First Times in Medicine
Brene Brown’s podcast recently devoted an episode to First Friggin’ Times (FFTs). It is full of great advice for getting through a FFT in life, but some FFTs in medicine need a different approach. Below is some advice for getting through a medical FFT as learner and also some points for educators guiding others through FFTs.
Name the FFT. Be transparent with yourself and your seniors about your experience. For example, “I’ve practiced the lumbar puncture in the sim lab, but this will be my first one on a patient.” By naming it, we can normalize the nervous feeling about the experience. As an educator, I will inquire about a learner’s experience to normalize the FFT and also to ensure I offer the proper support for the FFT.
Preparation. A lot of FFTs in medicine can be anticipated. For instance, if you’re an emergency medicine resident, you’re probably thinking a lot about your first intubation on a patient. Take the time to fully prepare. Study all the steps and test yourself via visualization. Keep studying until you can fully visualize all of the steps of the intubation, including set-up and post-intubation care.
Judgement. Some FFTs you need to push through, others you need to ask for help. For example, a patient presentation to a senior resident or attending is almost always something we need to push through. Often, you don’t have enough time to feel fully prepared. You may forget a key detail or go slightly out of order. This is a moment to push through. You may pause and go back to correct yourself, but you’ve got to keep going. You can’t quit or punt this presentation. Procedures on the other hand, you do need to know when to ask for help. For example, let’s say you’re doing a central line, and you’re having difficulty threading the guidewire. This is not the time to just go for it, this is a time to ask for help. Learners don’t always know where the danger areas are in a FFT. Educators need to be present to anticipate the potential challenges and guide the learner.
Patience. If you’re teaching a child how to ride a bike, your natural inclination is to be patient and kind. The child keeps falling off, you offer advice and encouragement. You don’t say the child is a failure. Yet, when we try new things, we’re so quick to judge ourselves. Pause, breathe, and remind yourself that this is your first time. You don’t have to be perfect. For all complex and interesting endeavors, it will take time to master. When framed properly, this is actually a rewarding journey. Educators often need to step in and provide accurate feedback, as most learners will assume they did worse than they actually did or feel unsure how to improve for the next time.
Be comfortable being uncomfortable. “If we give up being new and awkward, we stop growing. We stop growing, we stop living.” -Brene Brown. Medicine is hard. There will be so many FFTs, sure there are less as your career progresses, but they never go away. The sooner that you can begin to embrace the vulnerability and be kind to yourself as you continue on your journey, the better you will feel and also the better physician you will become.
Speak positively and kindly. Our instinct is to speak kindly to another person in a FFT. Yet, for our own FFT, we are often quick to speak negatively to ourselves. This negative self-talk can be a self-fulfilling prophecy. Speak kindly to yourself; “This is my FFT, I’m doing my best. My attending is here, and she’ll help me if I get stuck.” As an educator, the same applies. I have yet to see a time when being curt or raising my voice has actually caused someone to perform better in the moment. Our words and tone during the FFT really matter.
Tell me about your FFTs! Tweet me @EMSimGal
