It’s a little shocking to write this out, but I have been a medical physics resident for nearly eight months. Perhaps sharing my experience so far will be helpful for anyone who (a) happens to find themselves in my shoes AND (b) happens to find this website.

Overall the residency has been an amazing learning experience. I’m grateful that I am part of such a kind and supportive group of physicists who empower me with knowledge and encouragement to reach my goals. Thinking back to my perspective of what residency would be like before I started, I really had no idea what to expect. Here are some of the things about residency that took me by surprise.

Quality Improvement Project (QIP)

The Accreditation Council for Graduate Medical Education (ACGME) has requirements for medical residency programs to include a quality improvement component. While I believe that medical physics residency is loosely based on medical residency structure, medical physics residencies are still a fairly new requirement. Because of this new-ness, there is still a way to go before program requirements mature. The report from Task Group 249 (“Essentials and Guidelines for Clinical Medical Physics Residency Training Programs”) states: “Although optional, clinical research and development projects should be included as part of the clinical training program, provided they do not detract from the residents’ clinical training.”

By the way, at the time this blog post was written, the AAPM Education Council was requesting comments for an update to TG-249. I suggest giving this report a read if you’re a student or prospective resident and want to get a better idea of what will be expected of you.

My residency program requires residents to complete one QIP during their first year and two QIPs during their second year. QIPs are defined as six month long projects that aim to… well… improve quality. If that sounds vague, it kind of is, but thankfully for the first project, the physicists will propose project ideas and timelines. For subsequent projects, the resident can propose their own project idea. For example, automating a clinical workflow, designing a phantom, improving image quality, could all be topics for a QIP.

I started my project after completing two months of residency. I’ll start this off by saying that when I first went to Duke’s virtual residency fair (shoutout to STSC for hosting this!), I thought I was way out of my depth when the physicists were explaining the QIP process. I struggled for a year and a half on my master’s research project and was disappointed that it didn’t result in a publication. I bring this up to say that grad school was demoralizing and the prospect of doing more projects felt exhausting. Because of this, I didn’t even consider myself a serious candidate for matching with Duke. I feel really sad typing that out, because it’s heavily laden with Imposter Syndrome, but that was my reality!

Despite all of that, I have found the QIP process to be well-structured and gratifying. The expectation is that you finish a project in six months, tie a bow around it, and call it done. That is something I had been sorely missing, the feeling of successfully completing something and the dopamine rush that comes with it. Moreover, these projects can provide an excellent opportunity to share your work at conferences. I’m looking forward to submitting an abstract for the AAPM annual meeting based on the results from my QIP.

The Amount of Reading

I’ve joked with my family that residency feels like getting paid to read. While I may have a pretty deadpan sense of humor, that statement is no joke; Residency has involved A TON of reading. Radiographics articles, Bushberg, scientific papers, you name it. Every week, I have a laundry list of things I need to read before meeting with my rotation mentor (typically meetings with rotation mentors will include pop quizzes, so it’s read or die essentially). This has been a boon for me, as someone whose whole identity revolves around knowing stuff. Physicists as a whole have to know how a lot of things work, and if we don’t, we ought to know where to look or who to ask to figure it out.

The Oral Exams Made Me Feel Like I Was Having a Heart Attack…

…but I think they’re going to get easier. Oral exams aren’t super common in the US education system, but you can expect them in residency as a way to prepare you for ABR Part 3. My first oral exam was after my mammography rotation. Reflecting on it, I overmemorized factoids and didn’t spend enough time simply talking out loud. The feedback I got was that I knew the facts, but my delivery was lacking confidence. Confidence is key, and lack of confidence is certainly a weakness of mine. However, I firmly believe in the concept of “faking it ‘till you make it,” so practice for my next oral exam will involve much more talking in front of the mirror.

Being a New Resident was Isolating

Now this is my hottest take if you’ve stuck with me for this long. My first month or two as a resident were a little rough on my mental health. I refer to myself as an outgoing introvert. I like connecting with people and I think building community is essential, but it’s not something that comes super easily for me. I’m not the best at small talk and it takes a while for me to get comfortable in social situations and to truly be myself. With that in mind, I recognize that structured social situations (e.g. classes, clubs, etc.) kept my social engine running previously. I had places where I spent a significant amount of time with the same people almost every day, and this generated camaraderie. Kurzgesagt did a great video on this topic and the loneliness epidemic in general.

When I started residency, there weren’t any social safety nets at work. It took me a while to realize I had to actively seek out these connections, even if it was difficult for me to work up the energy to do it. This phenomenon is far from unique to medical physics residencies. I will comment that our residency cohorts are much smaller compared to other medical residencies, but from a cursory Google search I did (sorry, no citation, but it was Reddit), those residents are also feeling a bit lonely. I have a hunch that it has to do with how much of your life that residency takes up. Residency is a niche experience to boot. That niche-ness is amplified in a field as small as medical physics, and amplified again when we’re separated out into our respective specialties. If anyone relates to this and is looking for advice, I’d say to start looking for community outside of work. When work starts consuming too much of your life, it becomes harder to feel satisfied with life as a whole.

I’m also happy to report that after getting settled in, I get along great with the physicists at work and I feel like I truly belong in this residency and this city. One of the reasons I started this blog was to share my experiences with others in hopes that it would be helpful or relateable to someone out there. Since medical physics is such a small field, there isn’t a lot of content out there about what it’s actually like to be a resident. I hope this post could be a small window into that world.

That’s all for now. Thanks for reading!