Concerns about junior residents

[Perrotfish]

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But seriously, I think you absolutely could have a whole class that is bad. It could be an acquired condition.

Could be. My differential at this point:

1) The whole class is bad because they were recruited badly: A coin can turn up heads 9 times in a row, and a program can recruit 9 below average Interns in a year.
2) The whole class is bad because they were trained badly: there was a cultural shift in the last year that the OP didn't appreciate that made people lazy
3) The whole class isn't bad, but OP's Intern is and he's projecting it onto the class. All stereotypes are based on someone overgeneralizing their experience. This could be another example of that.
4) The Intern class isn't bad, but OP is getting stuck doing their work because he's not intimidating enough. Maybe they do just need to be pushed more.
5) The Intern class isn't bad, but they're bad whenever the OP works with them because he's inefficient. We've all had seniors/attendings like this: too many demands for status updates, always interrupting the work, rounds last forever and there are no orders entered at the end of them, etc. If everyone you meet is a jerk, odds are you're a jerk. This could be a similar situation.
6) The Intern class isn't bad. There is always someone who likes to tell you how much better they were 'back in my day'. Maybe OP is just one of them.

My money is on #6, but any of these is possible.

 

[VenusinFurs]

My program is not directly tied to an academic center. The hospital is large for the area, but certainly does not compare to a large academic center. We do not have walking rounds, we meet at 7 and do table rounds and then go do our work.

So I don't think all the interns suck. I think there are maybe three mostly competent interns in the class and one of them is lazy and sometimes sloppy, there are three who think they are competent but don't realize what they don't know, and there are three who are so lacking in confidence (at least one of them rightfully so because his medical knowledge is lacking) that they are paralyzed. Of the unconfidents, there are two who at least work hard and one who is sort of lazy.

The ones I had were the competent but kind of lazy one, and one of the unconfident ones who also has a touch of laziness. Competent but lazy one tried to refuse to do an admission and wanted me to do it instead because unconfident/ lazy girl had gone to clinic and had that patient last time, so "it might be a better patient for her to follow." I put the kibosh on that right away. Unconfident/ lazy one tried to get me to do the dictation on a patient who she was admitting, after I'd already helped her out a ton by calling consults, putting in orders, etc, by saying "so...can you help me? like, should I do a dictation?" I put a kibosh on that as well. I think in the class in general there is this fear that they might not get to leave by 7 o clock and that this would be the end of the world. Maybe I just speak for myself here, but I would never have dreamed of trying to refuse an afternoon admission after I'd seen all my patients or trying to get them to do a dictation on my patient. What even the **** is up with these people.

 

[VenusinFurs]

Could be. My differential at this point:

1) The whole class is bad because they were recruited badly: A coin can turn up heads 9 times in a row, and a program can recruit 9 below average Interns in a year.
2) The whole class is bad because they were trained badly: there was a cultural shift in the last year that the OP didn't appreciate that made people lazy
3) The whole class isn't bad, but OP's Intern is and he's projecting it onto the class. All stereotypes are based on someone overgeneralizing their experience. This could be another example of that.
4) The Intern class isn't bad, but OP is getting stuck doing their work because he's not intimidating enough. Maybe they do just need to be pushed more.
5) The Intern class isn't bad, but they're bad whenever the OP works with them because he's inefficient. We've all had seniors/attendings like this: too many demands for status updates, always interrupting the work, rounds last forever and there are no orders entered at the end of them, etc. If everyone you meet is a jerk, odds are you're a jerk. This could be a similar situation.
6) The Intern class isn't bad. There is always someone who likes to tell you how much better they were 'back in my day'. Maybe OP is just one of them.

My money is on #6, but any of these is possible.

Like of course I've considered that maybe I was just as bad, but really...the general consensus, even amongst the current graduating class, is that my class was good and the current interns suck.

 

[thepoopologist]

Just push them to the floor and poop on their faces. Scream, "how dare you disobey me!" while last nights digested dinner plops on their faces.

 

[Law2Doc]

My program is not directly tied to an academic center. The hospital is large for the area, but certainly does not compare to a large academic center. We do not have walking rounds, we meet at 7 and do table rounds and then go do our work.

So I don't think all the interns suck. I think there are maybe three mostly competent interns in the class and one of them is lazy and sometimes sloppy, there are three who think they are competent but don't realize what they don't know, and there are three who are so lacking in confidence (at least one of them rightfully so because his medical knowledge is lacking) that they are paralyzed. Of the unconfidents, there are two who at least work hard and one who is sort of lazy.

The ones I had were the competent but kind of lazy one, and one of the unconfident ones who also has a touch of laziness. Competent but lazy one tried to refuse to do an admission and wanted me to do it instead because unconfident/ lazy girl had gone to clinic and had that patient last time, so "it might be a better patient for her to follow." I put the kibosh on that right away. Unconfident/ lazy one tried to get me to do the dictation on a patient who she was admitting, after I'd already helped her out a ton by calling consults, putting in orders, etc, by saying "so...can you help me? like, should I do a dictation?" I put a kibosh on that as well. I think in the class in general there is this fear that they might not get to leave by 7 o clock and that this would be the end of the world. Maybe I just speak for myself here, but I would never have dreamed of trying to refuse an afternoon admission after I'd seen all my patients or trying to get them to do a dictation on my patient. What even the **** is up with these people.

While it's clear you are working with some lazy interns, the mere fact that you are getting these requests and push back tells us you let the lines of authority got blurred early on. If they appreciated the chain of command there really would be no reason to put the kibosh on anything. They would keep their heads down and whine to each other, not you.

 

[IlDestriero]

This service is a total wreck. You need to make the PD aware of the problem, work on reasonable expectations, and change the way you operate.

 

[rokshana]

absolutely agree with L2D here...sure maybe the interns share some of the blame...but sounds like they feel they can get away with these these things because their seniors let them...it would NEVER have occurred to me to say maybe someone else should take an admission because they would be better at it...i assumed (and when i was the senior, i did) that the resident gave an admission because it suited the intern, either in interest or capabilities...or to ask a senior to do a dictation (i was more than happy to take them up on an offer...hate dictating...)

you do now have the chance to fix some things this next year...you are getting a new set of interns...you need to set the rules early and establish that hierarchy come july 1st...or you will have another set of interns walk all over you as a 3rd year...course it will be interesting to see how these interns deal with interns as the become the residents...karma can be a bitch...

 

[VenusinFurs]

This class seems better so far. At least the one or two I've met.

Guys... is it crazy to expect a family medicine resident at the start of his second year to know what to do about a mildly elevated troponin that is trending upwards?

 

[Siggy]

This class seems better so far. At least the one or two I've met.

Guys... is it crazy to expect a family medicine resident at the start of his second year to know what to do about a mildly elevated troponin that is trending upwards?

Let's be honest, a lot of physicians period don't know how to handle a mildly elevated troponin. The first and only thought is, "OMG, NSTEMI" when there's a whole list of common diseases that can cause a mildly elevated trop.

http://circ.ahajournals.org/content/124/21/2350.full

 

[VenusinFurs]

Well, yes. That is definitely the case, and it can really muddy the picture if you have someone with chronic kidney disease and their troponin is slightly elevated from their baseline and you have no idea what that means, and etc. But, I mean, this dude calls me before he even gets an EKG or sees the patient. Which would be fine if my only responsibility on nights was to babysit him, but I also am like the only person in-house for the Peds floor and I am the first point of contact for the brand new intern on OB GYN who is on service all by herself.

Basically, some of these dudes can not at all operate independently, and that is really ****ing scary.