So i'm wondering in your program how does it work with who does the admissions? Does the intern go see the admission and the resident wait until they are done and meanwhile put in orders, etc and then go see patient or do they do them together? Or does the resident do the admission while the intern takes care of floor work? I'm wondering because usually as the intern I would do the admission, see the patient while my resident would wait, unless we got two at once and I would be the one to present to attending, etc. But now I am working with a new senior who either has us seeing the patient together (and she pretty much takes over the history taking) or she does them while I take care of floor work. How does it work with other people?
Who does the admissions? Intern vs resident??
- Thread starter nope80
- Start date
- Joined
- Dec 14, 2006
- Messages
- 69,368
- Reaction score
- 61,721
Sounds like you have a resident that doesn't know how to be one yet. Sorry.
i was told the way it worked was that the intern really needs to have every opportunity to perform the admission:
1) ideally, the intern should independently see the patient, and the resident sees patient afterwards. if swamped, to save time, the resident sometimes sees the patient together with the intern, but should let the intern lead the interview and examination, and only interject with questions or looking for clinical findings that the resident thought were missed. rarely does the resident see the patient first, unless i.e. intern is at conference and patient really needs to be evaluated, or intern is at clinic. in this case, intern still independently sees patient afterwards.
2) intern should place all admission orders. but again, if intern is preoccupied and patient really needs some orders and has been waiting for a while, resident could place skeleton orders like vitals, fluids, diet, etc. rarely should the resident place significant management orders unless it was absolutely necessary.
3) intern and residents always write separate notes. intern notes should be detailed, and resident notes are kind of like teaching attending notes where it is more summarized and can say "refer to intern note for more details." rarely would a resident write a team note in situations such as extremely busy, multiple codes and rapid responses, etc. and resident is trying to prevent work hours violations or is being really nice especially in the first half of the year.
if you feel that your resident is detracting from your learning experience, you may need to do something about it. if you feel the resident is good but just not used to being a resident and are comfortable with saying it, bring it up with him/her. if not comfortable and want to wait, you could write your concerns in the end of rotation eval. if really concerned, then you'd have to bring it up with either the teaching attending, chiefs, or the PD's depending on what kind of hierarchy there is for stuff like this in your program.
1) ideally, the intern should independently see the patient, and the resident sees patient afterwards. if swamped, to save time, the resident sometimes sees the patient together with the intern, but should let the intern lead the interview and examination, and only interject with questions or looking for clinical findings that the resident thought were missed. rarely does the resident see the patient first, unless i.e. intern is at conference and patient really needs to be evaluated, or intern is at clinic. in this case, intern still independently sees patient afterwards.
2) intern should place all admission orders. but again, if intern is preoccupied and patient really needs some orders and has been waiting for a while, resident could place skeleton orders like vitals, fluids, diet, etc. rarely should the resident place significant management orders unless it was absolutely necessary.
3) intern and residents always write separate notes. intern notes should be detailed, and resident notes are kind of like teaching attending notes where it is more summarized and can say "refer to intern note for more details." rarely would a resident write a team note in situations such as extremely busy, multiple codes and rapid responses, etc. and resident is trying to prevent work hours violations or is being really nice especially in the first half of the year.
if you feel that your resident is detracting from your learning experience, you may need to do something about it. if you feel the resident is good but just not used to being a resident and are comfortable with saying it, bring it up with him/her. if not comfortable and want to wait, you could write your concerns in the end of rotation eval. if really concerned, then you'd have to bring it up with either the teaching attending, chiefs, or the PD's depending on what kind of hierarchy there is for stuff like this in your program.
It really sucks! I knew something was wrong with this system, especially since every other resident I ever worked with does not work like this at all. My resident is a second year and doesn't seem too comfortable in the role. I think that this person wants as much practice doing admissions as possible and hence the reason why they do them without me really being involved. And also she gets really nervous about time..I'm fast but her goal is to quickly jet through the things and if she had to wait for me to get done the history, she would feel behind...Its such a waste of rotation and I have tried to indirectly bring it up to her but she kind of brushes it off...
she sucks. dont feel powerless. go above her and get it fixed. you're in training and frankly she's in training too. she needs to learn how to be a resident not a resitern.
wow, from day one I've been doing everything one my own, getting feedback along the way...I'm a lot more competent for it now. The resident is really stealing your learning opportunities. I would talk to the chief resident, don't be overly dramatic or accusatory about it. If the chief is a reasonable person, he/she should diplomatically address the issue with the resident. All they would have to say to open the discussion is something like, " why did you do such and such admission?" then the cat's out of the bag, and your saved from being the little snitch...
on the bright side, it seems you have seniors who do pick up the work if things get hectic. That's not the case everywhere...
on the bright side, it seems you have seniors who do pick up the work if things get hectic. That's not the case everywhere...
Don't go above her. Talk to her first. Just explain since you are the intern taking care of the patient you would like to do the H&P. You can say how it worked better for you when you did that before with your other senior.
Depending on how well you know her I would approach it more as this would help me (you, the intern) rather than she is doing something wrong. Then she is less likely to be defensive or feel like you, the intern, is telling her, the resident, how to do her job. If it is still a problem after talking to her and you feel strongly enough about it maybe try talking to one of the other pgy 2/3 residents for advice and if they would consider mentioning something to her.
I would generally not take it up to the attending level unless you really think it is a big deal and at least talk to her first. I would be upset if someone went to the attending without talking to me first, wouldn't you? Furthermore, she might complain to her classmates about it and you could end up with a reputation you would rather not have.
- Joined
- Dec 14, 2006
- Messages
- 69,368
- Reaction score
- 61,721
Has anyone seen this happen more often with women upper level residents than with men? I have.
- Joined
- Feb 5, 2010
- Messages
- 146
- Reaction score
- 0
Yep.
So how should I start the conversation? How can I state this diplomatically? I def have said it indirectly but she just doesn't care at all. She takes all the admissions and always wants to be the one to present to our attendings...
oh god yes
- Joined
- Dec 14, 2006
- Messages
- 69,368
- Reaction score
- 61,721
You know I think it's just part of the naturally way we are wired. Women tend to want to make sure no mistakes happen, and as such can get real micromanagey, whereas men know mistakes will happen but are confident in our abilities to fix whatever the intern broke without too much trouble.
You've got to let people struggle themselves or they don't grow. Medicine really is a learn to swim by throwing you in the deep end of the pool kind of expereince.
Plus ever met a woman who could actually sit still?!
yes.
- Joined
- Jun 8, 2005
- Messages
- 764
- Reaction score
- 4
@OP...
IMO, the hierarchy of who does the admit goes something like this:
1) intern
2) MS4
3) MS3
4) Psych rotator
5) MS2 (who just happened to be on the ward for an "interesting physical exam finding")
6) sister service MS4
7) PA or NP
8) moonlighter
9) staff
10) senior resident
11) fellow
Maybe we should cluster these into tier 1a and tier 1b? What do you guys think?
IMO, the hierarchy of who does the admit goes something like this:
1) intern
2) MS4
3) MS3
4) Psych rotator
5) MS2 (who just happened to be on the ward for an "interesting physical exam finding")
6) sister service MS4
7) PA or NP
8) moonlighter
9) staff
10) senior resident
11) fellow
Maybe we should cluster these into tier 1a and tier 1b? What do you guys think?
