Teaching style and tips

[chromaticscale]

I'm a new PGY2 and currently on a relatively chill elective service with 1-2 interns at a time. I really care about making strong interns/residents so I have been perusing the internet and podcasts (e.g. Curbsiders IM episode on PGY2 year) to learn how to guide interns through residency. I've just started but I try to help prime the interns to think about what questions to ask and what to look for during chart review before they see the patient, as well as go through a differential and run the assessment and plan with them when we have time. When there is down time, I try to go through some topics with them (e.g. logistics and how our hospital works, what to do when a code blue is called/ACLS case, how to page or call the nurses/patients etc.). Mainly, I want them to succeed in the wards/ICU which are the most stressful rotations.

I notice that some interns are more efficient than others, and I wonder if I need to be a bit more pushy or strict. The interns I've worked with so far have said that I'm very patient. One intern said that I am good at teaching; I also remember when I was an intern that a third-year med student complimented me that I am a good teacher. Thinking about these made me wonder if I would be happy being in a career that involves a lot of teaching rather than doing something like private practice.

I'd like to know from your guys' perspectives and experiences:
1) What is your teaching style, and what do you think are the pros and cons of it?
2) Any tips for developing strong interns?
3) Anything you've seen others do that you recommend or don't recommend?

My perspective: I think I'm a nice person and I don't agree with the old-school hazing that I notice some of the attendings at my program do. I lean more towards a progressive approach.

Appreciate any insight!

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[tantacles]

I think the big picture things that I try to do are:

1. Try to give independence, but encourage interns to come with any question or just to run even routine things by me if they want to double check

2. Never get angry. The second you become angry, you've lost your intern and they no longer can come to you for help and feel comfortable.

3. Acknowledge privately when the attending has said something that may not be evidence-based and is more based on routine or protocol. This is one of the hardest parts of medicine, and many attendings (probably me too!) are not good at acknowledging when what they do is based on evidence and when what they do is based on experience, so helping clarify these things with interns is important.

4. When overruling, start with an authoritative approach, explaining your reasoning and why you think you need to go in a different direction. If you have an intern who isn't thrilled with going along with you and insists that their way is the right way, then and only then is the time to take an authoritarian approach. Even then, be open to going with the intern's plan, particularly if it's not something that is evidence-based that they are rebelling against.

I don't know, man. I'm always just winging it.

 

[SXMMD]

1. I emphasized and rewarded strong work ethic and integrity, especially in weaker interns. In turn, they all worked hard for me. I never put anyone down for not knowing something, but I also (aggressively) held my interns accountable for how they carried themselves. Keep in mind that the work is stressful and good people have bad days, so be mindful of your individual intern's personality, strengths and weaknesses, and don't snip at them for small things or the occasional bad day. Above all else, model the principles you try to teach jr residents. Interns called me a hardass, but I was the first person they came to with a problem because they knew I was in their corner.

2. I would echo what tantacles said about being authoritarian. I prefer to give interns room to develop their decision making, but sometimes you need to take control. It can still be a teaching opportunity but in those moments I wasn't asking permission from/negotiating with my interns, I was telling them what to do and holding them to those orders. I had to learn when to take over and when it was ok to let the intern go a less efficient/ different route than I would go- took me a minute to cede that control, but I became a much more effective teacher when I learned when/how to let the interns do their thing vs taking the reins

I enjoyed teaching a lot, it made me a better learner. Have fun with it and don't be afraid to develop your own style!

 

[smartparts]

To questions #2 and #3, one mistake I think people make is trying to pick up EVERY inch of slack EVERY day. What I mean is that when residents assign an intern to do something, if it's not done within an hour, the resident just goes and does it themselves. I think this takes away the sense of accomplishment interns feel when they check things off their list and leads to a progressively more lax attitude each day because they feel like they can't do anything right or the resident will do it anyway so there's no consequence. I find that doing more routine, behind-the-scenes stuff that should be done every day but often goes unsaid (varies by program) actually helps interns more because they feel disheartened when they go to do something and see that you already did it. They'll learn to be more autonomous and the second or third time they do something difficult, they'll be much faster at it. Keep your interns updated, especially at the end of the day so there's no duplication of work, but don't make them feel like they missed something. If you do need to take over a task, tell them beforehand (don't just do it) and assign them something new that's popped up since rounds ended.

Some of the worst feelings I had as an intern was paging The Scary Consultant only to have them get upset at me because they just got off a 15 minute phone call with the resident and coming back from conference to find that my patient that I wanted to say goodbye to has already left the building. The residents obviously meant well but I wasn't able to face The Scary Consultant (which made the lead up to my next encounter with them just as anxiety-laden) and I was deprived of the satisfaction of discharging a patient I helped get better. Interns will never speak up about these things because its hard to argue with someone who is helping you.

tl;dr - March behind or side-by-side with your interns, not in front of them.

 

[acapnial]

Agree with smartpants, doing stuff for your interns is really not helpful to them except in uncommon circumstances. When you do intern stuff for the interns you're a) creating confusion about whose job is what, b) teaching them that if they don't do something in a timely manner you'll do it for them (seriously removing the impetus to learn skills in efficiency), c) sending the message that you don't think they can get the job done themselves, usually in a more demotivating way than motivating. You have to guide and teach quite a bit, especially early in the year, but just doing big chunks of their job for them is not doing anyone any favors. Plus when the intern gets a sense of "If I don't do this then it it won't get done", it really enhances their sense of responsibility and autonomy. Quality learning ensues. But do have to watch what the interns are doing closely this time of year, and in critical situations you might have to take control, as that's obviously not the time for gentle self exploration and learning.

Your punishment/reward system (which as a resident mostly comes down to "good job!" and "not so good job!") should be consistent, independent of your mood that day. Treating someone poorly over some small thing because you're in a bad mood shatters your credibility as a leader.

Lots of organized/semi-organized teaching is always a good thing.

Also agree to try to act like the resident you want the interns to become. Lots of 'em pay way more attention to what you do and how you behave than what you say.