CanMEDS Manager
Unique Demands

Unique Demands and Special Considerations





Are there unique circumstances and special considerations that require unique management skills? Are there things that increase stress levels and need extra management attention?


Starting residency

The transition from medical student to resident is an enormous one in terms of learning, responsibility and stress. It may also involve a geographic change and may coincide with other significant life events. There is likely to be activity in many spheres of your life - emotional, financial, educational... that need to be uniquely managed during this time period.


You are asked to provide advise to the new residents starting in your programme. What do you tell them?


You are asked to provide advise to the new medical students. What do you tell them?


Have you followed your own advise? if not, why?

How to maintain your own priorities in face of professional pressure?


from the PAIRO website:

Things I wish someone would have told me when I started residency.

  • Connect with a senior resident in your program and learn the “inside scoop” about residency. Every program is a little different, so this will help you prepare for residency!

  • Don’t worry about call beforehand. If you prepare and plan for the typical problems that arise when on call, you will be more relaxed.

  • Avoid making any major decisions when you are post call. For example, sending letters to your program director, scheduling rotation evaluations, and making post call purchases - can sometimes be more costly than you planned!

  • Get involved. Organize outings with your program as well as with other programs. Consider starting or joining a study club; it will be good for academic and social support.

  • Try to set aside a little time for physical activities and mind relaxation. It may be challenging at times but it will provide you with more energy to take on your busy schedule.

  • Be sure to book a holiday within the first 3 months of residency. Adapting to your new role as a doctor will be an exciting learning experience and taking the time to recharge with a holiday will make it more enjoyable.

  • At times it may seem like you are working very hard and no one notices. Although not everyone provides encouragement or recognition, keep in mind that when you are doing your job well, most patients notice.

  • There’s a lot to be learned in the “scut” work that you are doing! It’s not just a rite of passage.

  • To prevent over-exhaustion, try to create an environment that will guarantee you a good “day’s” sleep post call. Curb your caffeine intake before your shift ends and get a good blind for your bedroom window.

  • Be efficient with your time. You should never have to stay later than 5 to 6pm when you’re not on call–that’s why there is call. And don’t leave your daily chores for the on call person. What goes around comes around.

  • Ask for help if you are not one knows everything and no one expects you to know everything right away.

  • Having a good support system to guide you through these times will keep you centered and focused.

  • Accept that you are going to make mistakes during residency. The important thing is to own up to your mistakes and get assistance so that you can learn from the experience.

  • Be a team player. Support your colleagues both in work and emotionally! They know what you are going through–they’re experiencing it too. Always remember that you are not alone and you are definitely not the first one to feel this way–GUARANTEED!![1]


Women in medicine

Women have different patterns of practice, are more likely to be in salaried positions, tend to talk longer than allotted times with patients and as a result earn less than male physicians. [2] Women are more likely to work in primary care and academia and are also more likely to work part-time or in salaried positions.  Though there are more women entering academic positions they are not proportionally represented in senior management positions. This can mean a decreased rate of career progression or hitting ’the glass ceiling’ in academia, isolation, frustration and demoralization.


In heterosexual relationships women still carry the bulk of the responsibility for home and child care. This stressful juggling act of two full-time jobs can lead to sense of always shortchanging someone. “Ultimately, stress leads to burnout with its associated physical problems and illnesses, relationship difficulties, negative thoughts and feelings, and exhaustion. Women physicians are 60% more likely than male colleagues to report burnout.” [2]


Other stressful situations

Other family situations that can be associated with increased stress include - illness in the family be it a partner of child, single parenting, relationship difficulties not just separation and divorce, a partner traveling a lot or working in a different city.  Within communities being a new comer, ethnic or religious minority status of any sort can also place unique demands on a person. Gay or transgendered physicians may experience increased stress from being closeted at work and in the community if they live in small or rural locations.


When illness comes home with you

Many physicians have health issues, physical and mental health. Diabetes, MS, bipolar disorder, musculoskeletal injury, substance overuse or abuse, anxiety and depression - we are not immune!  There is not often space for us to reveal our own challenges and struggles.  This isolates us form one another and in the end makes us all weaker.  Find trusted colleagues with whom you can be honest and share burdens.

As well as providing care at work many physicians have care-giving responsibilities at home. Parenting is the obvious example of this but it goes beyond this.  Becoming a physician may place you in a unique role in your family and you may become involved in the health of family members - translating medical information for them, or actually providing care for ailing grandparents, parents, siblings or other relatives.  Acute illnesses in your family may be very demanding for a period of time, but chronic illnesses  may be something that you need to work into your schedule somehow and manage along will everything else.

These things compound the usual stresses of residency such as time pressure, financial concerns, performance anxiety and the looming threat of examinations and licensure not to mention decisions around final practice location and details.


Times of trauma

The end of relationships, financial stress, addictive behaviours, critical illness or death in family are all times of personal upheaval and trauma. Strive to give them the time and attention they deserve, do not minimize them. They are important matters and deserve that level of care and attention.


Suggested Strategies

  • define work time, take time off and really be off

  • schedule breaks and holidays, personalize your workspace

  • keep up with paperwork

  • learn and use organizational and time management strategies

  • make career decisions based on work-life balance – choose the job with parental leave, flexibility or mentoring programmes if they will be important to you – or work to establish the things you need

  • nurture your relationships – partner, children, friends and extended family and give them the time they deserve, not the time left over

  • nurture your relationship with yourself, spend time alone, learn something new, follow your dreams

  • take care of your self – your body, your mind, your psyche, your soul

  • monitor your stress level and take positive action early

  • financial stress is insidious, deal with it

  • addictions and substance abuse are signs of stress and stressors themselves, get the help you need.



1. PAIRO - Professional Association of INternes and Residents of Ontario. from the Resident Well-Being section accessed September 24, 2011

2. Gautam M. Women in medicine: stresses and solutions. West J Med2001;174:37-41.

All references for this section