of wisdom prompt discussions and dialogue on a broad scale that would not easily be achieved without the benefit of social media. The information shared ranges from personal experiences to clinical pearls, from tricks of the trade to important lessons to remember and internalize. These interactions also allow new physicians the opportunity to join a professional community online and reach out to mentors and thought leaders, which may have otherwise felt a daunting and impossible prospect. These tweets and discussions give the feeling of a community and remind all of us this is a shared journey that many have embarked upon. This can make the overall experience of being a new doctor feel less intimidating.

Each year, a new wave of these pearls of advice are released onto Twitter by a wide range of physicians, from trainees to the more seasoned. I have compiled here some of my own personal tips for new docs. I have also included a list of tips for new attendings. There is some overlap; however, new attendings face a whole new type of challenges that should be addressed as well. Taking that first step into being the ultimate decision maker can sometimes seem even more overwhelming than learning the ropes as a new intern. (I’ve modified a few of these slightly from the Twitter 140-character limit for more clarity.)

#TipsForNewDocs

1. Be nice to the nurses, the people who work in the cafeteria, the cleaning staff, the social workers, the dietitians—everyone who works at the hospital. We are a huge team and no one can do their job if the others aren’t doing theirs. We are all important. Learn people’s names.
2. Listen and watch very carefully every single day. The days and months fly by and pretty soon you will be expected to teach someone else. See one. Do one. Teach one.
3. Make time for socializing with your co-residents. They will be your lifeline. Start making friends.
4. Do not ever say, “I’m just covering this patient.” That patient is your responsibility. They are a person. It does not matter that you are not the primary team, or you are just covering overnight. If you don’t know something, say, “I’m not sure, let me check” instead. Take ownership.
5. Do not call a consult without knowing why you are calling the consultant, and also know the patient’s history. See number 4. Have a summary statement ready with pertinent labs.
6. Never be ashamed to say, “I don’t know,” or to ask questions. You are there to learn and we are there to teach.
7. Do. Not. Lie.
8. Start working on your binder of mentors early. Start collecting names of people you relate to as you work with them, or you see doing what you want to do, or living a life similar to yours.
9. Start your #AwesomeList where you keep track of your successes, things that make you proud, or remind you why you do what you do. It can even include thank you cards from patients, etc. Look at it if you are feeling down.
10. If you feel like things are getting too hard or you are getting burned out, ask for help. This is where your Awesome List and your binder of mentors will come in handy.
11. Have fun! I had an amazing group of co-residents and I had a blast in residency. Remember why you went into the field that you chose. If you feel yourself getting burned out, talk to someone. Go back to something that defines you (a hobby, a movie, a sport).
12. Don’t lose sight of who you are. Try to find time for yourself, your family, and whatever makes you happy.
13. Work hard. Your patients’ lives depend on you, and your colleagues depend on you.
14. If you know you will need a day off or clinic coverage, try to find coverage early! The earlier you find someone to cover, the more your chief residents and co-residents will appreciate you.
15. Medicine has changed. Be an advocate, whether it is on the hospital floor, lobbying at the Capitol, or on social media. Your patients need you to advocate for them, other physicians need your advocacy, the health care system needs your fire and passion. Use it. Don’t lose it.
16. Even if you think you doing everything right, someone may still feel otherwise. Don’t get discouraged. Reflect. Even if you are doing everything right, there is always room to improve.
17. Life happens. No one can predict what challenges you will face over the next few years. How you respond and handle them will define you as a physician, and as a person.
18. Learn where the free food is!
19. Your senior residents are your biggest allies. Learn from them.
20. Be mindful of what you post on #SoMe (social media). If you wouldn’t feel comfortable seeing it on the news, don’t post it. It’s easy to feel anonymous when you post online., but you are never truly anonymous. You hold great responsibility with your white coat and stethoscope. Never forget that. The words you type and the things you say carry great weight.
21. Assess daily possible barriers to a safe eventual discharge—and address them early so your patients’ transition out of the hospital is smooth.
22. When patients are on antibiotics, write the start date and stop date (or ongoing) next to them in your assessment and plan and update daily.
23. Try to avoid starting maintenance fluids unless absolutely necessary. Boluses “as needed” are better. It is less likely your patient will gets fluid overloaded than when fluids are continuously running.
24. Find your support system and keep them close. Ask for help. Your mentors, colleagues, friends are there to help you. If you are struggling, or feel down, reach out to someone. Don't try to go it alone if you need help.
25. Learn as much as you can. Determine where your deficiencies are, then spend time trying to correct them. Go to tumor boards or conferences you normally wouldn't. Pick up patients you don't see as often. Pick the brains of your current attendings. Make cheat sheets on common diagnoses.
26. There will come a time when you have to deliver bad news. From that moment, you will forever be a part of that patient and their family’s history. They will remember your face and how they felt for the rest of their lives. This is an enormous responsibility. Do not take it lightly. This applies to people at all levels of training/professional life.

#TipsForNewAttendings

1. Teach. If you are in the academic world, teach the residents, students, fellows. If you are in the community, educate the nurses, the support staff.
2. Be patient with yourself. There is a learning curve that is just as steep when you start off as an attending. Don’t beat yourself up.
3. Continue to ask questions. Reach out to senior colleagues, reach out to your former co-fellows, contact national experts. The more questions you ask, the better physician you will be. It doesn’t mean you don’t know enough, it means you are constantly learning.
4. I repeat this on this list because it is extremely important. There will be days where, despite feeling like you have done everything right, someone will get mad or upset at you. Don't take it personally. You don't know what life battles they are going through. And reflect. Maybe you can improve on something for next time.
5. Know what you don't know and ask questions/read!
6. Keep in touch with your binder of mentors and continue to develop those relationships, as well as find new ones that line up with your career path.
7. Imposter syndrome exists, and it is almost inevitable you will be facing it at some point. Be prepared. And when it happens, remember your worth. Pull out your Awesome List.
8. Take on projects that can help advance your career or give you personal satisfaction. Learn what things you can say no to, and don’t second-guess your decision.
9. Find the time to be a mentor. We will be the ones who help the next generation of physicians achieve their dreams and goals. Support them, motivate them, lift them up, educate them, guide them.
10. Find out ASAP who you can go to for help about how things work in your institution as well as for medical questions. And don't be afraid to ask questions! Everyone was in your shoes at some point.
11. Take the extra time to listen to your 90-year-old patient talk about courting his wife, or your hospice patient brag about her basketball accolades. These moments are precious to them, and they trust you enough to share the details of their lives. The few minutes you may end up behind in clinic will be worth it. You will never regret spending the extra few minutes with them.
12. Don’t forget why you are doing what you do. Our profession is unique. People trust us with their lives. Do not take it for granted. And do not forget that each of your patients is a person first, and a patient second.

Related reading

• Rashid MA, McKechnie D, Gill D. What advice is given to newly qualified doctors on Twitter? An analysis of #TipsForNewDocs tweets. Med Educ. 2018;52:747-56.
• Wong K, Swamy L, Jardine DA. #TipsForNewDocs: Mentoring From Miles Away. J Grad Med Educ. 2017;9:674-5.

Dr. Jain is a board certified hematology/oncology physician on faculty at Northwestern Memorial Hospital in Chicago. She has written for Doximity and KevinMD. You can follow her on Twitter @ShikhaJainMD.