Hi everyone,
As a second-month intern, I was assigned to the MICU at the Philadelphia VA. We had about a dozen patients whose beds were arranged in rows. Beyond some flimsy curtains, there was no privacy. The veterans had bread and butter diseases: liver failure, ARDS, septic shock, and cardiac arrests- just like today. But back then, the attending visited for about an hour a day; after that, we were on our own.
I had two residents that month. One decided we weren’t busy enough, so she roamed the floors looking for more patients; the other saw how hard I was working and stepped in to help. One resident scolded me for not knowing all the drip rates; the other taught me what I needed to know. One resident showed off how smart she was; the other let me shine. Ultimately, both residents went into pulmonary and critical care; only one became a role model. He’s on the faculty at Pittsburgh now, and more than 30 years later, I still look up to him.
These days, it's a rare Yale resident who doesn’t do everything possible to support their interns. They help when the work gets overwhelming. Their words are honest and encouraging. They know when to hold back and when to intervene. They know when to push and when to reassure. They acknowledge their interns’ contributions. They welcome questions and debate. They encourage intellectual risk taking and give candid feedback. They teach. They foster team spirit and camaraderie. They put their interns’ needs before their own.
In other words, our interns have wonderful residents, not just sometimes but nearly always. But don’t just take it from me. Last week, in the spirit of positive reinforcement, I asked the interns to complete this sentence: “I really appreciate it when my resident…”
Here's what they said:
I really appreciate it when my resident…
- Senses that I'm overwhelmed on VA floors and offers to hold my pager.
- Recognizes and provides credit for the tasks I accomplish.
- Supports me as I’m handling difficult situations by acknowledging my efforts and offering to help with other daily tasks.
- Asks specifically what they can do to help me be more efficient in getting tasks completed in the afternoon. My seniors thus far have given me the optimal balance between autonomy over my patients and supervision as needed. What also helps for me is just reassurance and positive reinforcement - to know that yes, intern year is hard, but the learning curve will flatten over time and we all will feel more confident with each day on the job. Even just small mentions of something done well ("That was a nice presentation", "Your decision about X was a good idea") mean the world.
- Asks me how I am really doing, and then takes a few moments to sit down, listen, and respond.
- Reminds me to have a “low threshold” to reach out with questions or concerns.
- Encourages me and teaches me to do procedures, even when things are really busy.
- Pushes me to commit to a management decision and justify it, even if it turns out to be wrong.
- Answers any question I have with patience and understanding, no matter how simple or “silly”
- Approaches our tasks/to-dos as a team, makes it clear they are there to help
- Asks me how I’m doing periodically, with work flow and otherwise
- Offers tips/tricks for how I can improve my presentations and “things I wish I had known as an intern” etc...
- Offers ways to build team camaraderie beyond work (coffee breaks!) and boost our energy throughout the day
- Cares about my mental health. Whether it’s just encouraging me to take a quick break to breathe or going to grab a snack/coffee with me when things have settled down; it always makes for a better day when your senior shows their care.
- Gives me feedback and tells me ways to improve for next time!
- Establishes a good balance between supervision and autonomy based on the individual intern’s needs in order to foster our development as physicians
- Helps make the endless calls that need to be made during and after rounds, gives me credit for my work during rounds, and makes me feel like we are truly a team caring for a diverse list of patients.
- Asks me “Do you need anything? How can I help?” Often times, things are going smoothly so I don’t need much — but I still appreciate those check-ins nonetheless. It shows they care about helping me out, both as a teammate and as a friend. I’ve been so lucky to have had each resident ask that simple question to me on every rotation — and I’m super grateful for that!
- Finds time to share a quick five minute pearl of knowledge from something they were reading related to a patient on our team. As an Intern it can be hard to find time to read new things as you are adjusting to a new service so having someone distill the information into five minute chunks is helpful.
- Takes the time to set goals and expectations for the rotation
- Pushes me outside of my comfort zone while at the same time always being available to help when I need it
- Notices if I am falling behind with tasks on a busy day and offers to help with things like calling families and getting consents when I have a lot on my plate
- Takes the time to offer constructive feedback that is truly pointed and candid, telling me what I do well and suggesting ways I can improve
- Works to get me out a little bit early on days we are not admitting
- Checks in to see where I stand with my work and what I have left for the day
- Gently points out that I can be better at triaging tasks and offers insight as to what is more essential in the moment
- Encourages me to be an independent thinker in coming up with my own plan before offering input
- Makes sure I eat on busy days and sleep on long nights
- Reviews the task list/orders with me after rounds to make sure we didn’t miss anything, we agree on the plan moving forward and I can prioritize my work for the day.
- Treats me more like a friend than just a colleague. It makes work really enjoyable, fun, and it fosters a great working environment that is conducive to both learning and best patient care.
- Challenges me to come up with my own plan when I bring up a problem I’ve noticed with one of my patients, rather than telling me what to do in that moment. It’s helped me to develop and grow my clinical judgement and reasoning.
- Goes over my signouts with me, to ensure I’m putting enough (and not too much!) details for the night team.
- Allows me to sign-out to them on light days, so I can just go home and get a chance to cook a fresh meal.
- Lets me go home before sign out when the work is done
- Helps pre write the HPI for admissions when I have a lot to do
- Keeps the discharge summaries up to date to make discharges easy!
- Calls some of my consults or updates families when we have a million things to do
- Acknowledges their own strengths and weaknesses, identifies the needs of their patients from a big picture level, and helps encourage a collaborative atmosphere among their peers. Whether it’s checking in with the intern on how they’re doing, making sure support staff have what they need to carry out medical orders, or focusing on patients’ human needs on the day to day, I really appreciate it when my resident shows me how to be a better doctor from all these respects.
- Makes me feel that all my questions are worth answering - no matter how basic or far-fetched
- Allows me space to come up with my own plan and then discuss
- Backs me up on rounds when our attending questions management decisions that we made
- Acknowledges difficult moments (specifically, negative emotional reactions to events, or patient deaths) and offers time and space to debrief
Of course, the caring goes both ways. As one intern shared, “I really (don’t) appreciate it when my resident doesn’t sleep on their 28! I am always amazed by how hardworking and humble you all are, and how functional you are despite being the sleep deprivation - but please sleep, your rest and sanity are just as important as ours!”
So, a special thank you to all the residents in our program who labor endlessly to support their interns. With your mentorship and friendship, they can do anything. All interns should be so lucky.
Have a good holiday weekend, everyone,
Mark