I asked Dr. Honora Sandifer to respond to this invitation because I was interested in how she organized her time to make her such a successful resident. As a second-year resident on my inpatient service, I found her to be uncommonly dependable. Medical students commented that she was the best resident they had had in medical school—not just the best psychiatry resident, but the best resident on any service. She was a role model for women students, but for men too. Clearly bright, clearly hardworking, but was there some other ingredient?

The residency at our university (not unlike other programs I am sure) is a juggling act of competing demands on the residents’ time. Education versus service is a perennial tension. Readily available supervision hopefully makes the clinical duties educationally valuable. And with greater clinical experience, residents learn to rely progressively on themselves, their judgment, their experience, and realize when they need to ask for help. Dr. Sandifer’s commentary indicates how important it has been to have learning experiences apart from clinical experience and how one informs the other.

As is evident from Dr. Sandifer’s experience, having a child presents a large demand on residents’ time that both men and women have to be responsive to. Some residents also juggle moonlighting jobs in their "spare" time (our program permits this once residents have passed USMLE Step Three). Some residents pursue research interests in elective time or time they find after hours. And everyone must develop a reading strategy, not only to keep up with assignments, but also to keep up the information explosion (probably no field is changing as quickly as psychiatry).

I asked Dr. Sandifer once how she managed to know so much about her patients. She said she came in as soon as they got up to preround, following them to the cafeteria if necessary to talk with them before official rounds began. Her notes reflected a to-the-point understanding of their problems and the decisions that would need to be made. If I asked for a lab result or for a medication dose, she had the number at hand—causing me to wonder if she were some sort of savant that could keep entire medical records in her head. But no, her strategy was to keep only essential information. If I had a reason to ask, she had anticipated that reason. Depakote level? 65. Did we do thyroid studies? Yes, they were normal. Occasionally I would fantasize asking something perversely irrelevant just to see if she would know the answer, but I did not want to undermine my own credibility. There is really no time for gamesmanship in a busy clinical service. Though I recall times I was embarrassed by my own professors with such questions, it was never by the professors I respected most.

What Dr. Sandifer’s commentary tells us is that she genuinely cares for her patients, the staff—remembering to ask about their problems and express appropriate concern—and her colleagues. The nurturing link between the way she cares for her daughter and her patients is also evident. The representative day she describes indicates another ingredient that seems to help ensure personal and professional success: she has been able to find mutually supportive interactions with her fellow residents, faculty, staff, and her family.

Dr. Dyer is affiliated with the Department of Psychiatry, East Tennessee State University, Johnson City, TN. Dr. Sandifer is a graduate of the East Tennessee State University psychiatry residency program and is currently in practice in Charlotte, NC.