A view from the coffee room…on the friendship between residents

Residency, and especially surgical residency is hard1. Burnout, depression, harassment, emotional exhaustion, and stress are way too familiar with current surgery residents2-7. Unfortunately, the situation has not changed much since I was resident8, 9. But what has changed is that we acknowledge this now. I have to say though, it is good that I did not read these articles before I started my surgical career about 27 years ago.

Surgery residency and residency in general changes previous personal relationships and this is tied to evolving professional identity10. Strange working hours, and patient-doctor relationship confidentiality may lead to fewer talking points with non-medical friends and family11. Further, these relationships with non-medical friends and family may not thus provide the support they used to,11, 12 especially when dealing with work-life and residency.

Although surgery is one of the most demanding among all medical residency programmes13, and the Covid-19 pandemic made it even more stressful14, there are rewarding moments. For me, it was feelings of belonging and camaraderie, friendship with co-residents, in addition of course to improving dexterity and learning plastic surgery.

Friendship is a voluntary relationship between autonomous individuals15. This might be the most prosaic definition of friendship. Analyzing this definition, an additional word voluntary is an excellent clarification, otherwise starting a friendship might lead to unpleasant legal actions and restraining orders.

During my residency, I made friends with my co-residents. We shared experiences. We talked about medical errors and successes. We shared challenging patient encounters and complications and learned that everyone has them. We learned from each other the best ways to survive in the hospital infrastructure jungle. We talked about our consultants and what was the best way to ask a loaded question, to get the answer you wanted to hear. We made fun of the typical responses of our consultants. We talked about our consultants´ personalities, what was good about them and what everyone hated. We scrutinized different personal and distinctive operative techniques employed by our consultants and swore that we would never do it like they do. We heard older residents talking about earlier parties. We learned what to wear in the summer gatherings – not too formal. We heard anecdotes and an oral history of plastic surgery in Finland. We laughed together on the post-on-call fatigue. There was no need to describe exhaustingly what was in my mind16, we all just knew. At first, I was the one listening and not long after I was the one telling the stories and transferring the tradition. In retrospect, and extensive literature search – the support was tangible, emotional, and informational16.

Social belonging improves resident well-being17; this is natural, we are herd animals.

Human herding has been studied especially in the context of economics, marketing and finance18. We humans need others to survive and prosper19. We learn and can change our behaviour by observing what and how others do. This is social learning and passing tacit knowledge. Without tacit knowledge our expertise is not complete20. The concept of tacit knowledge was very difficult for me to understand, after all I am a surgeon, and my idea of knowledge is tangible. It was only after I specialized and started to guide and train younger colleagues, I suddenly heard myself talking about things that I did not know I knew. Phew, pretty metaphysical, isn´t it.

Now, I am a consultant and a professor. I am still friends with my ex-co-residents, though we chose different paths in plastic surgery. They are my go-to friends when I need a neutral second opinion. And a final note, we know what you residents are talking about. We have been there.