Monday, June 20, 2011

Hints for New Residents

I was a general surgery residency program director for 24 years. I’ve seen them come and go. Here is some advice for those of you who are beginning residency training.

Never be afraid to say "I don't know."

Never be afraid to ask for help. Some of the worst disasters I have ever seen were because a resident didn't want to bother a more senior resident or an attending and blundered badly.

Respect your colleagues and your patients.

Until you gain a great deal of confidence, do not manage things over the telephone.

A patient who is restless or anxious may be hypoxic. Make liberal use of the pulse oximeter. Do not sedate a restless patient without personally seeing him.

Sometimes postoperative abdominal pain is due to urinary bladder distension. Learn how to use the bladder scanner yourself. 50 mL of urine output could be overflow incontinence.

Trust, but verify. [Or better yet, at first trust no one.] For example if someone tells you a lab result, say thanks and look at all the lab results in the computer yourself. Many times the nurse will say, “The labs are normal” and later you will find that the serum CO2 was 15.

Listen to the nurses (if they seem to know their stuff). They can really help you if you let them.

Be good to the nurses. If you are a jerk, they can make your life miserable.

If a nurse you trust calls and says a patient “doesn’t look good,” get to the floor as fast as you can.

You will get busy. Learn to prioritize. Learn what can wait and what needs to be done immediately.

Look at all your patients’ imaging studies yourself. Don’t just rely on reports. One, you will learn how to read them. Two, radiologists are not infallible. One of my PAs recently picked up abdominal free air that was missed by a radiologist. When in doubt, review the studies with a radiologist in person. I do it all the time.

Read, read, read. This isn't like school. You can't cram for your boards. You can’t learn 4 or 5 years’ worth of material in a one-week review course. You have to learn it as you go along.

Don’t embarrass your peers on attending rounds or at a conference. If you are asked a question and you know the answer fine. But if your chief resident is presenting a case to the chairman and says the patient’s hemoglobin was 7.2 gm/dL, don’t raise your hand and say, "Oh, no. it was 7.6.”

In the “Information Age,” there is no excuse for not obtaining old records on a patient. I have had op notes and path reports faxed from Ecuador. Surely you can get them from the hospital across town.

Can you think of more tips? I am open to all suggestions.


Jeremiah said...

While I am still years away from needing this info I still appreciate you putting it out there.

Thank you.

Neil B said...

This is great information. Thank you.

Dermot O'Riordan said...

There are only three rules: ask, ask & ask. If you don't ask you're on your own.

By end of post should aim firstly to spot the sick patient from end of the bed (a skill you probably had BEFORE entering medical school but now can only link in terms of numbers, oxygen sat, UO, reps rate etc.

Secondly learn how to prioritise and organise your time

Skeptical Scalpel said...

Dermot, good comments. I would add "listen" as well. Listen to your patients. They will often tell you what is wrong.

KSibert said...

A great list--just as appropriate for residents in any field, not exclusive to surgery. Other small points: Don't look at your phone during rounds. Don't look at your phone during conferences. And please don't regard Wikipedia as a reliable source for medical information.

Skeptical Scalpel said...


Thanks for the pertinent comments. Ah, yes. Wikipedia. A few more and maybe we'll have enough for a handbook.

Anonymous said...

Always address to paints by name, not by room number or disease

I'd stress again the reminder of not studying from Wikipedi

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