The Hitchhiker`s Guide to the Residency

By Giuseppe Reale, MD, Catholic University of the Sacred Heart – Rome.

November is coming and, with it, the end of my 4-year Neurology Residency. After being on-the-move for so long, it is normal to calm down to settle accounts.

The complexity of neurological disorders has always been tremendously wonderful to me. When I was an undergraduate, it came to my mind that solving puzzles in order to help people could be a fascinating way of being a doctor indeed. A couple of months after joining Neurology internship -mainly because of my impatient temperament-, I understood that, yes, I wanted to solve puzzles, but I wanted to do it rapidly! This opportunity was made real by the Stroke Unit of my University Hospital. Seeing neurologists in an intensive care environment was amazing and inspiring. It was 2012, before the thrombectomy Era: I still remember the unspeakable thrill I experienced every time I saw an early neurologic improvement just after intravenous thrombolysis. After 2012, acute stroke care rocketed: trials on thrombectomy in 2015, the time-window breakthrough with DEFUSE-3, DAWN, WAKE-UP, EXTEND and so on. When such a revolution shakes your field of interest, you are extremely excited, motivated and determined to get a progressively deeper insight into the discipline. And your Residency goes on faster than you expected.

Now, I am older, probably not wiser, but for sure I am a “survivor”. To younger colleagues intending to follow this path, I would say “Don’t panic and read this brief guide to the Residency”.

  • Choose the right mentor. I was extremely lucky because I found the right person since I was an undergraduate. Sometimes it takes longer. A good mentor should be a motivated and enthusiastic clinician and researcher, able to teach you and involve you in clinical projects, respecting your time and space. A good mentor should interact with you as a peer and not as a subordinate. A good mentor should be inspiring, showing you the way, without putting barriers to your personal development. A good mentor should be there when you succeed and when you fail. A good mentor should be someone to look up to.
  • Keep studying. Residency can be tough. Often you are in a hurry and feel overwhelmed by clinical duties, bureaucracy and deadlines. In this situation, putting studying aside is the easiest way to keep breathing. But consider how rapidly the acute stroke care changed in the last 7 years (and so did multiple sclerosis, migraine, amyloidosis and other diseases): is it a train you want to miss? Get updated and keep studying neurological diseases and their semeiology, rehearse neuroanatomy and neurophysiology: it will help you more often than you imagine. Do not get stuck in the routine. Ask questions and look for suitable answers. Go deeper when you do not understand. Share ideas and discuss challenging clinical cases with colleagues.
  • Do research. With research, you will build a peculiar cast of mind that will come in handy in many situations, even in daily life. Curiosity and enthusiasm that come with research will often give you the strength to carry on when all seems dark and pointless.
  • Do not miss any occasion to open your mind (personally, clinically and scientifically). Join conferences, meetings, workshops, get in touch with national and international organizations (ESO, as an example), build strong networks, and make friends. Look for awards, bursaries and scholarships. Occasions to develop social, scientific and clinical skills will come, even when it seems impossible – don’t miss them!
  • Fly-low. Be kind to your colleagues and other hospital staffs, especially nurses. They are your family and safety net there – do not mess up. Don’t be arrogant, don’t be afraid to ask for help. Share your fears, hopes and concerns with your colleagues: you will find out that you’re not the only one to have such kind of problems or doubts.
  • Remember that there is life out there. Do not forget your friends, your family, your partner. Do not forget yourself. Try to keep healthy, even if eating chips every day instead of having a proper lunch seems the best way to save time and go home earlier. Keep doing your hobbies, do not leave your favorite guitar rusting in a corner or your running shoes aging under your bed.

Obviously, these are just suggestions from an average, expiring Neurology resident. As far as I am concerned, I think that European Stroke Organisation gave me many opportunities to meet colleagues from all Europe (ESO Summer and Winter School), visit other Institutions (Dpt to Dpt Programme), build research networks and have a deep insight into the stroke field (ESO Conferences). So, I would warmly recommend younger colleagues who are starting their residency and are interested in cerebrovascular diseases to join ESO activities in order to boost their professional growth, knowledge and group of friends.


For anything else, the answer remains 42.