Doing well in residency

[Rimagine]

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Hi everyone,
As we are only a couple of months away from beginning intern year, I want to get a sense of what it takes to do well in residency. Currently, I am thinking west coast hospitalist vs fellowship; and it'll be an uphill battle for me. I know we still get evaluations from seniors and attendings, but do programs assign grades? How does one obtain AOA status as a resident? What else is important besides connections, publications, and +/- USMLE 3 in landing that coveted hospitalist/fellowship position? Thanks so much in advance!

 

[ROBINHO]

Work very hard. Arrive very early to pre round on your patients and tie all loose ends before heading home (dont leave a lot of things for night float resident/crosscover). Be likeable, flexible and on good terms with everybody. With these basic skills...u will be well liked by senior residents and attendings. In internship the most important trait is being a very hard worker not the smartest.

 

[babdoc]

Ditto to the above. Also, have everything you might need to know written down. It's impossible to know absolutely everything about every patient. But, if you have it written down, it will be close at hand when you're asked for a patient's last three INRs. Internship is less about knowledge and more about efficient data collection.

 

[PD1]

You will be able to open many doors by gaining the trust of your attendings and program director, these traits may help:
1. benevolence: be a good guy - avoid making derogatory comments about anyone (colleagues, RN's and patients) - smile often
2. reliability: do ALL the tasks they assign to you (taking notes help)
3. competence: able to deal with the problems expected for your level of training - don't have to be the smartest, but reading helps (both medicine in general and about your patient), expand your differential diagnosis, try to come up with your own plan
4. honesty: don't throw curved balls when mistakes happen
5. openness: listen and look to the eyes when someone is talking to you, seek and be willing to accept feedback

 

[chocoginger]

Hi everyone,
As we are only a couple of months away from beginning intern year, I want to get a sense of what it takes to do well in residency. Currently, I am thinking west coast hospitalist vs fellowship; and it'll be an uphill battle for me. I know we still get evaluations from seniors and attendings, but do programs assign grades? How does one obtain AOA status as a resident? What else is important besides connections, publications, and +/- USMLE 3 in landing that coveted hospitalist/fellowship position? Thanks so much in advance!

I've never heard of AOA status as a resident....but in terms of what makes a good resident:
-Be efficient: it helps to have some sort of system to get tasks done, esp as an intern on inpatient medicine.
-Show up on time
-Know your limits, and don't be a cowboy/girl. Don't be afraid to ask for help
-Don't be lazy. You're a part of a team, so do your part.

I know a few people who went to prestigious medical schools, and were first authors in prestigious publications, etc...but then got kicked out of residency (even after matching to competitive fellowships) because of issues with one or more of the above.

 

[lifetime]

Nice thread OP and thanks for the wonderful responses. Can anybody shed some light on how to be efficient. Anything in particular you wish you knew before starting that would've helped you be more efficient?

 

[Deferoxamine]

Likeability should probably be #1-5 on this list.

Showing off in front of your interns (i.e. being overly efficient to the point that it hurts patient care, being the first to sign out everyday leaving the "cross-cover" intern to deal with the crap you were "too efficient" to do) and kissing ass or being overly verbose about how much you know about everything even when it isn't relevant - I have watched these traits ABSOLUTELY destroy interns' reputations by PGY-2. Getting 90% of your class to hate you is a terrible idea, and eventually everyone just blacklists you. Attendings and chiefs and even the PD starts noticing. Interns you work with as the show-off PGY-2 will know that everyone hates you, will have a hard time looking past that when they just worked 78 hours last week and are asked to fill out an evaluation about you.

Don't make enemies. Residency is a social game. Period.

As a PGY-2, I worked with roughly 25 interns throughout the year and only got a negative/constructive evaluation comment from one of them the entire year. Though I certainly wasn't the smartest or most efficient, I'm certain the positive evaluations went a long way in establishing a positive reputation with the higher-ups. Showing that you can work well and play well with others can only help you.

 

[chocoginger]

Agreed---be efficient, not "efficient".Truly being efficient means getting your intern/resident tasks done in a timely manner while providing the best possible care and being a responsible team member. It's possible. You don't want to be the person known as being slow. It effects everyone on the team.

How to be efficient? As an intern, you'll realize certain things are more time consuming, and you can multitask certain things. Call your consults/call radiology for approval/etc as early as possible in the day. If there are computers on wheels around, try to use them so you can order labs/imaging that the attending decides s/he wants while rounding. Be on top of labs as them come back. Respond to them appropriately. In the beginning of residency, this usually entails asking your resident what to do. Don't worry too much about it now though. Things will probably be specific to your institution in terms of how to work the system efficiently.

 

[TeamZissou]

Good thread, one of the few useful ones I've seen in a while so thank you.

I get told to "have a system". As a medical student my system consisted of having a letter size sheet of paper I tote around with me that has the pts previous two labs, meds, allergies, problem list. While this works now I imagine there must be a better way as a resident. The time it takes to write that info down on 8-10 patients is not going to fly. My program uses epic fwiw.

Anyone have suggestions that are more modern? Ideally utilizing technology to cut down on mundane copying over of details to pen/paper.

I should add it must comply with hippa, so my gmail account and googledocs is out.

 

[ThoracicGuy]

Back in my day as a resident, I made notecards with the patient info on it. I'd have the labs, meds, plans, etc on that card each day. It was small enough I could put in my coat pocket or even my back pocket of my scrubs. Yes, it was copying info from the computer, but it was alot less bulky than a notebook of papers and quicker than loading something up on even a tablet. As an intern, speed is key. If your upper levels know they can get the right answer from you quickly, they will like working with you.

 

[disorder]

Good thread, one of the few useful ones I've seen in a while so thank you.

I get told to "have a system". As a medical student my system consisted of having a letter size sheet of paper I tote around with me that has the pts previous two labs, meds, allergies, problem list. While this works now I imagine there must be a better way as a resident. The time it takes to write that info down on 8-10 patients is not going to fly. My program uses epic fwiw.

Anyone have suggestions that are more modern? Ideally utilizing technology to cut down on mundane copying over of details to pen/paper.

I should add it must comply with hippa, so my gmail account and googledocs is out.

Use Epic's sign out sheet. Fold it 5/6-7/8 hot dog style so you can still see the name.
Write down labs, subjective findings, pertinent tasks.
Keep that paper an extra day.

Update the next day's sign out with the same stuff.

 

[dozitgetchahi]

- Get ready to mimic the preferences of your attendings/residents, even if you think whatever they're doing is not the best/not evidence based/backwards/whatever. Articulate your point of view and advocate for what you think is right, but back off if you're not getting a favorable response. The only time you want to really raise a fuss is if you're being asked to do something that will put a patient directly into danger.
- If you're admitting/dealing with issues etc, always try to formulate a plan first and then bounce it off attendings and residents. This is the way you really learn what to do. Likewise, by the end of the year you should respond first to pages about critical issues, try to stabilize the situation as much as possible and only then call your resident to see if anything else was necessary. You need to do this so you're not still fresh meat when you're leading the team as a PGY-2.
- Don't be an ass.
- Don't be the guy who orders weird meds and/or always does weird stuff that doesn't conform to local practice customs/guidelines/etc.
- Document EVERYTHING you do. When I cross cover, I write a note every time I do so much as order a Tylenol. It covers your ass. Plus, there's nothing more irritating than coming in the next day and seeing that the night float people ordered a bunch of random stuff with no explanation of what the hell was going on etc. These notes don't need to be long - do a two liner unless you need to include a physical exam etc.
- Signouts need to be good. Streamline them so that the person you're signing out to (who is likely cross covering and admitting and thus has a lot of stuff going on) knows the critical issues/things to follow up etc but no more. There is nothing that sucks more than dealing with the people who want to give you a full H&P on every single pt they're signing out to while you have 3 pagers going off at once and your resident is hounding you to go do the next admission etc. On the other hand, you must make sure you sign out ALL the important info - skipping something essential is a good way to get in trouble when things go awry.
- Keep your notes and discharge summaries concise (I had trouble with this for a while - it takes some time to do right). Put everything in documentation that needs to be there, but no more. This isn't like medical school where the person who writes the longest, most verbose notes packed with the most irrelevant crap wins the prize. Those types of notes take waaay too long to write, and nobody wants to have to read them either.
- Speed is important, but at the end of the day it is probably better to be a bit slow but methodical/thorough than to be 'efficient' but sloppy/dangerous.
- Likewise, tie up loose ends and stick around to ensure your patients get good care (within reason, of course). Don't be like the prelims at my program who zip through rounds, blast out their notes and leave the cross cover person holding the bag to follow up all their consults/labs/imaging that they couldn't be bothered to stick around for. It's poor form.
- Keep an even keel. Be calm, pleasant and professional. Garnering a reputation for being a high maintenance, high drama emotional mess will not win you many friends.
- Clean up. Shave as often as is feasible (if you're a dude). Don't walk around in a filthy white coat like so many residents do. Throw out tattered/ill fitting clothing. Polish your shoes once in a blue moon.
- Don't be the person who is always trying to get their schedule changed around and/or is constantly trying to get some sort of exception made for themselves etc. This is an excellent way to irritate the wrong people.

 

[visari]

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- Don't be the person who is always trying to get their schedule changed around and/or is constantly trying to get some sort of exception made for themselves etc. This is an excellent way to irritate the wrong people.

this is gold! especially in internship. You're going to miss a few weddings and family occasions. If you are trying to get people to cover your calls so you don't miss any party, you will buy yourselves a lot of enemies which will eventually get back at you really bad. People will notice your laziness, don't be a smarta**

 

[Kaputt]

I wouldn't ever count on getting AOA status as a resident. My class recently elected a some residents and faculty into our chapter of AOA, and it was literally a popularity contest.