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So how many of you interns have been tortured by your senior residents and attendings for the 80 hr rule???. IM sure many interns and juniors are facing this issue with disgruntled seniors.
Senior Torture
- Thread starter apma77
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The only torture I've received is that my cheif yells at me when I come in early and stay late.
He doesn't want me to pre-round if I'm not post call. That means I have to come in at 6:00 AM. He also doesn't want me staying late in the day either. I have to be out the door by 6:00pm. My program is very serious about these hours.
I think all the Residents here realize that this is a HUGE plus for all. My chief Residents all seem to be estactic that they don't have to work 120 hours this year.
He doesn't want me to pre-round if I'm not post call. That means I have to come in at 6:00 AM. He also doesn't want me staying late in the day either. I have to be out the door by 6:00pm. My program is very serious about these hours.
I think all the Residents here realize that this is a HUGE plus for all. My chief Residents all seem to be estactic that they don't have to work 120 hours this year.
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My program has been the same. I have been surprised how respectful the other residents and fellows have been. They encourage me to do what is necessary and then get out of there ASAP. It is a test of our management and communication skills so that continuity is not screwed up. However, the fellows and residents have not been crappy about it to me and seem happy that they also can get out of there to do other things as well.
N
njbmd
Hi Folks,
The 80-hour work did not get rid of the work! You have less time to get it done. Right out of the shutes, the new interns have to get up to speed and get the daily work done. Surgery is very task intensive and you have to move pretty fast to get everything done. The work didn't go away just because hours were cut. The folks who started last year under the old system had the advantage of more time to get up to speed.
Here at UVa, we have been under the 80-hour rule since January. We have been able to get most things done but we are still shifting and delegating. The main thing that the new interns had to learn to do was keep things organized and do a good sign-out to the Night Float Resident. They have been struggling with just getting the day-to-day tasks completed in a timely manner. As an intern, your main job is to take care of the hundreds of details of bedside patient care. If you order a test or study, you have to follow up on the results. If you write orders, you have to follow up to make sure that they have been carried out. You can't sign these kinds of tasks to the Night Float unless you know your patient is going for a late study.
If you have a Night Float resident, you have to keep in mind that they do not know your patients as well as you do. You have to anticipate your patient's night needs and provide specific guidelines for the Night Float. You also have to remember that this person is covering a large number of patients so they don't have the luxury of "reading the chart" to find out what has been going on with your patient. Tell them things that you would want to know if you were in their position. You can't just write down a bunch of lab values and leave. You also need to check in with the Night Float when you come in to start your shift so that you know what happened overnight with your patients.
When your chief or senior resident tells you to leave, you need to keep a list of what you have not done so that you can sign it out. You should not be signing out dictations! You can always do your dictations when things on the floors slow down. Dictating a good discharge summary is an art but the more you dictate, the better you become at it. Dictating operative reports is much the same. You are going to be pretty rusty at first but you should be able to get up to speed quickly. Find a good template and stick with it at all times.
Good communication and organization has to be present for the 80-hour work rule to keep the patient care level high. You may be spending less time in the hospital but you don't have the luxury of downtime to tie up loose ends.
njbmd
The 80-hour work did not get rid of the work! You have less time to get it done. Right out of the shutes, the new interns have to get up to speed and get the daily work done. Surgery is very task intensive and you have to move pretty fast to get everything done. The work didn't go away just because hours were cut. The folks who started last year under the old system had the advantage of more time to get up to speed.
Here at UVa, we have been under the 80-hour rule since January. We have been able to get most things done but we are still shifting and delegating. The main thing that the new interns had to learn to do was keep things organized and do a good sign-out to the Night Float Resident. They have been struggling with just getting the day-to-day tasks completed in a timely manner. As an intern, your main job is to take care of the hundreds of details of bedside patient care. If you order a test or study, you have to follow up on the results. If you write orders, you have to follow up to make sure that they have been carried out. You can't sign these kinds of tasks to the Night Float unless you know your patient is going for a late study.
If you have a Night Float resident, you have to keep in mind that they do not know your patients as well as you do. You have to anticipate your patient's night needs and provide specific guidelines for the Night Float. You also have to remember that this person is covering a large number of patients so they don't have the luxury of "reading the chart" to find out what has been going on with your patient. Tell them things that you would want to know if you were in their position. You can't just write down a bunch of lab values and leave. You also need to check in with the Night Float when you come in to start your shift so that you know what happened overnight with your patients.
When your chief or senior resident tells you to leave, you need to keep a list of what you have not done so that you can sign it out. You should not be signing out dictations! You can always do your dictations when things on the floors slow down. Dictating a good discharge summary is an art but the more you dictate, the better you become at it. Dictating operative reports is much the same. You are going to be pretty rusty at first but you should be able to get up to speed quickly. Find a good template and stick with it at all times.
Good communication and organization has to be present for the 80-hour work rule to keep the patient care level high. You may be spending less time in the hospital but you don't have the luxury of downtime to tie up loose ends.
njbmd
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Sounds like UVA needs to hire better/more ancillary staff. It also sounds like UVA needs a better computer system.
Right now the specific surgery department I'm rotating through is going to hire two more PAs. One is "learning" here right now. He's extremely helpful. We also have an NP who does all the dictations and discharges... besides countless other tasks. Last year they rotation had one intern and the NP. Now two interns, PA, and a NP are responsible for the same amount of work. The computer system here is also very helpful. It tracks everything that is done. I can see what is ordered, results, X-rays, scanned documents, etc.. I can also check all this at home on the internet.... including the VA's CRPS system. Very nice for homecall.
I know scutwork and paper work is just part of the job, but in reality it doesn't really make you a better surgeon. Heck, I'm not training to be a secratary.... and I don't see any of my Attendings doing the scut.
Right now the specific surgery department I'm rotating through is going to hire two more PAs. One is "learning" here right now. He's extremely helpful. We also have an NP who does all the dictations and discharges... besides countless other tasks. Last year they rotation had one intern and the NP. Now two interns, PA, and a NP are responsible for the same amount of work. The computer system here is also very helpful. It tracks everything that is done. I can see what is ordered, results, X-rays, scanned documents, etc.. I can also check all this at home on the internet.... including the VA's CRPS system. Very nice for homecall.
I know scutwork and paper work is just part of the job, but in reality it doesn't really make you a better surgeon. Heck, I'm not training to be a secratary.... and I don't see any of my Attendings doing the scut.
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Sounds like you WANT people to be tortured. Sorry but it doesn't have to that way. Any program that is serious about the 80 hour work rule knew that they had to improve a lot of things. More PAs. Better computer system. etc...
I think the 80 hour work rule is about right. The medical system had become so bloated and inefficient.
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The above poster is quite right about the necessity of a COMPLETE sign-out. You need to communicate very clearly about what's going on with your patients and what your chief/attending wants done with them if a given trend continues. At my school last year, when a "bad" sign-out was given, if there was a question about the patient it was directed to the chief of the service. The chief then educated his intern about how to properly sign out to the night float. Sucked to be the guy who got chewed on, but most people learned their lesson pretty quickly.
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daredevil,
many of these details are in fact important. When you sit thru and read previous dictations by allied health professionals which are incomplete or uninformative about what actually happened to a patient you'll get a different perspective. Medical record miscommunications are one of the frequent offenders in bad outcomes among acute & chronically ill patients (just observe the problems you get when services change each month & that's with physicians doing the communicating)
For the most part, PA & NP's will only be asked to assume the lowest of delegated duties @ teaching hospitals, & if you are appropriately professionally paranoid about your patients (as you should be as a surgery intern) you'll find yourself doubling up much of their work.
This new environment you're starting is going to be a very mixed bag for your training. It will definately change the culture of expectations of your junior years (PGY1-3) in a good way. The consequences of this however is likely to be not insignifigant decrease in patient contacts & operative experience. You will also have some of the peaks & valleys of your workload shifted to your senior years in a way most people will not enjoy. I expect that many of the less strenuous electives previously enjoyed at many programs will also be curtailed as manpower is rearranged to cover the core services at your main teaching hospitals. Like I said, a mixed bag
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I can't believe they would have NPs do the d/c summary either. Not because they are NPs but because how can you do an accurate summary if you never assumed responsibility for the patient? I suspect the referring MDs and GPs in your neighborhood are going to be unhappy...
Eddie,
At my hospital (yes, i'm in Canada) they have "extended role nurses" who do do discharge summaries in addition to rounding with the residents, removing drains and chest tubes, writing orders, coordinating home care etc. I would say that they actually do a better job at these things than the junior residents and clinical clerks. They are well trained, are good at what they do, and I trust their judgement.
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I did not mean to suggest that they were not capable of doing these tasks because of training level -- I meant it is hard to do a good d/c summary if you are not the person chiefly caring for a patient, because you are "looking in" on the chart. In my experience, even the nurses who round with the team are still a step removed from the patient plan, leading to reports that are incomplete or miss a very important aspect of the patients care (or necessary follow up investigation by the GP). This is, I believe, what Dr. Oliver is referring to. The other tasks you mention are very appropriate for an EP-nurse.
Yes, I have worked with them in Canada too. They are often very good.
Yes, I have worked with them in Canada too. They are often very good.
