Starting a little bit late, but felt that life skills would be presentations would be really very, very beneficial for you as residents in the training. So we -- we picked a couple of what we think are important topics to present to you. And our first one is going to be on the Resident and Attending Relationship that sometimes adversarial, hopefully not hopefully a collegial, but it's a fine line that you need to walk between the Resident and the Attending and especially had some insight on that. So we’ve asked Dr. Johnny Alayon owned from Seattle to speak to you on this. Now, Johnny was previously in San Antonio at the UT program.

He and his lovely wife Suhad just moved up to the Seattle VA program where they're taking very active role Residency Training Program up there, personally I'm very, very happy that they did. That's a -- that was a wasteland for the VA, and I'm very hopeful that that's going to become a very, very important program based out of Seattle. So with that said, let's please welcome Dr. Johnny Alayon to the podium.

Dr. Johnny Alayon: Good morning. I just want to thank Dr. Friedberg for inviting me here to speak on the Resident-Attending relationship, and this is kind of a loaded I guess topic if you look at it from both the Resident and the Attending perspective. It's something that we all have gone through one time or the other once props more, more than one likely as a resident, and then hopefully you know by getting involved hopefully we would love all residents to get involved as an educator. I mean it's very important to not leave that kind of spectrum or, or that stage in your life and not be able to teach the next generation. I think the perspective and, and one of the things that we always worry about is that is it us versus them, and that goes both ways. I mean it’s the attending's as well we're like those residents and, in, in, in what do w supposed to do how do we get through to them. And the resident's perspective is why are they always on top of us. We're trying to do the best that we can. It's something new. We're learning, so it's, it's definitely something that we have to look at both sides and as a resident as well as attending you have to kind of step out of your shoes and kind of look at where the other group is coming from I guess.

So defining the Attending-Resident relationship it's tough, I think at some point in the process both the Resident and the Attending field that it could be a little bit more parental you know they're treating me like a kid or I have to treat them like my children so that they get the notion of what I want them to go. It's almost like we have to you know as an Attending we almost feel like I need to hold their hand. And as a Resident, you're feeling god if they just let me go they'll see how far I can get and do well by on my own. Ultimately, I think what we all want to have is a collaborative kind of relationship, but we're working as a team. We use the knowledge and experience of the attending's, the enthusiasm and passion of a resident, wanting to learn and get more out of everything, asking questions that maybe would have not been raised.

Putting a different perspective in the attending's, I always tell my residents and not just in Seattle, but where I -- when I was in San Antonio at the VA and the UT Health Science Center Resident I'm going to learn as much from this patient from you as I hope you learn from me because we're going to -- its, it's a new set of eyes that gets to see this patient and how different perspective on how to treat this patient and where they're coming from. One of the things that we always see with resident's is you know we teach them, and then they come and present, and we go in the room, and the patient tells you everything that you're like, he didn’t say that as a resident. And, and the attendee is like well you didn’t ask. But sometimes it's not just that you know the relationship there is the Attending-Resident and Patient relationship.

The patient definitely is going to open up a little bit more to the attending and that's just kind of human nature, and you have to understand that, but what you do learn from each patient that you see as a resident is it there are sometimes you're just going to have to be more specific with your questions. You're not going to open up all the way or immediately. I got this quote "if you cannot teach a man anything you can only help him discover it in itself". I think that's important. I think we have to as an attending is to show residents. This is where we want you to get to. Now you have to find that path to get to that spot. I always try to give residents insight of where we want to see you in a stage in your residency, where you should be after your first year, where you should be at after your second year, and where we would like you to be once you complete our rotation and our program.

But the cornerstone to this relationship is trust. Attending has to look at and they must be clear of expectations of residents. If you're not clear of your expectations, you get ambiguity of what the resident presents to you. We also expect residents to make prudent medical and surgical decisions. The resident their trust, they have to be able to speak up when he or she has questions, and we'll also expect the attending to deliver knowledge and experience in an environment conducive to learning. And the one thing that we learn as residents and as attending's that everybody's different. And we have to find that difference, and we have to kind of teach so that that resident gets the most out of their experience with that one patient or with the rotation as a whole and that's difficult. That's hard. I mean it's hard from the resident's perspective, and is very difficult from the attending. I always thought that you know as a resident well he should just know how -- the best way to learn, but everybody's different.

So the other thing is understanding, understanding where each kind of team is coming from whether it’s the attending or resident. The attending must understand that the residents have very widely in values, very widely in willingness to perform, very widely and reliability, and they're not cheap labor or patient sitters, and that's really from a resident, you know, I just feel like I'm just seeing more patients and doing everything and they're kind of sitting back and just checking off and going okay we're done. As a resident, your understanding needs to be that attendees can't be authoritative I mean, that's just part of what we are sometimes who we are, but a lot of it has to do with it's their patient and ultimately they're responsible, so their expectations and like I mentioned before they have to set those expectations so that you know.

The resident also must understand that attending's have a lot of real-world experience, knowledge and skills to convey so every attending that you encounter has something to teach you. Good or bad something that you'll take and use for the rest of your career or something that you're like I'm not probably going to sue that ever, but it's something that you can learn. It's a lot easier and I think as you grow, you'll understand the reasons behind it and I think as you're growing now, you understand why your father and mother told you not to do something even thought I'll find out myself, but at the end of the day everybody's looking you know especially the attending is looking for your own good.

And also the last thing is they do not have to be a friend for you to learn from them, so you don't have to be their friend to get something out of the Attending-Resident relationship. You just have to understand what they have to offer and hopefully take as much of it as you can. I always tell the residences you need to be a sponge, and your job is to be a sponge. Take out all the information you can from every attending you encounter, and kind of decipher what is best for me, what am I going to use, what is the best outcome at the end of the day or at the end of residency. So here's the contract that you guys have as a resident and as an attending.

Resident, I'm here to learn. As attending, I'm here to teach. So Albert Einstein said "Everything should be made simple as simple as possible no simpler". I think this is about as simple as you can get when it comes to the Resident-Attending relationship. You know your goal. You know your expectations. Your expectations to learn something every day, and take that point and use it the next day, but don't forget what you've learned the day before whether it's good or bad. And the attending's goal is to teach you something everyday they didn’t -- you didn't know going into the patient encounter or into the day or into the rotation. That's important. If you don't get anything out of it everyday your goal is to leave your rotation, leave your patient, leave your day and go back and reflect.

What was the one thing that I got out of today? Was it good or bad? Doesn’t matter, but you got something out of it? Am I supposed to read more? It's just simple. You know should I looked at this patient from a different perspective? You know, so it's a really simple thing, but definitely that's the contract that you guys need to take going into the residency as well as the attending needs to take as well. So this, this is to remind me that at some point in your stage of teaching, and your stage of learning you're going to be the big brother, and at some point you're going to be the little brother. And what you need to say is promise me you'll always remember you're braver than you believe and stronger that you see, and smarter than you think.

And that's the one thing you have to teach from a resident you have to teach that to students. From attending you have to teach that to residents and every stage you have to learn from that and improve. And hopefully at some point to the residents here at some point you'll be standing up here and teaching this to the next generation is that's pretty much all what Residency-Attending relationship is. Its -- I'm willing to learn, I'm willing to teach, but I'm also willing to give of myself to this profession. Thank you.