Suggestions for learning how to manage junior residents?

[alpinebrook]

I've recently become a senior resident, and am finding it sometimes difficult to manage junior residents -- the ones who subtly mutter under their breath when you ask them to do a routine task that is required for good patient care, etc. I guess some people just don't want to work that hard, and this is the first time in my life that it's become my problem. I have had essentially no formal training or experience in teaching and managing others.

I've always been the sort of person who bends over backwards and is polite. When I was junior, I looked up to my seniors and wanted to be helpful. Is it too much to expect the same? I know hierarchy in medicine has its problems, but it's there for a reason; now that I'm senior myself, I'd like to be treated with a little more respect.

Any tips or suggestions? I know it's important to keep your cool. I hate confrontation.

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[ValentinNarcisse]

Do not fear confrontation. If you can learn anything from surgical specialties: make your expectations clear and call people out when they do not meet them. As for muttering under breath, I would there and then say ‘excuse me?’. Depending on circumstance, dismiss them for the day and do the work yourself. I promise you they will never do it again.

 

[Ironheme]

Respect is earned. I'm very clear with what I expect. This helps them know what I want and what I don't want. I also am very fair. I tell them I expect hard, good quality work. I treat them to lunch, let them go early when they've busted their butt to get extra things done. I take the time to teach them.

Sometimes you have to confront in order to get the results you want. I had an intern that said she would do the work later. So I told her fine, if she needed the break she could have it.

She then asked what I would be doing. I told her, finishing her work (on top of mine).

She then decided she didn't need the break. I never had that issue come up again.

 

[DokterMom]

What would you say if you didn't fear confrontation?




Say that.




I'm actually not being flip. But you're letting your own baggage (fear of confrontation) compromise your performance. If what you'd say isn't 'printable', you could say something along the lines of "Once you have a little more experience, you'll understand why that's important. For now, just do it and learn."

 

[jurassicpark]

Nobody received training in residency for teaching/managing others. You pick it up from mama's knee so to speak.

If you're afraid of your juniors, then they will pick up on that and ride over you. You don't and shouldn't have to be an ogre, but you have to be firm and assertive as the leader of your group.

 

[Kakoy]

When I was an intern, I looked how all my seniors and attending managed the team and pick up aspects that I like and incorporate that into my leadership style.

When I was in training, at the beginning of the month with the new group ( med students/interns/random person in the room), I would have everyone sit down after rounds ( no calls/ no interruptions for 5 mins) and goes through my prepare speech of expectations for the month ( what we are doing is for the pts, I would never ask you to do something that i have not done myself, yada yada, we need to work as a team to provide the best care and get everyone out on time, yada yada yada).

I never had a problem! When I know the team worked hard, I do buy them coffee. I also bribe the nurses and floor secretary with coffee and donuts. It was well worth it!

ETD: When I was chief fellow and had to make another fellow cover a 3rd fellow for an emergency, I did get push back. I explained that we all work as a team and help each other out. If she ever had an emergency, one of us would cover her as well. Didn't get any push back since ( I suspect she was a little scare of me for the rest of the year).

 

[Keona]

As an upper level we would send out an email before the month began with expectations for the interns and 2nd years so there was something to refer to. It helped alleviate them thinking something wasn’t their job.

 

[obgyny]

I've recently become a senior resident, and am finding it sometimes difficult to manage junior residents -- the ones who subtly mutter under their breath when you ask them to do a routine task that is required for good patient care, etc. I guess some people just don't want to work that hard, and this is the first time in my life that it's become my problem. I have had essentially no formal training or experience in teaching and managing others.

I've always been the sort of person who bends over backwards and is polite. When I was junior, I looked up to my seniors and wanted to be helpful. Is it too much to expect the same? I know hierarchy in medicine has its problems, but it's there for a reason; now that I'm senior myself, I'd like to be treated with a little more respect.

Any tips or suggestions? I know it's important to keep your cool. I hate confrontation.

I feel you. I’m more of an introvert (which is rare in my field) and also non-confrontational. I had a hard time transitioning to senior resident when my junior residents were overly cocky and extroverted people.

I don’t know what is it with newer residents, but they can feel more entitled and complain a lot more. When I was an intern, I was nothing but polite, I treated my seniors with respect and didn’t question them.

I never wanted to be a jerk senior resident (like some of the ones I’ve had), but you do need to lay down the law. Make your expectations clear and early on. Call out the residents for not doing something or making a mistake. If they make a mistake, I’ll make it a learning opportunity for them.

No matter how confident they are, YOU are the one with the most experience. They don’t know what they don’t know, which can be dangerous. Patient care comes first. Don’t let them walk all over you.

I let my junior residents have plenty of autonomy, but I stepped in if patient care could be affected. I took the time to teach them, and I would help them out if their workload was getting too much. I tried to lead by example.

 

[Crayola227]

At some point, if I've lost my temper, I'm going to just say, "Your job is what I say it is. Unless patient care is at stake, you do what you're told in medicine."

That's just reality. In my experience, whatever sticker shock people get from a nice big dose of reality, usually gives way to respect. People appreciate boundaries. If they don't, guess what, kid gloves weren't going to work on those people, so I lose nothing applying a firm hand when it's called for. Not doing what you're told, imho requires a firm hand.

 

[jurassicpark]

At some point, if I've lost my temper, I'm going to just say, "Your job is what I say it is. Unless patient care is at stake, you do what you're told in medicine."

That's just reality. In my experience, whatever sticker shock people get from a nice big dose of reality, usually gives way to respect. People appreciate boundaries. If they don't, guess what, kid gloves weren't going to work on those people, so I lose nothing applying a firm hand when it's called for. Not doing what you're told, imho requires a firm hand.

This is true. You're in a group of over-achieving mostly Alphas. It's like raising wolf cubs, gotta achieve dominance and slap them down if they try to bite you. But once again, this doesn't mean you have to be the monster or personification of old-time angry attending.

It's hardest when you've JUST become the senior, you're still unsure and truthfully maybe a little frightened. Personally looking back I went the other way when I first became a senior, I came a little too hard on them at first. When I was a senior-senior I ended up treating my interns like grandkids. Cute little kittens that needed their noses wiped but they somehow responded to that too and purred.

 

[Entadus]

Great thread, thanks for the input everyone, this is my first month having juniors and it's quite the fun change

 

[Mass Effect]

At some point, if I've lost my temper, I'm going to just say, "Your job is what I say it is. Unless patient care is at stake, you do what you're told in medicine."

That's just reality. In my experience, whatever sticker shock people get from a nice big dose of reality, usually gives way to respect. People appreciate boundaries. If they don't, guess what, kid gloves weren't going to work on those people, so I lose nothing applying a firm hand when it's called for. Not doing what you're told, imho requires a firm hand.

And 99% of the time, everything will be fine. Truth is, being a senior can be tough and the skills required may be different depending on the junior. Most will respond in a collegial way, but when you get those few who don't, it's a nightmare.

The bottom line is, the job is the job and you have to be frank about it. Treat them with respect and be compassionate if they're feeling overwhelmed, but I agree that boundaries is the way to go. Keep everything professional, teach, and explain why you want/need them to do whatever you've assigned. Also, never lose your cool.

 

[CopaceticOne]

My goal in managing interns is 1) they should be afraid of disappointing me and thus try really hard to do the right things, 2) they are never afraid to ask me any question even if it is silly or something they should know, and 3) they know that if they ask for help I will give it to them, even if they should be able to do it on their own, because that is what this whole process is about - Learning and growing.

TL;DR - The job of the senior is to grow the junior's skills and knowledge over the course of any given rotation - do this in whatever way the junior needs to be managed.

 

[asahi88]

I'll add:
1) Never trust'em. Watch closely. Assume they're trying to kill your patients
2) Remember medicine is a small field and these guys could end up as your colleagues later
3) Buy pizza on call days (most important)