I have learned more from my failures than my successes. My current practice is a hybrid of academic and community sites, and I have worked in myriad community hospitals from busy ones to single coverage critical access hospitals. Each has its own challenges and lessons.

Emergency medicine residencies focus heavily on foundational knowledge, procedural competency, and professionalism. But we often learn real life, practical skills during our first years out of residency. I have learned much of this the hard way. Hopefully, they will make your first few years out a little easier.

1. BE EARLY, BE PREPARED, AND INTRODUCE YOURSELF

For your first few shifts at a new facility, introduce yourself to the nurses, consultants, and ancillary staff. If you are single coverage right off the bat, you need to be familiar with your facility’s OB, peds, and difficult airway resuscitation equipment and resources. Ask your charge nurse or medical director to walk you through it. You do not want to be fumbling through the pads or OB equipment during a critical resuscitation.

Arrive early, especially when relieving the overnight physician. Institutional culture varies, but it always goes a long way to relieve your colleagues 15 minutes early.

2. STAY CONFIDENT, BUT HUMBLE

You do not want to brag about your airway or central line skills just to be humbled by a difficult peds airway or angioedema your first shift. Medicine, especially emergency medicine, is a humbling profession. When you do have a challenging angioedema or case, I personally find it helpful to take a couple of breaths. I recently learned the power of fully exhaling instead of the typical “take a deep breath” advice. I now practice this routinely. Remind yourself that you know what to do. You are well prepared for this. Getting anxious will not help. Mind over matter. Lead your room well. Know your contingencies.

If the resuscitation does not go as well as you wanted, learn from it and move on. The past is the past. If you have a difficult outcome, it is helpful to know what risk management support you have at your hospital. Sometimes there is a risk management staff member on call to support you in navigating challenging outcomes, including your immediate documentation.

3. ATTENDING LIFE CAN BE LONELY, SO FIND YOUR COMMUNITY

For those starting a career in a new practice environment, it can be lonely at first while you nurture relationships. Residency sets you up for success from day one, but transitioning into a new job takes courage and time. Give yourself grace.