Hi everyone:
Let’s fast forward to a Sunday morning a year from now. On June 21, 2020, when we stop to reflect, will we be able to say 2019-20 was a spectacular year? If so, how would we know it? What does a spectacular year in our residency look like?
The Executive Council wrestled with this question last Thursday night. To be spectacular, we decided, we’d have to excel in three crucial domains: patient care, education, and wellness. Here are some ideas:
Patient Care
- Prioritize face time with the patients. We need to leave the computer and check in with patients more than once a day. We need to answer their questions and address their fears. We need to get to know them as people, not just patients. Let’s implement “social rounds” every afternoon.
- Write efficient notes. This is one way to step away from the computer. Let’s write concise, readable notes. Let’s delete the meaningless detail.
- Promote patient wellness. We need to combat post-hospitalization syndrome. We need to get patients out of their rooms, encourage walking, offer mental stimulation, provide rehab when needed, and ensure they sleep.
- Address substance use disorders. We often overlook opportunities to address smoking, alcohol use, and substance use disorders. Let’s move these issues from the social history to the medical history, where they belong. Let’s ask our addiction medicine colleagues to teach us and help us address these issues effectively
Education
- Identify and discuss learning objectives at the start of each rotation. Let’s name objectives so we don’t get lost in the competing responsibilities and tasks we face each day.
- Commit to giving feedback. Let’s open ourselves to coaching and finding ways to grow. Let’s make feedback thoughtful, specific, actionable, and helpful (“Keep doing what you’re doing,” “work on efficiency,” and “read more” don’t count)
- Improve access to educational materials. The Chiefs will continue to use the Residency blog to post resources. We will work on recording as many noon conferences as we can.
- Promote introspection. The Chiefs plan to create a robust series of M&Ms and will encourage routine follow up of patients we discharge.
- Work deliberately on skill development. Let’s raise the quality of our physical exam skills, practice procedures, and perfect our notes and oral presentations
- Read the literature: Let’s use online databases, perform literature searches, and bring articles to rounds
- Support the philosophy of residents teaching residents. The model of residents collaborating with the Chiefs to lead Report is but one example.
- Raise POCUS to the next level. Let’s continue to develop our ultrasound curriculum and use our new equipment.
Wellness
- Acknowledge the essential importance of wellness in our lives. If we’re not well, we can’t care for patients the way we should, and we can’t learn.
- Care for ourselves physically. We need to eat well, exercise, and sleep. If and when necessary, we need to make time to go to the doctor (It’s an ACGME requirement for programs to ensure residents have time to go to the doctor, so if you need to go, just ask).
- Set our minds free. We need to find time to do nothing
- Foster community. We need to help each other thrive, both in and out of the hospital. Spend time together. Share a meal. Play games. Hang out.
- Be honest with each other. Residency is hard. The long hours, high expectations, and huge responsibilities can make any of us feel discouraged and isolated sometimes. Don’t be a hero and pretend it’s not true. It’s true for everyone. Me too. Open up. We’re in this together.
- Acknowledge the central value of life events. Though it may not always be possible, let’s do our best to cover each other so we can go to weddings, celebrate holidays, and spend time with loved ones.
- Don’t ask, do. Anticipate the needs of our colleagues, especially but not only the new PGY1s and PGY2s who are going through major life and career transitions. Just help. If your intern says she really doesn’t need help, you can bring her a muffin.
- Get to know each other. The term “resident” doesn’t begin to capture who we are as people. Learn about each other’s lives, interests, and talents. You can’t even begin to imagine how awesome we are. Just ask.
- Show appreciation. Say it out loud. Every day. Extraordinary accomplishments are rare by definition. It’s more important and valuable to acknowledge everyday hard work and the small but essential things we do to care for patients, teach each another, and support one another.
The ideas listed above aren’t meant to be all-inclusive, and many elements are undoubtedly missing. We’re going to have another spectacular year this year, but we need to name our objectives to ensure it happens. So please, share your own ideas. What does a spectacular year look like to you?
And now, I’m off for a long bike ride,
Mark
PS Thoughts from the business world on trusting our colleagues to do the right thing: https://www.linkedin.com/feed/update/urn:li:activity:6535470294486839296/?smid=nytcore-ios-share
And, finally, from my brother, Dr. Myron Siegel, a very, very serious and highly intellectual exploration of the history of bloodletting. https://www.nbc.com/saturday-night-live/video/theodoric-of-york/n8661
MDS