Advice for new 2nd years

[theneh]

advice?
I'm concerned for call, we have a lot of acute care medicine at my shop. We do everything overnight, Codes, Rapids, ICU admits, ICU coverage...For instance, 3 people were on last night. Me, another intern and an absent resident. We had 8 admits: 3 critical care within 1 hour: septic shock, SAH requiring intubation and eventually emergent ventric. (yes we have to deal with neurosurgeons directly), cardiac arrest/hypothermia protocol...+ 4 floor admits.
How the hell could I manage all of that with 2 interns who don't even know how to replete K+?

My thought is to just DO EVERYTHING, orders, procedures that are immediately necessary etc, and then have the interns and myself write up everything when there is breathing room...

Is it just me or does this scenario sound incredibly dangerous?

---

Members don't see this ad.

 

[jdh71]

advice?
I'm concerned for call, we have a lot of acute care medicine at my shop. We do everything overnight, Codes, Rapids, ICU admits, ICU coverage...For instance, 3 people were on last night. Me, another intern and an absent resident. We had 8 admits: 3 critical care within 1 hour: septic shock, SAH requiring intubation and eventually emergent ventric. (yes we have to deal with neurosurgeons directly), cardiac arrest/hypothermia protocol...+ 4 floor admits.
How the hell could I manage all of that with 2 interns who don't even know how to replete K+?

My thought is to just DO EVERYTHING, orders, procedures that are immediately necessary etc, and then have the interns and myself write up everything when there is breathing room...

Is it just me or does this scenario sound incredibly dangerous?

Haha. Welcome to supervising resident status.

I always survey the scene, get a lay of the land, and handle business if necessary - put in the orders. Let the interns do the H&P and other documentation. Do all communication with attendings and consultants.

I hate to say it, but the night you described does sound busy, but not that crazy to me these days. You'll get used to it and get better at it.

Don't stop until everything is done.

Make sure you interns know that not only is it ok to ask question but that it is MANDATORY

 

[theneh]

thanks. that's pretty much how i'm gonna approach it. i personally believe our 3rd years generally sucked as supervising residents except for a couple (they all probably know i think that at this point, haha)...but it made me a lot more competent because i literally would be looking up articles and even at times calling attendings directly for help while admitting patients...now i know more, can do more, and the attendings/specialists all know who i am and trust my judgment (to a degree)...BUT, this is a dangerous way to learn and some other interns in my year have made some egregious mistakes because of it...
I hope this next batch is good...2 things that i think will carry them far is a genuine compassion for the patient and interest in learning. unfortunately neither of those things are learned characteristics.

 

[Gastrapathy]

Remember trust but verify? Change it to "trust no one, your interns are there only to sabotage the patient, and verify" and you'll do great.

 

[theneh]

I'm on an elective service right now, but i caught an order for "KCL 120 meq IV"...I obviously d/c'd it and found the intern and went over replacement and writing orders for 20 minutes. I'm nice, but if it were a different senior the intern would have gotten roasted, mainly for not letting the resident know.
Scary...I am pretty sure I never did stuff like that...

 

[indiamacbean]

honestly that just sounds like overnight call at a big academic teaching hospital. busy, yes. frantic, often. I think that's how call generally goes.

I think the problem is that with the change in duty hours and the absence of overnight call as interns we are placing people in a role for which they are not prepared. you will manage it and you will be fine. a lot of what I am seeing right now in the hospital as a fellow is a lack of confidence among second year residents.

 

[sluggs]

I'm on an elective service right now, but i caught an order for "KCL 120 meq IV"...I obviously d/c'd it and found the intern and went over replacement and writing orders for 20 minutes. I'm nice, but if it were a different senior the intern would have gotten roasted, mainly for not letting the resident know.
Scary...I am pretty sure I never did stuff like that...

For as far back as I can remember there has been a trend in under-replacing K until the rhythm goes bad. Now here is a kid showing initiative and guts...