Someone once told me that the learning curve after completing residency is steep and the first three years after graduation will set your practice pattern for the rest of your career. I’m still very early in my career as an emergency physician. However, this year, I have experienced and seen things as an attending that I did not get exposed to in residency. With a new crop of emergency medicine graduates entering the workforce, I feel obligated to share the lessons learned during my first year as an attending.

• Don’t be afraid to ask for help. On my first shift as an attending, I had a patient who I wasn’t sure how to manage. I felt somewhat intimidated and embarrassed to ask my colleagues for help. That was a mistake. Remember that you won’t know everything stepping into a new role and environment. I soon learned that I should never be too proud to ask for help at any point in my career. It can leave you stuck and ultimately can lead to poor patient care.
• Trust your training. Stepping out on your own as a new attending is scary. There are going to be moments when you doubt your decisions and feel stuck as a result. Should I order this test? Can I safely discharge this patient? Remember that you are a well-trained emergency physician who is equipped and capable of managing whatever task is at hand. All the hard work and hours spent in residency will not be in vain.
• Be humble, or your patients will humble you. I graduated residency feeling like I was hot stuff. At the time, I thought I was merely confident but not overly confident. In reality, that confidence was hubris. Hubris will ultimately lead to mistakes, and it is the patient who ultimately suffers.
• Continue learning. A career in medicine is a lifelong learning process. Every shift, every patient, every visit you will be exposed to something new. It’s the innate beauty of working in emergency medicine. This is a time in your career where you will be malleable to adopting new practice patterns and techniques. Now is the time to evolve and grow in your practice as opposed to cementing yourself into any one routine.
• Trust your gut. Call it your intuition, your sixth sense, your hunch. If you think something seems off about a patient, you’re probably right. Never ignore that feeling! And always trust the gut of your experienced colleagues. Experienced nurses are rarely wrong.
• Being lucky > being smart. I was told often in residency by sage attendings to always “be a dumb, diligent doctor.” This notion is a reminder not to cut corners when it comes to patient care. Get a complete history from a patient. Commit to a comprehensive but appropriate workup when evaluating a patient. This mantra has already saved my tail a number of times.
• Know your support staff. I learned early on that you are only as useful as your support staff. I made an effort to commit to knowing every nurse’s and technician’s name in the emergency department when I first started as an attending. Do your best to communicate your plan and reasoning to your staff. Involve them as much as you can in the care plan. Always treat them as equals, and they will always have your back.