Thursday, January 10, 2008

First Day Tips for Surgical Interns

Every registrar or consultant has a talk that they give to new interns joining their team. It is about establishing heirarchy, rules, standard operating procedure, and team-building.

My talk generally incorporates a few important principles:
  1. Your job is to make my job easier. Just don't do anything illegal, unethical, or dangerous in order to do so.
  2. The consultants may mark your assessment form, but I tell them which boxes to tick.
  3. If I ask you a question about a patient, don't lie. If you don't know the answer, tell me that you don't know the answer.
  4. If I ask you to do something, I expect it done by the end of the day. If it isn't done, tell me why and when it will be done.
  5. Don't leave messages for me. If I am busy doing something, come and talk to me. If that means getting changed and coming into theatre, then do so.
  6. Decisions may be made on the ward round, but reasoning is discussed in the operating theatre. If you want to know why, come to theatre and listen.
  7. I expect an update at least once during the day and once at the end of the day. Don't go home without letting me know.
  8. Never be afraid to call me at any time - work, home or mobile. I would much rather know about an ill patient than a dead one.

Apart from laying down the ground rules, I expect interns to learn along the way. There are many things that you have to work out for yourself, or are merely applications of common sense. Here are some tips:

  1. Know What You Need To Know. Keep on hand a list of common phone numbers, pager numbers, and hospital stationery. Memorise the important ones. Know who your patients are and where they are at all times.
  2. Don't Shit Where You Eat. Nurses, Ward Clerks and Registrars that you need to make referrals to can make your life hell. Other interns will sometimes cover for you if you are busy. Keep them on your side. Sleeping with hospital staff (or patients) is a potential disaster area. Don't try it unless you are willing to cop the ensuing flak.
  3. Prioritise, Prioritise, Prioritise. Every ward round generates work. Usually a lot of it at once. Decide what is important, do what must be done immediately, and plan out your day so that the other tasks get done in a timely manner.
  4. Work Smarter, Not Harder. There are lots of time-saving ways to made your work efficient. Do things in batches. Keep pads of pre-filled pathology slips. Check results on all your patients together, not just one now and one later. Fill out Discharge Summaries ahead of time.
  5. Predict and Pre-empt. All units work on a timetable. Know the timetable, and what tasks need to be done before important events like unit meetings, ward rounds, and operating sessions. Repetition abounds. Start to recognise patterns in your registrar and consultant's behaviour in regards to certain patients, conditions, presentations etc. Predict what will need to be done and make preparations beforehand.

A great deal of being an intern is learning to work within a team, being responsible for and to your patients, and getting yourself organised. These are skills that take time to develop - but they will come.


chinaski said...

Gold. I'm printing that list out and giving it to the new interns, with your permission.

Hildy said...

Thank you! This is all perfect advice, and if I get this list from a registrar, I'll know who it is...

Does anyone have a copy of Barbados Butterfly's tips for interns series?

The Girl said...

Great post - thanks!

Milk & Two Sugars said...

I have two questions:
1. Do the majority of your colleagues prefer that their interns come and speak to them in surgery rather than call or page, or is it a preference that needs to be negotiated with each registrar individually?
2. Just how interested are you in your patients' medical comorbidities? (And are you more interested if they are directly related to their surgical condition?)

Sheepish said...

Hildy: Unfortunately, BB's tips have disappeared into the ether. Perhaps if you are lucky she might choose to release copies to a lucky blogger to post again.

Chinaski: Feel free to use my list. Even better, give it to Hildy and she might think that you are me!

M&TS: I don't know anyone who would rather speak on a phone, or answer yet another page, instead of talking to someone face to face. Never underestimate the value of a direct chat. Even better, each time you catch up with your registrar - look around. You will get a better idea of what they do and how you can help.

I am very interested in my patients' comorbidities - but not in detail. I always want to know if my patients have ischaemic heart disease, stable or unstable angina, renal impairment or failure, liver disease, COAD, GORD, diabetes, thyroid or adrenal dysfunction, a smoking history, prostate cancer with bony mets, social setting, etc.

I do not, however, need to know their FEV1, VO2Max, EpO dose, PR interval, degree of axis deviation, short synacthen test result, or the length of their big toenail, unless it is directly relevant to the problem at hand.

Your registrar needs enough information to get an overall picture of the patient. Surgical registrars are no different to medical registrars in this regard. If they need further information they will ask you.

The ability to present a concise, clear summary of a patient's comorbidities in less than 30 seconds is an essential skill to learn. We all expect you to do it proficiently by the end of your intern year.

The Shrink said...

If I ask you to do something, I expect it done
- more than anything 'cept the not lying, this has to be the key personal attribute. If you're not reliable, how can you work in a team that's making life/death decisions?

The ability to present a concise, clear summary of a patient's comorbidities in less than 30 seconds is an essential skill to learn.
- this is the key personal skill. People I work with best are those who can tell me what I need to know, not a lengthy biography and not incomplete generalisations. The skill of distilling things down into the salient clinical information and relevant context for that issue at that time has to be the most important skill to develop.

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Keep on hand a list of common phone numbers, pager numbers, and hospital stationery. Memorise the important ones. Know who your patients are and where they are at all times. You have given the best advices here.

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Othman said...

Good tips but you sound like a Nasty consultant.

Your tone is god like.

Most of the people who are saying good list good list! have obviously never come across a "real" consultant.

A real consultant is one who you are obliged to follow. You listen to him out of respect and love. He invests in you and you return the favour by working hard and showing him that you have evolved at the end of your posting.

Sheepish said...

Othman: My tone is not god-like, because I am god. No, not really.

I am a real consultant because my hospital ID badge says so. Perhaps I am nasty too.

What you are talking about is a "leader" - one who inspires others to follow them towards a common vision.

Well, I am not a leader. I am a surgeon and I am here to treat my patients to the best of my ability. Get with the program.