Being a good senior resident

[Ypo.]

There are a ton of threads on this subject for new interns, but I didn't find any for the senior role. Thought it might be a good thread to start seeing as how we are at the beginning of the year again.

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[lowbudget]

Start by double checking everything but don't let the interns know you're doing it.

 

[anon-y-mouse]

There are a ton of threads on this subject for new interns, but I didn't find any for the senior role. Thought it might be a good thread to start seeing as how we are at the beginning of the year again.

Don't micro-manage. Don't try to 'teach' after we've both been up for 19 hours together. Allow me to come up with my own plan. Don't treat me like I'm stupid. Help me come up with a system if I look like I'm struggling -- you used to be in my shoes too. Be highly efficient and allow your intern(s) to be efficient as well... i.e. I don't want to stay every day till 6pm when I can sign out at 4 just because you spend 20 minutes socializing with that cute GI consultant. Don't pimp me in front of the medical students. Make sure my presentations are polished and we're on the same page about the plan before I have to present to our attending.

 

[docdaname]

1) dont continually ask me to "run the list"...or after 5 minutes after we run the list, start asking me if I did stuff yet. Nothing is more frustrating when Im working on one thing, and you (the resident) ask if I did something else, then I switch to that, and you ask if i did something else. Lemme work!

2) help out! Please dont sit on the computer next to me checking email and playing on facebook while I am working hard! Especially if you see my pager contiues to go off . You (the resident) are allowed to help call consults too! also in this regard, communication helps. If you put in orders for a pt or called a consult, lemme know, so I dont repeat the work.

3) as mentioned above...allow me to come up with a plan, and/or go see the pts myself. A lot of times intern year we went and saw the pts together (me and the resident), in an effort to "save time". Which it sometimes did, but not always. And Being on the other end, i know its really really really hard to do this...but please, stay quiet!, and let me interview the pt! You can ask stuff i left out in the end. Its kinda annoying when you walk in, and the resident immediately takes over and starts interviewing the pt, then after 5mins stops, looks over, and goes "oh...why dont you take over". Its kinda hard to do that in the middle. Lemme talk to the pt, then tell you what I think and what my plan is. If its 3 am, and we are busy (or not), then I dont care, lets just get the pt seen and admitted. but if we have time, lemme do it.

4) bring food (optional): this one has nothing to do withe being a good resident. I just really like snacks.

ps...being a resident is hard! I mean...way better than being an intern, but its a little scary with the med students and interns looking to me! especially at night...when im the most senior person...and my backup is paging a cheif resident or attending at home!

 

[Stitch]

I think there's a fine line between supervising interns and micromanaging them. Find out how to walk that line. Make sure things get done, but give them the chance to do it.

Make your expectations known. Communicate. You shouldn't have to tell someone twice, but you do have to tell them once. Let them know 'hey I'd like to be aware of x,y,z if it happens.' People can't read your mind.

Help out. You know how easy it is to get swamped as an intern. If you're getting slammed with admissions, then do one yourself, or at least start it. Take the time to teach as you go (I agree taking a teaching moment at 0200 during the first 'down time' is annoying and not helpful).

If there's an issue with an intern (perceived laziness, bad decision made, whatever) deal with it directly and immediately. Nothing is worse than someone who bitches about it for a week behind the other's back. Don't be a jerk, just explain why what they did was inappropriate and what to do next time.

These skills are important, especially if you end up supervising residents some day.

 

[dragonfly99]

-I agree, help the intern with the work
-Try to resident the urge to "take over" and interrupt the H and P unless you are really pressed for time
-I would add try to teach the med students because the intern doesn't have time
-agree about not pimping the intern in front of the students (or attending). Try to make the intern look smart, not dumb, on rounds. It will help if you all discussed the plan in advance.
-I would add try not to lose your cool ever, or even sound irritated. It's hard sometimes, but it's important. Negative motivation or negative reinforcement usually doesn't work...people just become like dogs who have been kicked too much, or they get angry and/or defensive. Therefore it's good to try to redirect people if they are screwing up, but then teach them why they are wrong quickly, efficiently, and nicely. It's actually really hard.
-I would add realize that you can be wrong, even though you are the senior. Occasionally the intern or med student will have an idea better than yours, so it's good to listen to them.
-I would add don't get an attitude with the fellow or attending(s). Usually not at the beginning of the year, but sometimes @the end the residents start thinking they know everything. Remember, experience counts. Also at the end of the day the fellow and attending have to answer for whatever you did - it's their a-- on the line ultimately.

 

[Top Gun]

Be patient with your interns, especially in July. Realize that they're getting used to the system, and it will take time for them to get the hang of things. Know almost, if not as much, about what is going on with the patients as the intern. Be willing to help the intern whenever needed. Many times they are carrying 12-14 patients and often get overwhelmed. Actually, I think it is a good idea to round with the intern on all the patients so that the senior knows what is going on with the patients, and that you are both on the same page and can discuss the plan together.

 

[Droopy Snoopy]

Day 1 give expectations and a schedule for the month. Early in the year you should assume that your interns know absolutely NOTHING, not just about medicine but about the hospital and its workings. You know the attending and consultants better than anyone, so clue your guys into any preferences, eccentricities, or pet peeves and make them look good.

Also, each of the thousand things you take for granted now, like which of the 85 different lab phone numbers to call for CBC results or how to work the damn copy machine, will slow these guys down tremendously at first. Be patient, and be ready with the results of that 8 year old colonoscopy that your intern didn't get to because they got lost in the basement.

 

[geauxg8rs]

My favorite story when I was intern of how lame my senior resident was on an onc rotation. There were two terns who each carried 12 patients and a PA who carried 6. Total of 30 patients. The senior covers the ICU which would have between 0-5 patients. It is a manageable list except on sat and sun when there is no PA and no second tern. So theoretically the call tern is supposed to see 30 patients and the senior sees the icu patients.
So I see the list on Friday before call and the senior tells me I am covering the floor (30 patients) and he is covering the icu (2 patients). I told the senior that I was gonna see half the patients and when we came to the 16 th patient on the list I was gonna turn to him to present the next 15 patients. Long story short, lazy senior did not see any floor patients and the senior gets yelled at by onc fellow. I loved it! Message is to help a tern out.

 

[buckley]

--I would add try not to lose your cool ever, or even sound irritated. It's hard sometimes, but it's important. Negative motivation or negative reinforcement usually doesn't work...people just become like dogs who have been kicked too much, or they get angry and/or defensive. Therefore it's good to try to redirect people if they are screwing up, but then teach them why they are wrong quickly, efficiently, and nicely. It's actually really hard.
.

It is hard. How does one tell the junior resident--you need to show up, yes, even if the service is benign and the senior is here, yes, you need to show up. Seriously

 

[gutonc]

It is hard. How does one tell the junior resident--you need to show up, yes, even if the service is benign and the senior is here, yes, you need to show up. Seriously

You could tell them that the alternative is to not show up. Ever again. Maybe give them a copy of the Starbucks application to help drive the point home.

 

[dragonfly99]

Intern showing up should not be an issue. They should be given the assigned days off on the 1st or 2nd day of the rotation, and stick to it unless there is a good reason not to. If someone has an emergency and absolutely cannot come in, then the senior resident and/or fellow should be notified ASAP. If the intern is supposed to be working and doesn't show up within a reasonable time, and doesn't notify you, then you should tell the fellow and/or attending that the intern didn't show up. The probelm should be solved at that point. Sometimes people screw up...I overslept once when I was a med student, and it was a horrible experience...I was honestly just super tired from working 4:30a.m-9pm at night constantly, a schedule that I just wasn't used to. I felt bad about it and boy did I get chewed out. By the time people are interns this should typically not be happening. If it does, you should try to find out why. Was it that the person overslept once, got sick, is just generally irresponsible or was there some type of confusion about the schedule?

 

[EM2BE]

I agree with helping out where needed as a resident. When I was a student, I always noticed the residents helping the interns whenever needed with admissions, orders, seeing patients, etc. I am currently on a service where the resident (a PGY 2) decided they don't need to do anything but what they have been told is their job. We have not gotten any help this month (and yes, it's July and we are all still learning). Wish there was a way to say this is wrong, but unfortunately as the low person on the totem pole, I cannot do this.

 

[anon-y-mouse]

2) help out! Please dont sit on the computer next to me checking email and playing on facebook while I am working hard! Especially if you see my pager contiues to go off . You (the resident) are allowed to help call consults too! also in this regard, communication helps. If you put in orders for a pt or called a consult, lemme know, so I dont repeat the work.

I totally agree with 'help out'. Perhaps I have had really amazing seniors but I wouldn't have been able to survive if my senior didn't call some consults for me, deal with some sticky situations, or even help me update my signouts during the first few calls. I think saying "how can I help?" (and genuinely meaning it) -- or if the intern is overwhelmed has no idea what's going on -- just jumping in and helping -- can really make work a lot easier.

 

[gutonc]

I totally agree with 'help out'. Perhaps I have had really amazing seniors but I wouldn't have been able to survive if my senior didn't call some consults for me, deal with some sticky situations, or even help me update my signouts during the first few calls. I think saying "how can I help?" (and genuinely meaning it) -- or if the intern is overwhelmed has no idea what's going on -- just jumping in and helping -- can really make work a lot easier.

As a corollary to this...If you're going to help out doing "intern work" (and really...it's the team's work so you're not really "helping out," you're doing your damn job), just do it. Don't ask a million questions about how I want to manage something. We already talked about the plan 4 times today, just do something reasonable and move on.

I had a (very smart and well-respected but kind of D-bag) senior when I was on an ICU rotation as an intern who would always "help out" when we were getting close to the 30 hour mark. He would ask who I needed help with and I would tell him. Then he would say "so, which antibiotic should we give for his MRSA pneumonia and what dose? How fast do you want Mr. Smith's maintenance IVF going? What settings should Mr. Thompson's vent be on?" Ad infinitum until I got fed up and actually told him to go home. That may have been his plan all along but it was extraordinarily aggravating.

 

[buckley]

"don't you feel secure enough as a senior to handle three patients?" &^@&*&*!!!

 

[smq123]

"don't you feel secure enough as a senior to handle three patients?" &^@&*&*!!!

Who said that to you - it wasn't your intern, was it??!! 😱

 

[smq123]

Be patient with your interns, especially in July. Realize that they're getting used to the system, and it will take time for them to get the hang of things.

+1. And, when they do get things right, don't hesitate to tell them that they're doing a good job. Positive reinforcement never hurts.

 

[eforest]

You can try not to be like my senior who micromanages me when she's at the hospital, and then always leaves early, leaving me alone with the patients. So it's like she treats me like I can't do anything, and then, uh oh, it's four pm, she has to get out the door.. and I'm stuck with the rest of the work. When I call consults in front of her, she interrupts and interjects when I'm trying to speak to the consult. This turns into a confusing three way conversation where she's talking in one ear, the consult is talking into the other, and both are annoyed. The consult rightly so. She doesn't allow me to go to noon conference even though it is required. She caught me on my way there, and made me come and do work that could have been done AFTER noon conference. But she wants to leave early, so lets have the intern skip a mandatory conference so that she can do work that will allow YOU to leave early, while I get stuck staying until 8... again. Whenever I sit down to do a task, she decides I should be doing something else. Then, after having me do whatever the something else is, she gets mad when I haven't completed the first task.

I've almost snapped at her a couple times, but it's a small program and I don't want to alienate anyone. I'm just gritting my teeth and trying to survive the last week of her.

 

[subtle1epiphany]

There are a ton of threads on this subject for new interns, but I didn't find any for the senior role. Thought it might be a good thread to start seeing as how we are at the beginning of the year again.

Long time no see Ypo!
Excellent topic for a thread, I'm in the same place. Started PGY2 in an elective, but next is wards, so advice on how to manage a team as a "senior" is very high on my mind.

Micromanagement always drove me through the roof, a friend in the program would routinely interrupt during rounds. I'd just hold back and grit my teeth, but when he did that to the students, I intervened. How else are ppl to learn presentation skills? I hate saying it because it's so cliche, but you have to practice your presentation to get better, and if the senior interrupts the students....ugghh...

Same with the whole post-call "what can I do to help?" when it's drilled in to you that you call consults and discharge, then write notes. By the time the senior offers, which is genuine and appreciated, there's nothing to do but notes...so how does that help the intern?

gutonc makes another point I agree with, and to go further, when you're the senior on ICU (or any service, but this for certain) you need to figure out how to communicate effectively and efficiently. I don't care how, text msgs, text pages, discussions, notes, damned carrier pigeons, whatever. It doesn't help me as the intern to line up the patient, supervise my senior with procedures b/c she hasn't done enough, do the H/P, and manage the three crashing patients on the floor and have another I've never heard about arrive in the unit. Tell me first! Give me the story you heard so I can write an appropriate note and present something other than how I bolused the ESRD pt 4L crystalloid while attempting to place CVC in the IJs, the fellow attempted as well, and then shot a subclavian to the brain, leaving me to dig in the poor guy's groin for an hour at 5am while the fellow manages other crashing patients...for ****'s sake! /rant