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.