Advice for being senior for the first time

[IonClaws]

As the title states. I will be supervising multiple junior residents in a few weeks. Some are in my program and this will be a core rotation, others are in different programs and this will be an elective for them.

I've really never been a supervisor for anyone except medical students (and they can't really do anything except write notes for us).

So how should I approach my supervision? Gather my people around and make expectations 100% clear? How about pre-rounding? It's an obvious thing to do as a medical student or junior, but to what extent should the senior be rounding? Just on the super sick patients, or if there's a problem with a patient reported to me by a junior?

Thanks for reading, and please offer any advice you have!

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[GoSpursGo]

Honestly, everyone is different and this somewhat comes down to your own style. Try a few things out and decide what does and doesn't work for you. Also, to a certain extent your attendings may have different expectations for you, so you may want to discuss that with them whenever a new attending comes on service.

A few points that I would emphasize, or that I would offer my own experience on:
1) I think it's always a good idea to set your expectations clear on day 1. It doesn't have to be all-inclusive, but a quick 2-3 minute rundown of how you envision days working out and expectations that you consider most important. The less important things you can mention as you go along.
2) As you're rounding, make a check-list of everything that needs to get done on each patient. Then give your interns an hour or two after rounds to accomplish those tasks, and check in with them to see what's been done and what still needs to be accomplished.
3) You can't pre-round on every patient, but particularly in August I don't think I would expect all of your interns to know when they need backup on a sick patient. So keep a mental list of the patients that you know are likely to be the sickest, plus any overnight admissions who are new to the team, and plan to pre-round on at least those patients; when you get in, add the patients who are reported as having had some events overnight. Finally, if you have time, another subset of patients I would strongly consider seeing is those who are potential discharges.
4) Again, in August, your interns are still learning. So for really important things, I would definitely check the orders after rounds to make sure everything got put in correctly.
5) If your team is getting slammed, help out. Don't go overboard, as to a certain extent you should let your interns "figure it out" even though you could certainly do it more efficiently... but if you're getting a bunch of admissions while another patient is getting transferred to the ICU, taking an H&P or calling a consult or updating the sign out will be much appreciated.
6) Finally, you're still learning too. Don't be afraid to ask the attending if you're uncertain what to do. They should know that it's your first time being a senior and expect that you'll have questions as you learn your new role.

 

[TonsilPlucker]

As the title states. I will be supervising multiple junior residents in a few weeks. Some are in my program and this will be a core rotation, others are in different programs and this will be an elective for them.

I've really never been a supervisor for anyone except medical students (and they can't really do anything except write notes for us).

So how should I approach my supervision? Gather my people around and make expectations 100% clear? How about pre-rounding? It's an obvious thing to do as a medical student or junior, but to what extent should the senior be rounding? Just on the super sick patients, or if there's a problem with a patient reported to me by a junior?

Thanks for reading, and please offer any advice you have!

Good advice above.

My singular advice is to show that no task is above anyone on the team.

Yes, the intern vs the 3rd year will have different daily schedules/tasks but in a pinch, the 3rd year should be willing/able to do intern work if needed. It's up to you to show/set expectations for the team.

I always had a pre-block breakfast/lunch where I would set expectations, field questions (informally) about the rotation. You don't have to "pre-round" but believe me I would run through the list before rounds at home so that anything that came up from pre-rounds or even rounds I was already aware of. I feigned ignorance at times so that my juniors would feel like they had a win that day

Unless I was stuck in a 12+ hour case, I always would stalk my patient list. No more important thing as a resident than to know your patients.

Finally, allow autonomy as appropriate. Hardest thing as a chief but will allow jrs/interns to grow and gain confidence in their medical decision making. Ask questions not pimp. Even lob some softballs if needed.

Finally, try to schedule happy hours or lunches etc. Helps with morale. Often needed during a stressful time of life.

This is from a former surgical resident perspective.

 

[deleted480308]

1. I tell them never to be scared to call me or ask a question. If they think they are over their head on something I need to know.
2. They aren’t scribes. They might not be right on a plan but I need to know what they would do if I wasn’t there to stop them. That’s the only way to assess progress. I constantly refuse to just tell them what to do, “what would you do if I wasn’t here?”. Then we talk about how they reached that plan and what parts of that process were right/wrong.
3. Unless they lie to me, none of the patient care is their fault when I talk to the attending. If something got missed, I missed it. We can point out their misses privately in the resident room but I don’t throw them under a bus to attendings.
4. Negative feedback is uncomfortable but it needs to happen, it needs to be delivered in a neutral tone with specific points that need improving. It should be as private as possible.
5.Positive feedback should be as public as possible, let them see you tell the attending about a good plan idea or interpretation and make sure they get credit.

 

[GoSpursGo]

3. Unless they lie to me, none of the patient care is their fault when I talk to the attending. If something got missed, I missed it. We can point out their misses privately in the resident room but I don’t throw them under a bus to attendings.
5.Positive feedback should be as public as possible, let them see you tell the attending about a good plan idea or interpretation and make sure they get credit.

I completely agree with this--your interns need to know you've got their back. Credit gets shared, but the buck stops with you (and ultimately the attending) when something goes wrong. When your interns look good, you also look good by extension.

 

[Ironheme]

My best seniors were the ones that cared about me as a person. If I was working too much, they always made sure I wasn't burning out, and taking breaks. Usually we would eat together, and they would be the first one to stay back/send me to get food and cover while I was gone.

Agree with all the above. I also praised my interns in front of the attending when they came up with a good plan or ideas. If there was a failure, I took the blame for the team, because it was my responsibility to have supervised the intern, and ultimately my mistake.

 

[togaedere]

Agree with everything above.

think about the seniors you liked working with the most. What was it about them?

for me, it was clear expectations, availability, and a little freedom to make my own choices while knowing that someone was there if I happened to miss a critical detail.

 

[HemeOncHopeful19]

I didn’t see this mentioned but I always tried to give my interns an extra day off when possible. I would try to give them 5 days instead of the mandatory 4. I did not do this in my one upper level July month because I and the interns actually all agreed they wanted to get as much experience as possible.

Usually that meant I had to work harder (we picked up the Intern’s patients on their days off) but in my program and probably most others being an upper level is usually a better schedule overall than being an intern so I didn’t mind. I would have people coming to me years later telling me how much that meant to them.

I always thought it was crap when my lazier colleagues would disappear and not be around when their interns had questions but since you made this thread that’s not gonna be you.