Unfortunately, the note that has to be entered in the EMR has to be started and signed by a fellow (a person who has finished residency but still in training before becoming an attending doctor for those who don't know), and this is the note with the data, and so I (a first year resident) would have to be sitting next to the fellow, he would have to start the note, then I would have to switch seats with him, do some data entry, then he would have to write his impression ("normal", "COPD", "asthma", but in more doctor like terms) and sign the note. The way the system is set up makes this impractical.

His first responsibility is to whatever he wants to make with his life, not neccessarily his training. If he wants to run a medical startup that you call trivial, it's just as good (if not better) way to go as focusing on his residence and fellowship.

The default career directions for anyone, including medical residents, are just that - simply defaults, not some oath or moral obligation to follow that exact career choice 'till death do us part'.