Welcome to "Ask the Program Director," a column fromMedPage Today where your most pressing questions about residency -- from the application process to life as a resident -- are asked and answered.

Dear residency program director,

I'm a first-year emergency medicine resident working nights, and I can honestly say it often feels like "The Pitt." I have so much to learn in this environment, but as someone who is not naturally a night owl, I'm struggling to keep up (let alone keep my eyes open). Beyond just the challenges of providing high-quality care, this schedule is affecting my personal life and relationships too. My girlfriend and friends feel neglected, and when I do have time to socialize, I'm often cranky or exhausted.

I'll eventually go back to days but this night block has been brutal so far, and I still have a few weeks left. Any tips or recommendations to make it more manageable?

Dear resident,

Thanks for shedding light on a question I know many residents have, although few ask. I've watched some residents thrive on nights while I've seen others struggle unnecessarily. The difference is rarely grit or intelligence, but rather preparation, strategy, and shifting one's mindset.

I understand how rough nights can be. I spent 12 weeks doing night rotations as a second-year radiology resident, and my first job out of fellowship was serving as an emergency/trauma radiologist at a medical center where I worked 1 week of nights with 2 weeks off. So, having experienced nights as both a trainee and attending physician, I want to share five tips to improve your experience.

Prioritize Sleep

Feeling cranky and exhausted and struggling to keep your eyes open can be natural while on nights, but is often a result of sleep deprivation. I have found the most common mistake residents make on nights is underestimating the importance of sleeping enough before a shift.

As I am sure you already know from medical school, sleep loss impairs reaction time, ability to learn, decision-making, mood, and even empathy -- skills necessary to perform at a high level at the hospital. Lack of sleep itself may potentially explain a hindered performance and challenges with your personal life.

Aim for protected daytime sleep by closing curtains, silencing sound and notifications on your cell phone, and potentially using an eye mask. When you are post-call, sleep should be your first priority. Your emails and social obligations can wait. Getting adequate rest can do wonders for your performance at the hospital and can also allow you to be present in your social life.

Optimize Your Clinical Handoff/Sign-Out

A good night usually begins with a good sign-out or handoff from your fellow peers. This can set the tone for your entire night. As an emergency medicine resident, feel empowered to ask your co-residents who the most critically ill patients are so you can mentally prepare and triage your approach to the night. Knowing the patient's code status, what special needs some patients may have, and anticipating events that may occur overnight can bring a strong sense of preparation throughout the night that will set you up for success.

A similar sign-out in other fields such as internal medicine, surgery, or even radiology can help you plan your night so you are not surprised if things do turn south as the night progresses. Although you cannot prepare for everything in medicine, the more prepared you are to anticipate what will happen, the smoother your night will likely be.

Approach Nights With a Learning Mindset

This may be a tough ask, but is absolutely necessary if you want to survive and thrive on nights. Most residents, including myself when I was a resident, dread nights and simply want to survive and "get through it" without harming patients or making egregious errors. If you can shift your mindset and treat it as a unique learning experience to make important clinical decisions with less traditional supervision as during day shifts, you will get much more out of nights.

Night shifts are necessary for your growth as a competent physician. It is on nights you often encounter clinical scenarios that you may not see during a typical day shift. On nights you will learn important lessons because you are given more autonomy.

I vividly remember a busy night in the emergency department as a radiology resident and missing a case of grade 3 acromioclavicular injury. It was a miss that has been etched in my memory ever since. But it taught me to carefully scrutinize the position of the acromion and clavicle on a shoulder x-ray. I often teach this miss to my residents when giving case conferences. These experiences allow us to learn and grow as physicians and shape the way we teach and approach clinical care.

If you approach nights with this mindset and embrace the spirit of lifelong learning, you may even start to enjoy your night shifts and will certainly learn much more than expected.

Know When to Ask for Help, Without Guilt

Through my many conversations with residents, I have learned that one of the most stressful aspects of night work is deciding whether or not to ask for help. This can often be a source of stress and anxiety for residents across multiple specialties. I have found that residents often delay escalation out of concern for burdening or waking attendings or senior colleagues.

My advice is if you are unsure whether something warrants a call, it probably does. Hesitation usually causes more harm than help. As attending physicians, we expect calls from our trainees when taking call and we would rather help a patient than wake up to a preventable disaster. Having the courage and understanding to get help when needed will reduce your stress and anxiety during nights.

Bring and Practice Joy During Nights

Bringing joy to nights may sound counterintuitive. However, you have to protect your mental health, particularly during nights when fewer people are around, and feelings of isolation and emotional vulnerability can be amplified.

This can look differently for different people. When I worked nights as a resident and attending, I would take a 10-minute break to just walk around the hospital. This helped clear my mind and allowed me to refocus my energies so I could function at a high level. For others, it could mean texting a loved one, enjoying ice cream, or watching sports highlights on your phone. Whatever it is, make time to step away for a moment and do something that brings you peace, happiness, and comfort. These little things can be the difference between an enjoyable experience and a miserable one.

Night shifts do not define you or your overall performance, but they do shape judgment, autonomy, and resilience. These are all key characteristics that allow you to be an indispensable provider.