Wook gave you a lot of good advice there. I’ll add some stuff but you’ll do just fine with that advice.
I used to document a quick free text full note on each patient. I do that with off service and interns still but not the upper level residents. I just put in the mandatory attestation that I performed a full H&P on the patient with my upper levels once I’ve seen a note or two from them and have verified it would protect us in court. High risk conditions or patients (like my nec fasc who was sat in the waiting room by triage) I will put in more into my free text note.
If you’re going to change something for the patient workup, tell the resident you’re doing it. I don’t make them put in the new order or take out the old order, and I make sure to follow up on anything I add. I explain why I’m doing it as well. Most common thing is working up a PE/ doing a d-dimer or not. But sometimes I don’t think a patient needs a workup at all and if the department is backed up, I’ll cancel everything and discharge them. That is much more rare. More often (if we have bed capacity) I’ll leave the workup but tell them why I don’t think we needed to do the workup. I let them follow up on the negative workup then discharge. It’s good for them to see the negative workup and realize it doesn’t all require a workup. That is one of the hardest things for them to do I find, especially the late second years. Third years start getting a bit more gestalt.
When in doubt, I still default to doing a workup as I’m still pretty early in my career and my patient population seems to have bad things hiding when Im suspicious and go looking. Unfortunately, my residents also know that so they’re extra cautious working with me and tend to over order compared with what I would do. It’s a balancing act.
Be cautious with bad airways. If you aren’t sure about your resident and how good their skills are, don’t be afraid to have them observe a bad airway rather than forcing them into doing it. Focus on teaching what you’re doing during the bad airway if you take over though. Especially do it with one la that require SALAD technique if they’ve never done that. I speak from experience there and wish I’d taken first look. You sometimes have to realize for them what they don’t know and have to ask them point blank about it. That said, I defend my resident’s procedures when they need them from encroachment from other services and try to advocate for why my resident should do it. This can be tough in a busy department but they need to know how to work procedures into their workflow as well.
I cap new interns and off service residents at 3 patients at a time. Once they prove to me they can manage three, I let them go up to four. After four, I tell them to let me know when they need me to pick up some for them. Once they can handle four, they can realize better when they’re in over their head. If an intern is drowning, things will get chaotic and the department grinds to a halt (in my experience anyway). You’ll find what works for you with your residents. I have certain things I focus on and teach them (doing two things anytime they get up to improve efficiency, running the list frequently, finances and insurance planning, etc) and you’ll find what is interesting for you to teach. Residents often don’t make for easier shifts, but they can. I focus on making sure that shifts with me are safe for the patient and educational for them, while making sure the department is still continuing to move well.
