The Example We Set: Thoughts on the End of Residency Training

It was six in the evening at the beginning of my intern year, and I was rotating on general surgery. A senior resident wanted me to discharge a routine post-operative day surgery patient, and cardiology needed to see the patient non-urgently before they left. Cardiology was not eager to come in for a non-urgent consult at six in the evening. And when I could not make it happen, the senior general surgery resident screamed at me through the phone, furious that the patient would now have to be signed out to the on-call team and discharged the next day.

In the grand scheme of residency, this is a fairly ordinary story. I am probably not the only intern who has been yelled at over a delayed discharge. But the night before, my grandmother in Shanghai had suffered a stroke and passed away. Because of the COVID-19 pandemic, my family and I could not travel to be with her. Instead, my parents, my brother, and I joined by video call at midnight as she was taken to the funeral home, with the authorities there requiring a quick cremation out of concern for the virus’s spread.

I walked back toward the workroom crying, struck by how absurd it felt to have just been reamed out over this when, that morning, I had barely been able to pull myself together to come to work.

A general surgery chief resident saw me in the hallway. She was not on my team. She would never work with me again. She pulled me aside, brought me to her office, and just sat with me. She surely had a hundred things left to do and wanted to get home. She chose, instead, to spend 15 minutes with me, an unknown intern.

I do not think she remembers that evening, but I have never forgotten it. Two residents. The same hospital, the same evening, the same overworked system. Neither of them knew what had happened to me the night before. One chose frustration, while the other chose humanity. Neither event appeared in a case log, but both residents taught me something that has shaped the surgeon I have spent the past five years trying to become.

What strikes me most is precisely that neither of them knew the impact that they would have on me still, years later. The resident who screamed at me was not being cruel to a grieving grandson but just being impatient with an intern who had failed to expedite a discharge. The chief who sat with me did not know she was catching someone on the worst day of his residency. She simply saw a person crying in the hallway and decided that mattered more than her to-do list. We rarely know what the person beside us is carrying, so our default is what matters. The example we set as senior residents and attending physicians is set in our most ordinary, distracted, inconvenient moments because we do not get to choose which of those moments will stay with someone for the rest of their career.

Residency concentrates this responsibility in a way few of us are taught to notice. The hierarchy of training means that a senior resident’s stress rolls downhill by default, landing on the people with the least power to deflect it and the least experience to contextualize it. An intern cannot tell a chief to take a breath. What interns can do—and what they inevitably do—is watch, absorb, and quietly decide, whether consciously or unconsciously, what kind of resident they will become. Every senior resident is teaching, all the time, whether or not they intend to be.

I learned how hard this is only when the responsibility was mine. As a chief resident, I discovered how much easier it is to become the frustrated voice on the phone than I had assumed as an intern. There were days when a missed task meant a patient would stay another night or when a consult could not be expedited any further and attendings asked why the patient was still here. In those moments, I could feel the same pressure that must have been on the other end of that phone call years earlier—and the pull to press my team to “make it happen.” What I tried to do, imperfectly, was take a second to process and make a plan with my team rather than react with frustration at them. One of my interns later told me at graduation that this had made a difference. I had not known they were watching. That, of course, is the point: Our junior residents are always watching.

Medicine asks everything of us: our time, our attention, our emotional reserves, our presence. It does this, sometimes, without asking whether we are okay, and it makes no exceptions for the other events happening in our lives. We cannot always control the pressure of the system we work in, but the way we treat others when that pressure peaks is one of the few things that remain entirely ours.

We will all have moments when we are tired and frustrated, standing in a hallway at six in the evening, wishing we were anywhere else. In those moments, we choose—often without realizing—which resident we will be. I hope we remember the one who opened her office door. I hope we choose to be that person.    

Dr. Zhou graduated from the Mass General Brigham/Harvard Medical School otolaryngology–head and neck surgery residency program in 2026 and is now a fellow in rhinology and endoscopic skull base surgery at Stanford University in Stanford, Calif. His interests include medical education and research on patient-reported outcome measures and quality of life in sinonasal disease.