I've just completed my internship year, and now I'm a senior resident ... whoa.
On the one hand, I feel as if I don't know much more than I did when I first started. But on the other hand, looking at the new interns, seeing how they're thinking, and comparing that to how I now approach a patient, it's apparent that I must have learned something.
It's kind of crazy to think that I was in their position just a year ago, and now it's my job to show them the ropes. They need to learn the little things: how to put in orders, how to write notes, how to draw an arterial blood gas (ABG). I faintly remember when I didn't know how to draw an ABG, but now I've done that at least 100 times, and it's second nature.
It's become second nature for me to approach the patient's bedside and perform a quick assessment. I now know how to first focus on the pertinent things, the things that truly matter. At first I, like most interns, tended to focus on the little details while missing the bigger picture.
I don't know how much my book knowledge has increased in the past year, but my clinical knowledge has grown immensely. I now have these new skills. I can intubate a patient, I can put in a central line, I can run a code, and much more. But more important, I'm learning how to manage a patient, and not just the patient's medications.
And by observing good examples and bad, I know what kind of senior resident I'd like to be and how I'd like to interact with the interns.
The most important thing is communication. To be effective, a medical team has to learn how to communicate efficiently, and the senior resident needs to provide leadership to make that happen.
During one rotation my senior resident wasn't great at this. I would ask the senior to go through our patients with me, to "run the list." And despite making this request multiple times, unfortunately it just never happened. The best seniors that I had were the ones who would run the list with us at least two or three times a day: once right before we rounded, a second time after we got done rounding to make sure everything was in place, and then a third time right after we got done with all the day's work, just before we went home. My cardiology senior would push us to have a perfected sign out list with pertinent info and meds and this really changed the way I thought of my patient care.
It's important to run the list to make sure everyone's on the same page and to make sure all the work that needs to be done gets done.
The best senior residents take the time to teach the interns instead of just doing the work. I learned so much by sitting down in front of the patient's records on a computer screen as the senior asked me, "So I see you ordered metoprolol 50 mg. Why are you doing this? What's the goal you're trying to achieve? Sure you want to look for thrombocytopenia. But if you find it, what are you going to do about it? How is that going to change your management?"
The other day I was discussing a patient with one of the new interns. It was a kidney disease patient who came in for volume overload. The intern, I think flustered with the overwhelming things being thrown at him, wanted to give him diurectics but couldn't explain to me why the patient was on fluids as well. And that, of course, makes no sense at all. So we went through the orders and looked at each one and their applicability to the patient.
It's important to challenge interns in this way. And having them involved in the team dynamic is really, really important. It doesn't happen all the time and I hope to change that.
When rounding and an intern is presenting a patient, the best seniors don't just give the answer. The best seniors are the ones who ask the interns questions during rounds to help them arrive at the answers themselves.
Starting my year as a senior resident, I have to admit that I'm scared. While I'm confident in my abilities, I am responsible for the interns and for making sure they learn and do the right thing. I'm also responsible for the patient. A single mistake on my part, a single oversight, and the blame lies on my shoulders. I hope I'm up to the challenge.