Trainee Talk: Reflections on the Trainee-to-Attending Transition

As a very new attending, I am sometimes asked by trainees what the transition from trainee-to-attending was like. I am now just six months into my first post-training position as an attending physician at Spaulding Rehabilitation Hospital and Brigham and Women’s Hospital in Boston. As a trainee, I would often ask new attendings this question too. At that time the idea of starting as an attending seemed far off, but still evoked a feeling of anxiety. As a trainee, I felt comfortable with the blanket of security of knowing there was an always attending I could run my plan by or ask for advice. I was not sure how I would manage without that. Now that I am six months in, while I am still learning and adjusting every day, I can say that the transition from trainee to attending has been smoother than expected and much more exciting. As I think back on the last six months there are a few things that I think have helped ease my transition, and I try to share this with trainees who ask me this question.

1. You are not alone. One of my greatest fears was how I would manage when I was stumped by a clinical scenario or new clinical problem I’ve never faced before. While I might be ‘on my own’ seeing patients, I have found I am certainly not alone in facing these scenarios. I’ve found that I am frequently bouncing questions and ideas off my prior co-residents and fellows who are now also starting jobs in their respective specialties. We are continuing to learn through each other’s opinions and experiences. We’ve also provided support to each other in a more holistic sense. I’ve also been able to go to my former attendings and mentors for advice on patient care. Their advice and clinical experience have been invaluable, and I’m grateful they’ve continued to be mentors even after the end of my formal training under them.

2. Referring to old (and new) educational resources. Multiple people have told me that they’ve learned as much, or even more, in their first few years of being an attending than during training. Now I can really understand why they said this! In addition to talking through cases with colleagues, I am still finding that I am gaining a lot from reviewing educational materials that are relevant to the patients I see. I find myself rereading neuromuscular textbooks and papers to review differentials and EMG protocols for the less common studies that come to me. Because of this, I feel I’m constantly still learning, which is exciting and keeps the job interesting!

3. Picking up tips from conferences. I was able to go to the AANEM Annual Meeting this year and found myself coming back to my new job with high-yield knowledge and skills that have changed my clinical practice for the better. At an ultrasound workshop, I learned techniques for ultrasound-guided Botox that I implemented the next week in clinic. I also learned new nerve conduction and EMG protocols and reviewed topics I find tricky in neuropathy work-up. It was a great opportunity to pick the brains of experts and directly improve my own clinical work based on their recommendations.  

While it is undoubtedly a challenging transition, I look forward to the next few years of learning and growing as an attending physician. I wish all those who are also in this transition (or will be soon) from trainee to attending the best of luck!