During the throes of his Osler internship, Rich Ambinder recalls falling asleep while listening to a patient’s heart. It was 2 a.m. He had been on the wards for roughly 26 hours. “I heard her say, ‘Doctor, doctor, are you awake?’”
It was hardly a proud moment, but an instructive one.
The 62-year-old Johns Hopkins Hospital oncologist tends to mention this anecdote whenever he and his son Alex, a third-year Osler resident, discuss their medical training experiences. The Ambinders are among a growing number of parent/child Osler trainees who can shed light on the challenges—and learning opportunities—that have accompanied their respective residencies.
“I think anyone from a generation earlier thinks there were some valuable things about continuity, seeing patients overnight and very sick patients evolve over a period of time,” says Rich. “But I have no doubt that the system I grew up in had many problems.”
As examples, he cites frequent 30-hour shifts, limited supervision (“No simulation lab; it was more see one, do one, teach one.”) and paper records (“It could take days before the medical records office could locate a patient’s history.”). Rich also recalls the small number of women in the program 35 years ago.
For his part, Alex, who will complete his residency in June, says he’s found the fatigue manageable. “I was actually hypomanic at first—it was so exhilarating,” he says. Still, Alex struggles with the 16-hour shifts and forced handoffs. “I’ve had people kicking me out the door when there’s a discussion about a patient that I’d like to be a part of,” he says. “Yet there’s something good about having boundaries.”
Some positive things about the program haven’t changed, agree father and son: the camaraderie and high-caliber teaching. Unlike the competitive environment in college and medical school, says Rich, “people in the Osler residency make you feel like you’re part of a team.”
Like his father, Alex will specialize in hematology/oncology. He begins his fellowship in July at Johns Hopkins, where Rich trained. After completing his first year, Alex will serve as an Osler assistant chief of service (ACS). “I hope to foster the same kind of environment that made my residency more enjoyable,” he says, “thanks to people who were excited about medicine and respectful of my own sort of learning but pushed me to do better.”
Helen Selonick Prevas, who completed her Johns Hopkins internal medicine residency in 2012 (Janeway), cut her teeth on Osler folklore. Both of her parents are alums: Martha Selonick, Osler 1979, and Stuart Selonick, Osler 1978 and Longcope ACS. They are currently in private practice. Martha is a cardiologist; Stuart, an oncologist. He has also been teaching Osler residents outpatient medicine for the past 30 years. Helen is the oldest of their three children.
As a youngster, Helen often “hung out” on the wards with her parents. She knew from an early age that she wanted to be a doctor. Now she’s about to complete her first year of a fellowship in critical care at the University of Maryland Medical Center. Reflecting on her Osler years, Helen says fatigue rarely overwhelmed her. “You’re too busy to feel tired. There are sick, complicated patients who need your attention.”
But between her second and third year, following the birth of her daughter, sleep deprivation hit hard. And her husband was in the midst of an emergency medicine residency in Delaware. Even with babysitting support, she says, maintaining a balance was tough. Thankfully, she says, Osler colleagues were kind about reworking schedules. “We’re used to swapping call,” she says.
Helen also discovered that the firm system was the perfect antidote to burnout. “The same four people were on every fifth night,” she recalls. “We’d all get together in one of the firm offices, eat dinner, use the computers. And when a problem arose, we’d deal with it together. We’d work on notes, ask questions. It wasn’t isolating. It wasn’t a grind; it was fun.”
In the 1970s, during Martha’s every-other-night-call era, very few female trainees—if any—had children. And, she recalls, because of the small percentage of women residents back then, she was often presumed to be a nurse. “That still happens,” she says, noting that cardiology attracts more men, “but not nearly as much.”
At family get-togethers, Martha says the threesome rarely disagree about the pros and cons of their Osler medical training. “I think fewer hours on call are better for everyone,” she says, noting that additional layers of support in the program shouldn’t affect quality of care.
To incoming Osler trainees, Martha offers this advice: “Spend time with the patients. Hear their stories. They’re the best teachers. But make sure to value mentors as role models”—words she may one day repeat to her granddaughter, should she, too, opt for a career in medicine.
The program’s latest parent-child duo: Johns Hopkins Medicine Nephrology Division Director Paul Scheel Jr. (Osler 1990) and Paul Scheel III, who begins his training in July.