Rotators not pulling their weight

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
J

jhawks

New Member
7+ Year Member
Joined
Apr 30, 2015
Messages
3
Reaction score
0
Members don't see this ad.
So I pulled a shift in the ED working along one of our rotating residents. I am an intern or essentially 2nd year at this time and they were a 2nd year essentially 3rd year Peds resident. It was busy so I was running around managing patients and much of the time I saw them just sit around finishing their last chart before picking up another patient. At the end of the 8 hour shift (us ED residents only work 8 hours!!!) they left while I sat around finishing the 15 charts of patients I had seen. I asked my attending to figure out how many patients the peds resident had seen and it totaled 8. I also let them have every peds patient instead of me taking them since that is their specialty.

I don't care staying 2 hours after or seeing more patients. What drives me nuts is that resident was my senior when I did my peds rotation (we do 1 month of inpatient peds) and they told me how easy us ED residents have it since we "punch out at 8 hours". She noted that she never left the ED more than 15-20 minutes after the 8 hour shift. Now I know why.

It just drives me nuts that some rotators (this one a year ahead of me) can see almost half the patients I do and then turn around and say we have it easy. Sure if I finished up every chart before grabbing a new patient I could be out at shift change but then again; I am pretty sure I would be in my PD's office. I just hate how rotators think that we have it easy based on their experience seeing 1 pph and getting out at shift change and thinking that is the norm for us. Anyone see the same with their residency?
 
Remember we are basically the only specialty which focuses on speed and accuracy. They're used to handling one pt at a time. Of course the ED is easy at 1 PPH which is what they know. We have Peds, FM, and IM in our shop we don't expect them to break 1 pph. Sometimes you get a good ones who will pick up a few more than their counterparts.
 
Different strokes for different folks. In em we are great at managing a lot of undifferentiated patients quickly. A peds,fp, or I M resident, ven a senior one, not so much. F her for thinking we have it easy tho.
 
Yea I see what you mean; what really got me is the idea they get from their ED rotation. They see 7-8/shift, leave after 8 hours, then tell us how easy we have it cause we get to leave after an 8 hour shift (because thats what they do). It probably irritates me more than it should.

Also when I was on my peds rotation I managed just as many patients, if not more, as my fellow peds interns (who at that time had 7 months of peds experience). I honestly don't think they need to see as many in the ED as I do, but really then why should I when I am on their rotation. Also not bagging on peds this happens with all specialties that rotate with us. Many residents from peds to surgery think we all clock out at 8 hours because that is when our shift ends.
 
There's several different issues going on here. One is that the rotator isn't working very hard. Do you have pods or do you pick up charts? If you pick up charts, you will just have to "encourage" the person to pick up more charts. If you're in a pod and use an EMR, just sign the rotator up for new patients as they show up and use him or her as a scribe - I do it all the time. If I have a rotator that's not pulling his or her weight, I'll just tell them "you're seeing bed 18." Also, mention it to your chiefs. We have just about everyone rotate with us. If people from a particular service continually are lazy, the chiefs or your PD can talk to their PD.

You also need to consider the fact that sometimes it makes you're life easier to let a rotator be lazy. A competent rotator can make your life easier, a poor one can make your life much harder. If you're encouraging a rotator to see more patients, but they don't know what they're doing, they're just making a mess. A lot of times I'll send my rotator home just so they get out of my way.

You need to not care what people think. That's part of EM. You be the best EM physician you can be and be proud of it. People will eventually figure it out. I had an IM resident tell me on CCU that she couldn't believe I "got half the month off." Then, she rotated in the ED. She asked where I go to get lunch. I just stopped and looked at her. I told her that I don't ever leave the department - I eat a sandwich at the desk. She asked why I couldn't leave. I told her that I have this pod - any patient that comes in this pod is my patient. What's going to happen if a hypxoic patient needing intubation, or a septic patient, or an critically ill patient rolls in and I'm upstairs? I saw a wave of "ah-ha" roll over her face. Not all people end up "getting it" - and you have to be fine with that. Grow some thick skin.

Finally, a separate issue is your charting. Staying late isn't a badge or honor or showing that you work harder than others. Learn to be more efficient in your charting. If you get a coding patient 20 minutes before shift change, yes, you'll be there late. You shouldn't be leaving 2 hours late regularly.
 
Thanks for the input TimesNewRoman. Couple of things though. Having a lazy rotator doesn't make my life any easier. We have pods but every resident, med student, PA, NP, or whoever presents directly to an attending. If a patient comes up it is essentially up to any of us working to sign up for the new patient. So essentially if a patient is on the board it is up to me, the other resident/PA/NP/med student, or the attending to pick it up. Say if the rotating resident picks the new patient up I have nothing to do with that patient. So simply picking up a patient by another resident, or whoever, keeps me from doing work. It is up to that person and the attending to manage the patient and I have nothing to do with that patient. So essentially even a med student grabbing a patient saves me from any work to that patient as they are not my patient.

Also I honestly do not care how lazy a rotator is. Just in 1 year I have worked with most residents in my hospital. I know who is going to show up and work hard and who takes their ED month as "getting out after 8 hours to have a siesta or drink some brewskis". Just that if you see 7-8 patients to get out on time do not tell me how "easy I have it" because that was your goal.

Also maybe it is my own fault but I am always at least 1.5 hours at the hospital, if not closer to 2 hrs, after my shift. I don't doubt that I could get better at my charting but then again I am just finishing my intern year. In my last two months in the ED I averaged 1.7 pph (my residency keeps track of this). The way I look at it is the only way to get good at this job is seeing patients, working them up, and treating them. If I cut down to 1 pph or even 10-11/8hr shift I could defiantly get out on time but I am cheating myself on becoming the best ED physician I could be and would rather spend the extra time.

This is all getting off topic. The idea is that I feel a lot of my fellow residents in other specialties get ideas on what I do on a daily basis based on their rotations in the ED. They clock out after 8 hours and think that we do the same. Some rotating residents do get it and when I call them for a consult or admit they don't automatically think it is just to get my patient off my service. Others think I am just dumping a patient because that is what they did simply to get out on time.
 
TimesNewRoman said:
Finally, a separate issue is your charting. Staying late isn't a badge or honor or showing that you work harder than others. Learn to be more efficient in your charting. If you get a coding patient 20 minutes before shift change, yes, you'll be there late. You shouldn't be leaving 2 hours late regularly.
Click to expand...

Agree with the other stuff TNR said as well, but this last part is huge. After 6 years as an attending I can tell you that one of the skills you need to develop is the ability to rapidly see, treat, dispo, AND document. Do not neglect this 4th part. It may not seem glamorous but it is a skill and learning to do it quickly and efficiently will make you a better doctor who has more time to see and treat patients. When you graduate and start up as an attending you should be able to see 2-3 pts/hr by yourself and walk out on time. If that's not happening then you need to ask your attending/colleagues how to improve your efficiency.
 
Every so often you'll get a great rotator. I can recall one from my senior year; it was a internal medicine intern who put some of our second years to shame. He was just phenomenal when it came to patient management and departmental flow. I tried to convince him to change to EM... didn't work.
 
One of my favorite attendings and dear friends once told me something that I believe is the most important mantra of emergency medicine residency: see as many patients as you possibly can every shift you work in residency to the point where you feel completely overwhelmed.

Our specialty is neat, we sit side by side with attendings and learn in a much more involved fashion than other specialties. If I said half the stuff I said to my ER attendings to a surgery attending I probably would have been put on probation. Other specialties just aren't like us. Sometimes residents forget that they're still a resident and they are there to learn (I know I did multiple times!) or in some cases just don't care. The best way to learn is to see patients. So if an off service guy or gal isn't pulling their weight, pull it for them. Do it with a smile. The best ER doctors are those who see multiple patients in a timely fashion without breaking a sweat and losing their cool.

Learn this trait in residency and I guarantee you, you will be the doctor when you come on shift the nurses give you a hug and say thank god you're here. Makes your job so much nicer. Good luck.
 
Not to defend the off-service person but not knowing the system can massively slow people down. We have a different computer program for the ED where I'm at and have another few things that create a learning curve.

More importantly they probably are just operating as they would for clinic patients. They probably don't even know the correct brevity of an ED HPI and the expected pace. And quite frankly they probably will not become good at it in 4 weeks just as you were not probably not a perfect peds resident while on their service.

Oh and being lazy can just make all of the above worse.
 
Perrotfish said:
NVM
Click to expand...

LOL I can only imagine what you were going to post.

As an IM resident, I can say without doubt that you ER guys suck hard when you come to the floors for your IM month (not sure if all EM residencies do this). You guys don't know our flow, our priorities, our way of presenting, etc. Some of you definitely don't pull your weight either, and if you came to our (capped, overwhelmingly busy) services thinking the ER was always busier than the floors you walked away with your eyes wide open. Some of our attendings dress you guys down pretty badly too.

As IM residents, we don't bitch much because you're only there for a month and we know it's not your cup of tea. We try hard in the ER, but most of us suck there for the same reason you guys suck on the floors.

You're good at what you do most, different strokes for different folks, etc. Don't be hatin'.
 
We don't expect our rotators to carry much weight. They are in the ED for ~1 month. The goal is not for them to do what we do. Some rotators really dislike the rotation and tend to cherry pick patients in their comfort zone, and that's okay.

We don't do floor months, just ICU. Our ICU attendings prefer the EM residents for getting things done in a hurry with sick patients and keeping our presentations and documentation brief. Our ICU attendings prefer the IM residents for other things.
 
nothing_to_do_here_by_rober_raik-d4cxltj.png
 
We do some hard off service months like ICU and Trauma and SICU. However there are certain rotations where I did not pull my weight like Obgyn(because I couldn't see half the patients) I was there just to get deliveries and they trusted you with nothing. Or NICU saw the least sickest kids or PICU saw the least sickest kids the atttendings refused for me to see any heart kids. So it goes both ways. Also were you in a peds ED or a combination? If it was a combination and she saw all the kids did you look at her notes. Often times peds residents make there notes very thorough and document EVERYTHING you would think you are getting the nurses and physicians note so I can understand why they are not up to speed.
 
It doesn't bother me too much. Off-service residents are there primarily for their benefit. Some of them are interested in everything and very proactive. Others I just try to direct to patients in whatever their chosen specialty is. Besides, I had some cushy off-service months as a resident where I did not have the same expectations for me like ortho and OB.
 
Rotating ER residents rarely pulled their weight on their IM rotations (icu, cards, etc) when I was a resident. We all are more invested on our home turf.
 
dozitgetchahi said:
LOL I can only imagine what you were going to post.

As an IM resident, I can say without doubt that you ER guys suck hard when you come to the floors for your IM month (not sure if all EM residencies do this). You guys don't know our flow, our priorities, our way of presenting, etc. Some of you definitely don't pull your weight either, and if you came to our (capped, overwhelmingly busy) services thinking the ER was always busier than the floors you walked away with your eyes wide open. Some of our attendings dress you guys down pretty badly too.

As IM residents, we don't bitch much because you're only there for a month and we know it's not your cup of tea. We try hard in the ER, but most of us suck there for the same reason you guys suck on the floors.

You're good at what you do most, different strokes for different folks, etc. Don't be hatin'.
Click to expand...

I can assure you that not all EM residencies are this way. I saw my medicine attending in the hospital recently. They went out of their way to ask if they could make calls for fellowship (doing a CCM fellowship) for me as I was the best resident they've had in a very long time. Our PD got an email from one of the medicine attendings that said "intern X is the best intern i've ever had, period." On MICU, we're almost uniformly the highest performing interns. One of the trauma surgeons spent months trying to convince one of our interns to switch to surgery.

And I'm at a program with a traditionally medicine and surgery programs that are traditionally considered VERY strong.
 
TimesNewRoman said:
I can assure you that not all EM residencies are this way. I saw my medicine attending in the hospital recently. They went out of their way to ask if they could make calls for fellowship (doing a CCM fellowship) for me as I was the best resident they've had in a very long time. Our PD got an email from one of the medicine attendings that said "intern X is the best intern i've ever had, period." On MICU, we're almost uniformly the highest performing interns. One of the trauma surgeons spent months trying to convince one of our interns to switch to surgery.

And I'm at a program with a traditionally medicine and surgery programs that are traditionally considered VERY strong.
Click to expand...

Same here. We don't do floor months but our residents are loved in our ICUs and we have strong IM and Surg programs (although our peds is a bit weak). We've had multiple folks go on to CC fellowship after being embraced and supported by our intensivists.

Also, I don't care nor expect a rotator to pull their weight. I expect them to learn some basics of emergency care and get an idea of what's a reasonable thing to a) send a pt to the ED for and b) work up to be done in the ED. If they can gain an appreciation of when it is and isn't appropriate for them to send a patient to the ED, what makes our job hard, and how to stabilize ill patients a bit better I consider that a success.
 
Last edited:
I can remember deliberately "not pulling my weight" on a rotation or two. I was checked out, as there was little to be learned on that rotation beyond "how to stay out of the way while the surgical seniors argued with one another while the patient died."

Oddly enough, our program director cancelled those rotations shortly thereafter in favor of more useful learning opportunities... much to the chagrin of those hosting departments.

Guess they weren't that useful of rotations after all.
 
TimesNewRoman said:
I can assure you that not all EM residencies are this way. I saw my medicine attending in the hospital recently. They went out of their way to ask if they could make calls for fellowship (doing a CCM fellowship) for me as I was the best resident they've had in a very long time. Our PD got an email from one of the medicine attendings that said "intern X is the best intern i've ever had, period." On MICU, we're almost uniformly the highest performing interns. One of the trauma surgeons spent months trying to convince one of our interns to switch to surgery.

And I'm at a program with a traditionally medicine and surgery programs that are traditionally considered VERY strong.
Click to expand...

Yup, and I can cite just as many examples to the contrary. Anecdotes and all that.

A lot of EM people (at least where I am) tend to think they are the very best thing since sliced bread. Whether anyone else outside the ER shares that opinion is the question - and at least in my neck of the woods, most people don't.
 
dozitgetchahi said:
Yup, and I can cite just as many examples to the contrary. Anecdotes and all that.

A lot of EM people (at least where I am) tend to think they are the very best thing since sliced bread. Whether anyone else outside the ER shares that opinion is the question - and at least in my neck of the woods, most people don't.
Click to expand...

Cool story, bro.
 
Pretty silly thread. When its your house, you tend to work hard and make sure things run well. When its not your house, you tend to not care too much.

I did residency before all of the hour restrictions and in off service rotations I would slack off. After the 100th hour of the week in surgery, I wish to just be left alone. But if I was a surgery resident, i would be pushing hard b/c thats my house.

No different than Peds/Pscyh/IM coming to the ED. They have been beaten up in their last month, its nice to take a little break and see 8 pts a shift.

I do find it ironic that an EM resident would complain about anything doing 8 hr shifts. Seriously.... Residency has 8 hr shifts? No wonder residents across the board are so weak coming out.
 
emergentmd said:
Pretty silly thread. When its your house, you tend to work hard and make sure things run well. When its not your house, you tend to not care too much.

I did residency before all of the hour restrictions and in off service rotations I would slack off. After the 100th hour of the week in surgery, I wish to just be left alone. But if I was a surgery resident, i would be pushing hard b/c thats my house.

No different than Peds/Pscyh/IM coming to the ED. They have been beaten up in their last month, its nice to take a little break and see 8 pts a shift.

I do find it ironic that an EM resident would complain about anything doing 8 hr shifts. Seriously.... Residency has 8 hr shifts? No wonder residents across the board are so weak coming out.
Click to expand...

I disagree. I busted my butt on off-service rotations. It's a matter of personal pride, professional relationships and our departments reputation in the hospital.
 
TimesNewRoman said:
I disagree. I busted my butt on off-service rotations. It's a matter of personal pride, professional relationships and our departments reputation in the hospital.
Click to expand...

I am sure you did but this thread is not about an individual. It is about the norm and not the exception.
 
dozitgetchahi said:
Yup, and I can cite just as many examples to the contrary. Anecdotes and all that.

A lot of EM people (at least where I am) tend to think they are the very best thing since sliced bread. Whether anyone else outside the ER shares that opinion is the question - and at least in my neck of the woods, most people don't.
Click to expand...

That's nice. But you aren't going to get any supporters here. This is the EM forum... where we come to vent about other services.

In pretty much every other forum there's some variation of "damn the ED is dumb" thread. And none of us (except Apollyon) wander around the other forums looking for people badmouthing us, because it's the internet version of sitting around in your residency break room and complaining about the other services.

It's all just venting and we can all throw out our anecdotes.
 
Last edited:
Doctor Bob said:
That's nice. But you aren't going to get any supporters here. This is the EM forum... where we come to vent about other services.

In pretty much every other forum there's some variation of "damn the ED is dumb" thread. And none of us (except Apollyon) wander around the other forums looking for people badmouthing us, because it's the internet version of sitting around in your residency break room and complaining about the other services.

It's all just venting and we can all throw out our anecdotes.
Click to expand...
Dude, I look at a LOT of forums. I don't go "wandering" and "looking for people badmouthing us". When I see it, though, I call it, and only sometimes, at that.

And you would be prudent not to speak for everyone else (except me).
 
emergentmd said:
Pretty silly thread. When its your house, you tend to work hard and make sure things run well. When its not your house, you tend to not care too much.

I did residency before all of the hour restrictions and in off service rotations I would slack off. After the 100th hour of the week in surgery, I wish to just be left alone. But if I was a surgery resident, i would be pushing hard b/c thats my house.

No different than Peds/Pscyh/IM coming to the ED. They have been beaten up in their last month, its nice to take a little break and see 8 pts a shift.

I do find it ironic that an EM resident would complain about anything doing 8 hr shifts. Seriously.... Residency has 8 hr shifts? No wonder residents across the board are so weak coming out.
Click to expand...

Programs w/ 8 hr shifts tend to have > 20 shifts/month. The RRC has a minimum number of contact hours/month that must be adhered to. I don't think that minimum has changed. The most common shift length that I recall from the interview circuit was 10 hours with usually 17-18/month. Two questions for you: 1) what was your shift schedule and 2) did you get to the ED up hills both ways and in the snow?
 
There are plenty of doctors not pulling their weight in the ED even outside of residency. In the real world they are called locums, travelers, moonlighters, or per diems. Some of them (the minority) treat the ED as an off-service rotation and make it their mission to see 1 pph. They usually don't last more than a month though - kind of like the off-service rotating resident. Isn't ironic? Don't you think?
 
Apollyon said:
Dude, I look at a LOT of forums. I don't go "wandering" and "looking for people badmouthing us". When I see it, though, I call it, and only sometimes, at that.

And you would be prudent not to speak for everyone else (except me).
Click to expand...

He he, we got them to argue amongst themselves about arguing with the rest of us.

2 internets awarded.

Of course not that my opinion matters in your breakroom but Apollyon is right as usual.
 
Last edited:
b-real said:
Programs w/ 8 hr shifts tend to have > 20 shifts/month. The RRC has a minimum number of contact hours/month that must be adhered to. I don't think that minimum has changed. The most common shift length that I recall from the interview circuit was 10 hours with usually 17-18/month. Two questions for you: 1) what was your shift schedule and 2) did you get to the ED up hills both ways and in the snow?
Click to expand...
False. There is a minimum number of ED months/blocks, but there's no minimum requirement for shifts/month. There is, however, a maximum.
Look at the spread between programs. Clearly the playing field isn't as level as we pretend.
http://www.jem-journal.com/article/S0736-4679(14)01233-5/abstract
Clinical hour ranges of 2670–5112 and 4248–6113 were observed for 3-year and 4-year programs, respectively.
Click to expand...
 
Apollyon said:
Dude, I look at a LOT of forums. I don't go "wandering" and "looking for people badmouthing us". When I see it, though, I call it, and only sometimes, at that.
And you would be prudent not to speak for everyone else (except me).
Click to expand...

Well yes, all it takes is an n=1 to disprove an absolute. So perhaps the "none" choice of words was poor. But the point still stands.
In real life we all know our consultants (mostly in the residency world) go back to their floors after coming to the ED and talk smack about us. So what. If we went around trying to set them straight and prove that their vented frustrations were really unfounded we'd never get anything else done, plus we wouldn't change their opinions. Right or wrong it's something we all do.
So if there are a lot of ED people on here who make a point of going to other forums for the purposes of trying to correct other specialties views of us... well... good luck to you. That would be a somewhat foolhardy thing to do in real life and it's nigh impossible to do on the internet.

x1s8ivwmm4tkr7otvwp0.jpg



Gastrapathy said:
He he, we got them to argue amongst themselves about arguing with the rest of us.
2 internets awarded.
Of course not that my opinion matters in your breakroom but Apollyon is right as usual.
Click to expand...

We do love to argue.
 
Gastrapathy said:
He he, we got them to argue amongst themselves about arguing with the rest of us.
Click to expand...
That was actually one of my favorite tricks in residency - let the two consultants battle it out. Get a call back with name of the service accepting the patient. Bonus points if the bed request was already in and to the right service.

To the point of the thread, in our program, off-service folks are usually assigned to a team with our seniors. If the rotator is pulling their weight, it makes for an easy night, and that's kinda nice one in awhile. If they don't, then that means the senior pretty much runs the entire side on their own, and they get a near-attending level shift. Which is what a resident should be aiming for from day one of intern year.

As with most things, you have very little control over your environment. You can't whip a fellow resident to see more patients, but you can control your additide. Don't by Polly Anna, but find the upside in every encounter. It makes things much easier.
 
Doctor Bob said:
Well yes, all it takes is an n=1 to disprove an absolute. So perhaps the "none" choice of words was poor. But the point still stands.
In real life we all know our consultants (mostly in the residency world) go back to their floors after coming to the ED and talk smack about us. So what. If we went around trying to set them straight and prove that their vented frustrations were really unfounded we'd never get anything else done, plus we wouldn't change their opinions. Right or wrong it's something we all do.
So if there are a lot of ED people on here who make a point of going to other forums for the purposes of trying to correct other specialties views of us... well... good luck to you. That would be a somewhat foolhardy thing to do in real life and it's nigh impossible to do on the internet.

x1s8ivwmm4tkr7otvwp0.jpg





We do love to argue.
Click to expand...

No we don't.
 
Doctor Bob said:
So if there are a lot of ED people on here who make a point of going to other forums for the purposes of trying to correct other specialties views of us... well... good luck to you. That would be a somewhat foolhardy thing to do in real life and it's nigh impossible to do on the internet.
Click to expand...
See, this is where you kind of miss the point. My point is just to show people what others say, when I notice it. I don't address it in the other forums unless it is prospective (like giving the tetracaine to patients to go). Otherwise, it's just an "FYI" thing.
You're you, and I get it, and that's why I don't usually respond to anything you say (such as, above, I believe, is the first time I ever did). I don't jibe with the way you roll. But, if you think that everything is passive, and that no one can change anyone else's mind, well, that is squarely on you.
 
Apollyon said:
See, this is where you kind of miss the point. My point is just to show people what others say, when I notice it. I don't address it in the other forums unless it is prospective (like giving the tetracaine to patients to go). Otherwise, it's just an "FYI" thing.
You're you, and I get it, and that's why I don't usually respond to anything you say (such as, above, I believe, is the first time I ever did). I don't jibe with the way you roll. But, if you think that everything is passive, and that no one can change anyone else's mind, well, that is squarely on you.
Click to expand...
Agree to a point. EM is still where it is (you guys are dumb down there hurdurrr) because not enough of us take the time to challenge that notion. Not enough of us sit at the meetings where gas, anesthesia, surgery, and IM talk about how to "fix" the problems at the hospital, and all of them point the finger at us. There are times for being passive, and times to challenge preconceived notions.
 
NinerNiner999 said:
There are plenty of doctors not pulling their weight in the ED even outside of residency. In the real world they are called locums, travelers, moonlighters, or per diems. Some of them (the minority) treat the ED as an off-service rotation and make it their mission to see 1 pph. They usually don't last more than a month though - kind of like the off-service rotating resident. Isn't ironic? Don't you think?
Click to expand...
A little too ironic?
 
As another newly minted pgy2 that JUST came off inpatient peds, I definitely get the whole "document everything." These guys write significant event notes for the most trivial thing, and obsess over the smallest detail that is guaranteed to have no real clinical significance. But the peds seniors did a great job letting me see patients that interested me and not much else. In my case it was working on the peds heme onc service (pops is an oncologist so ive always had an interest). They pulled some extra weight to account for the fact that peds isnt my specialty and I dont know the procedures in the childrens hospital as well as they do. So when I am supervising peds interns in the department this year the least i can do is keep them involved in the stuff that interests them and is applicable to their practice, as they did for me. So if they want to see all peds thats fine. But if it was a slow day and only 2 or 3 peds patients came through and they refused to pick up charts I would be a little annoyed, but it is what it is. Like the medicine guy said above, we suck at floors in general. I suck at following up on things and following patients for days on end. Medicine residents excel at that. Different strokes for different folks.
 
At my program we just accept that off-service residents are not going to be as efficient or as versatile as other EM residents. Attendings don't expect the same and they all seem to agree that off service residents require more oversight. But, we don't bitch about it or hold it against them (unless they're really slow). It would be pretty bad if they could walk in to the ED and do what we do just as it would if we could walk on to the floor and do their job the same. We have different goals and standards and it is not easy to switch between them. My problem is when they assume their experience is the same as ours in the ED, and in those cases I'm happy to provide them a reminder how they rarely see critical patients (EM residents sign up for them more quickly), they didn't place lines (central or peripheral), didn't ultrasound, didn't respond to trauma, rarely sutured, didn't see women with gyn or OB complaints, didn't see peds, etc. And I do not hold that against them unless they make some crappy remark about us. However some do rotate and enjoy their experience. Some of the prelim folks have said that they would have done their intern year in EM if it were possible (maybe someone should revive the "acute care internship" a la MCP in the 70s). Some do get involved with trauma or codes and place lines. All of us would be a lot less stressed if we just accepted the fact that those in other specialties will not be as good as us in managing our own specialties patients.
 
Just out of curiosity, if a peds resident were rotating on your EM service, would it be unusual for them to see adults as well as kids? I would think you'd send them in the direction of any kids who present in the ED, but if there are no kids at a given time, would the peds resident just sit on his rear end hanging out? Or do peds residents usually only rotate in pediatric EDs?
 
NurWollen said:
Just out of curiosity, if a peds resident were rotating on your EM service, would it be unusual for them to see adults as well as kids? I would think you'd send them in the direction of any kids who present in the ED, but if there are no kids at a given time, would the peds resident just sit on his rear end hanging out? Or do peds residents usually only rotate in pediatric EDs?
Click to expand...

There are some parameters for pediatric residents. They can see any kid, or any adult with a presentation that could likely be seen in a kid/adolescent. I'm not going to send the peds resident in to see the 84yr old dementia transfer from the NH, but the 24yr old vaginal bleeder is certainly fair game.

Although some could argue that the 84yr old dementia patient has about the same mental status as a 1yr old; but they don't get nearly as excited about Elmo stickers.
 
Doctor Bob said:
Although some could argue that the 84yr old dementia patient has about the same mental status as a 1yr old; but they don't get nearly as excited about Elmo stickers.
Click to expand...
My 85yr old patients have much more developed tastes -- last week a patient's daughter was successfully placating her with a copy of Vanity Fair. Or some other "trashy magazine", as she put it.

For the OP: ultimately, the management of off-service rotators is really up to the supervising doc, in your case the attending. It's tough if you as an intern have to tell a colleague to get a move on it. I would say that as frustrating as it is to be working with one of the (generally few ime) fly-catching rotators, it is far, far more frustrating to simultaneously have to push them to Actually Work while trying to protect the patient from them while trying to get them to Learn SOMETHING. Something. Please. I beg you, just show evidence you care a little thou twit who is drooling on the department's keyboard.

Back on track here. The slow folks who document were often slow and steady, but not terrifying like the truly less common few who seemed determined to vacation in the ED.

There was actually a study on the productivity of off-service residents, however. http://dx.doi.org/10.1016/j.jemermed.2014.11.001
Off-service residents showed a productivity of 0.529 PPH (95% confidence interval [CI] 0.493–0.566) and 1.40 RVU/h (95% CI 1.28–1.53) prior to implementation of shift cards. With the introduction of shift cards, productivity increased to 0.623 PPH (95% CI 0.584–0.663, p = 0.001) and 1.77 RVU/h (95% CI 1.64–1.91, p = 0.001). In comparison, first year EM resident productivity was 0.970 PPH (95% CI 0.918–1.02) and 3.01 RVU/h (95% CI 2.83–3.19)​
EBM: bringing shift cards to an off-service resident near you!
 
Doctor Bob said:
Although some could argue that the 84yr old dementia patient has about the same mental status as a 1yr old; but they don't get nearly as excited about Elmo stickers.
Click to expand...

QFT. We need something like the Rochester or Phily criteria for febrile octogenarian workup.
 
DoctorMedic said:
Remember we are basically the only specialty which focuses on speed and accuracy. They're used to handling one pt at a time. Of course the ED is easy at 1 PPH which is what they know. We have Peds, FM, and IM in our shop we don't expect them to break 1 pph. Sometimes you get a good ones who will pick up a few more than their counterparts.
Click to expand...

This is true. When I did my rotation, I would usually see 1 pt per hour, which was faster than expected for my level. It does take some time at first to see the patient, wait to present the patient, do the note, and wait for a new patient. Plus, my preceptors were more focused on quality over quantity, and I knew that if I rushed during seeing a patient or tried to hurry, I would miss LOTS of key concepts and findings.
 
jhawks said:
Thanks for the input TimesNewRoman. Couple of things though. Having a lazy rotator doesn't make my life any easier. We have pods but every resident, med student, PA, NP, or whoever presents directly to an attending. If a patient comes up it is essentially up to any of us working to sign up for the new patient. So essentially if a patient is on the board it is up to me, the other resident/PA/NP/med student, or the attending to pick it up. Say if the rotating resident picks the new patient up I have nothing to do with that patient. So simply picking up a patient by another resident, or whoever, keeps me from doing work. It is up to that person and the attending to manage the patient and I have nothing to do with that patient. So essentially even a med student grabbing a patient saves me from any work to that patient as they are not my patient.

Also I honestly do not care how lazy a rotator is. Just in 1 year I have worked with most residents in my hospital. I know who is going to show up and work hard and who takes their ED month as "getting out after 8 hours to have a siesta or drink some brewskis". Just that if you see 7-8 patients to get out on time do not tell me how "easy I have it" because that was your goal.

Also maybe it is my own fault but I am always at least 1.5 hours at the hospital, if not closer to 2 hrs, after my shift. I don't doubt that I could get better at my charting but then again I am just finishing my intern year. In my last two months in the ED I averaged 1.7 pph (my residency keeps track of this). The way I look at it is the only way to get good at this job is seeing patients, working them up, and treating them. If I cut down to 1 pph or even 10-11/8hr shift I could defiantly get out on time but I am cheating myself on becoming the best ED physician I could be and would rather spend the extra time.

This is all getting off topic. The idea is that I feel a lot of my fellow residents in other specialties get ideas on what I do on a daily basis based on their rotations in the ED. They clock out after 8 hours and think that we do the same. Some rotating residents do get it and when I call them for a consult or admit they don't automatically think it is just to get my patient off my service. Others think I am just dumping a patient because that is what they did simply to get out on time.
Click to expand...

How many patients are in each pod?
 
You must log in or register to reply here.

Similar threads

E
How to handle colleagues not pulling their weight
2
Replies
77
Views
8K
EctopicFetus
EctopicFetus
A
Aways in EM - necessary or not?
Replies
16
Views
2K
RustedFox
RustedFox
KGflyboy
Anybody else's Hospitalists not admitting patients anymore?
2 3
Replies
106
Views
6K
Splenda88
S
thegenius
Did any docs take the QBI deduction on their taxes?
Replies
2
Views
1K
Mount Asclepius
Mount Asclepius
J
Advice for EM rotation
Replies
31
Views
3K
Franzd'Epinay
F
Top