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Any thoughts? Thanks.
Tips on running a ward team for a new upper level?
- Thread starter rs2006
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The best seniors that I've known figured out the fine balance between trusting their interns (ie- minimal micro-managing) and focusing on the big picture for each patient. Having said that, your game plan at the beginning of the year w/ new interns is a lot different than your plan in May. In my opinion, a good SMR will:
-know the vitals of every pt daily
-physically examine the "less stable" pt's daily
-monitor for abnl labs, trends are always important (ie- don't waste your time writing down all the nl values, as brooklyneric pointed out in another post)
-f/u on the specific labs of interest for your pts (ie- Hgb for the GI bleeder, BUN/Cr for the ARF, ANC for the neutropenic)
-update your MAR's at least QOD
-know the results of every study obtained while in-house (otherwise, why order them)
-know what the consultants are thinking daily (ie- talk to the fellow, read their last note)
-sit down and make sure the daily goals for each pt are being met (eg- HR control, improving BUN/Cr, stable CBCPD, good diuresis)
-make sure that limitations to discharge have been addressed early (eg- PT/OT consult, specialty clinic f/u, home O2 requirements, family concerns or questions)
-meet w/ your interns for 10-15 mins prior to rounding w/ the attending to make sure everyone is on the same page
-allow your interns to develop their own plans before you throw in your 2 cents (this applies to MS3's as well)
-have a set plan for the day BEFORE the attending arrives, then adjust accordingly
-make sure everyone understands that you're a team (ie- no withholding info from the intern just to make yourself look better to the attending on rounds)
-teach your interns how to prioritize (eg- write orders for studies EARLY and call consults in EARLY instead of writing their notes or ordering tmw's AMLs first)
-watch out for each intern, making sure they don't feel overwhelmed or lost in the overall plan
-TEACH the students and the interns!
-help out with notes, discharges, orders, etc (think TEAM!)
Overall, your inpt senior month will most likely seem harder than the intern's, but you only do it 3-4 times a year. Overall, still easier than your intern year.
Hope this helps!
-know the vitals of every pt daily
-physically examine the "less stable" pt's daily
-monitor for abnl labs, trends are always important (ie- don't waste your time writing down all the nl values, as brooklyneric pointed out in another post)
-f/u on the specific labs of interest for your pts (ie- Hgb for the GI bleeder, BUN/Cr for the ARF, ANC for the neutropenic)
-update your MAR's at least QOD
-know the results of every study obtained while in-house (otherwise, why order them)
-know what the consultants are thinking daily (ie- talk to the fellow, read their last note)
-sit down and make sure the daily goals for each pt are being met (eg- HR control, improving BUN/Cr, stable CBCPD, good diuresis)
-make sure that limitations to discharge have been addressed early (eg- PT/OT consult, specialty clinic f/u, home O2 requirements, family concerns or questions)
-meet w/ your interns for 10-15 mins prior to rounding w/ the attending to make sure everyone is on the same page
-allow your interns to develop their own plans before you throw in your 2 cents (this applies to MS3's as well)
-have a set plan for the day BEFORE the attending arrives, then adjust accordingly
-make sure everyone understands that you're a team (ie- no withholding info from the intern just to make yourself look better to the attending on rounds)
-teach your interns how to prioritize (eg- write orders for studies EARLY and call consults in EARLY instead of writing their notes or ordering tmw's AMLs first)
-watch out for each intern, making sure they don't feel overwhelmed or lost in the overall plan
-TEACH the students and the interns!
-help out with notes, discharges, orders, etc (think TEAM!)
Overall, your inpt senior month will most likely seem harder than the intern's, but you only do it 3-4 times a year. Overall, still easier than your intern year.
Hope this helps!
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well said.
it's a lot to do, but after a bit, it becomes more manageable so to speak.
one thing to look out for is the intern that won't speak up for himself or herself. i work hard, and staying a little late doesn't really cross my mind. but to some interns, they get pissed... but hold it in. i guess in some ways you have to be a mind reader... or just ask them how it's going, and if they need help!
later in the year, i'd suggest loosening the reins, letting the interns a little more control. and giving them insight on how you see the case, and also showing them "senior resident" responsiblities/roles.
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From a medical student point of view, a good senior should also orient each team member to make sure that they are clear about what is expected of them. This may seem obvious, but I had several rotations this year where I had no clue who was cosigning my notes, should I preround on my own or as a team, where to find vitals if in a new hospital, etc. A lot of times it is very basic stuff, but if you can help a scared MS3 in any way, they will be grateful and much more eager to help out, as they know you are looking out for them. I guess this just goes along with the idea of being an organized team leader and making your expectations known.
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1) Don't give the sub-I too many patients. In some institutions their H&Ps don't count so you have to do it over regardless of how good they are. You have to cosign all their notes and add your own addendums. Give them enough so that they can learn but remember that the more H&Ps they get on call day the more YOU get.
2) Don't micromanage by ordering the patients labs or calling the consults yourself. Tell the 'tern to do it and why. That way next time they will know.
3) Make sure the interns take the time to teach the 3rd year med students exactly what to do. It takes up extra time in the begining to make sure they know where everything is, how to do notes, how to call consults, etc. But, after you have them trained up they make the interns more efficient. Which makes the team more efficient. The med students can be a help or a hinderance. It depends on how much effort you put into training them well that first week.
4) If you see a 'tern doing something that makes them inefficient - tell them. If they are writing 3 page Assessment/Plans on a progress note, tell them. Again, when the interns are more efficient - so are you.
5) Keep rounds short. The 'terns need time to get work done. The longer you keep them from getting it done early the longer they stay in the evening when they should be leaving the hospital to stay within 80hrs.
6) If a consult service calls and gives you info on a patient. Immediately pass it on to the tern or tell them to page them. If the 'tern doesn't know what is going on they will duplicate your orders which takes extra time.
2) Don't micromanage by ordering the patients labs or calling the consults yourself. Tell the 'tern to do it and why. That way next time they will know.
3) Make sure the interns take the time to teach the 3rd year med students exactly what to do. It takes up extra time in the begining to make sure they know where everything is, how to do notes, how to call consults, etc. But, after you have them trained up they make the interns more efficient. Which makes the team more efficient. The med students can be a help or a hinderance. It depends on how much effort you put into training them well that first week.
4) If you see a 'tern doing something that makes them inefficient - tell them. If they are writing 3 page Assessment/Plans on a progress note, tell them. Again, when the interns are more efficient - so are you.
5) Keep rounds short. The 'terns need time to get work done. The longer you keep them from getting it done early the longer they stay in the evening when they should be leaving the hospital to stay within 80hrs.
6) If a consult service calls and gives you info on a patient. Immediately pass it on to the tern or tell them to page them. If the 'tern doesn't know what is going on they will duplicate your orders which takes extra time.
