Advice to Interns from Program Directors

 From the 7/9/2021 newsletter

Perspective/Opinion

 

Advice to Interns from Program Directors

 

Compiled by Kathlyn Fletcher, MD MA

 

 

Dr. Fletcher asked several residency program directors from MCWAH to provide their advice to new interns: practical, funny, or both. Here is what they had to say …

 

 

Chad Carlson, MD, FAAN

Professor and Vice Chair – Education

Program Director, Neurology Residency

Program Director, Clinical Neurophysiology & Epilepsy Fellowships

• If you crave a tasty (soft) cookie, check out the Hub.
• It is never too early to start identifying and talking to potential mentors.
• Completing medical notes is not like enjoying a fine wine; notes do not benefit from letting them age or breathe, so complete them in a timely manner.

 

 

 

Yvonne Chiu, MD

Professor of Dermatology and Pediatrics

Program Director, Dermatology Residency

• Use the same password for your work (MCW, Froedtert, VA, and Children’s) accounts and change them all at the same time. Makes it easier to remember what your current password is when you move between sites.
• Bring your lunch when you can. You eat healthier when you are not relying on cafeteria food.
• For those residents who take home call and need to call patients, download the Doximity app. It allows you to call patients using the hospital name and phone number in the caller ID.

 

 

 

Sriram Darisetty, MD, FACP

Assistant Professor of Medicine
Program Director, Transitional Year Residency Program, MCWAH- St Joseph.

• Try not to be under-confident, but absolutely avoid being over-confident. 
• Autonomy is earned, not given.

 

 

 

Stacy L. Fairbanks, MD

Associate Professor of Anesthesiology

Program Director, Core Anesthesiology Residency 

• Prioritize sleep or you won’t get it.  Sleep 7-9 hours per night whenever possible. 
• Study a little bit every day.  Gaining the knowledge you need to pass certifying exams is a marathon, not a sprint.

 

 

 

Kathlyn Fletcher, MD MA

Professor of Internal Medicine

Program Director, Internal Medicine Residency Program

• Always do what is in the best interest of your patient. I actually borrowed this one from a former mentor, Dr. Arthur Rubenstein.
• The quality of your day is directly proportional to how many people you say “hello” to on your way into work.  I have no data to prove this, but I am pretty sure I am right.
• Patients want to believe that you care about them beyond your professional obligation to care.  I do have evidence to back this up and would be happy to provide it to anyone who is interested.

 

 

Camille Garrison, MD

Associate Professor, Medical College of WI, DFCM

Program Director, Ascension Columbia St. Mary’s Family Medicine Residency Program

• Don’t put emojis in a patient’s chart… 😊
• The patients you see are not a means to an end. It is an honor and privilege to care for them.
• Take advantage of every opportunity to grow while in residency, both personally and professionally. What you get out of residency, has a lot to do with what you put in.

 

 

 

 

Matthew Goldblatt, MD

Professor of Surgery

Program Director, General Surgery Residency

• Find good bathrooms

 

 

 

 

Alisa Hayes, MD

Professor of Emergency Medicine

Program Director, Emergency Medicine

• Give yourself enough time to park and arrive on time. Your PD will get a notification if you park illegally.
• The Froedtert finder app can help you navigate the hospital and find rooms / locations as well as notify security when you are leaving the hospital at odd hours.

 

 

 

Heather Toth, MD

Professor of Internal Medicine and Pediatrics

Program Director, Internal Medicine/Pediatrics combined program

• We are all here for you! Please reach out to us as we have all been interns at some point in our lives.
• Remember to stay in touch with family, friends, colleagues, hobbies and things you love.

 

 

 

 

Kathlyn E. Fletcher, MD MA is a Professor and residency program director in the Department of Medicine at MCW. She is the co-Director of the Graduate Medical Education Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Advice for Surgical Residents

From the 7/9/2021 newsletter

 

Perspective/Opinion

 

Advice for Surgical Residents

 

Compiled by Bruce H Campbell, MD FACS

 

Dr. Campbell, who entered a surgical field decades ago, asked his current residents what they have learned to keep themselves whole and able to function despite living in high-stress times and working under pressure. Here is some of what he learned from them, and about “grit” in surgical residents …

 

 

What sorts of things have surgical residents discovered that allow them to survive as trainees? Here is a list from current otolaryngology residents (and their friends):

• Everyone expects surgeons to be arrogant. Surprise people in a good way.

• Ask the right questions and listen carefully - often this will tell you more about a patient's condition than any test or image can.

• Get to know your patients beyond their chief complaint.

• Learn to understand and appreciate the environment that your patient came from, and you will glean so much more. “For the secret of the care of the patient is in caring for the patient.” - Francis Peabody (“The Care of the Patient,” JAMA 1927)

• Listen to the nurses. Learn their names. They are the ears, eyes, and heart of the floor. They spend more time at the bedside than any physician or care team member.

• Be forgiving of yourself and your colleagues. We all have one common goal, and that is to provide healing and nurturing for our patients.

• Mistakes are an inevitable part of medicine. Always be honest, show empathy, and commit yourself to a lifelong endeavor of learning.

• Practice self-care. “Just as a car can’t go as fast on a flat tire, you can’t give your best effort if you aren’t mentally, physically, and spiritually running on all cylinders." - U.S. Surgeon General Jerome Adams

• Find yourself a good pair of shoes. This will take you far, literally!

• Do not forget why you are doing what you do. Our profession is unique, people trust us with their lives, and we cannot take that for granted.

• Do not forget that each of your patients is a person first and a patient second.

• Informed consent is a process and a relationship, not a piece of paper.

• Stay up-to-date on your administrative paperwork and be kind to the residency program coordinator.

• Always act in the best interest of the patient.

• Stay humble.

• Just keep showing up even when you feel like you’re not doing well. It always gets better.

• See the patient before calling a consult.

• Stay current on your surgical case logs.

• Before ending any conversation with a patient, always ask, “Do you have any other questions?” That usually elicits their deepest concern.

• Knowing when to operate is at least as important as knowing how to operate.

• Balance humility and ego. It’s not easy. 

• Remember to enjoy simple wins and to learn from loss.

• Sleep when you can, eat when you can. 

• Wipe your feet of the day before you walk into your home to greet your family. 

• Be an organized junior resident but ask for help. Remember you’re human, too.

• Each patient is experiencing something at the same time you are, so even if this is your hundredth consult of the night at 3:00 a.m., try to bring compassion to the encounter. 

• Remember, at the end of the day, you are a team.

• Check for speckles of blood on your scrubs, booties, face, and mask before going to talk to patients’ families.

• Surgical training is uniquely stressful. Stay self-aware. Reach out for help. Watch for warning signs in others.

• Know your stuff, do the right thing, and ask for help when you need it.

• Don't forget to engage in things that make you happy, as residency will trick you into thinking success must cost you joy.

• Residency can unmask underlying vulnerabilities.  Don't be afraid to lean on your co-residents (and even attendings), either professionally or personally. 

• An ICU consult is better than a rapid response, and a rapid response is better than a code.

• There are two kinds of residents: the ones who write it down, and the ones who forget.

• Trust no one, expect sabotage, and always have a backup plan.

• Stay current. There is no glory in being technically adept and doing the same, wrong operation every day for the next thirty-five years.

 

On a related note, a recent article in JAMA Surgery confirms that grit, as a personality characteristic, is a good thing. Grit is defined as “perseverance and passion for long-term goals,” and is measured with a standardized GRIT-S questionnaire that asks about a person’s ability to concentrate on a project, their reaction to setbacks, their constancy in pursuing goals and interests, their self-identified work ethic and diligence, and their ability to thrive in the face of challenges. General surgery residents with higher “Grit” scores were less likely to report burnout, thoughts of leaving their training programs, concerns about their career choice, and suicidal ideation than residents with lower Grit scores. Grit scores were higher in women, more senior residents, and in married residents. The authors recommended that programs do what they can to bolster their residents’ grit.

Surgeons have unique roles and responsibilities in society; what can compare to the trust someone displays by allowing another human being to render them completely defenseless and then rummage around their insides? As an institution, it is our responsibility to prepare our residents to enter the world as character-driven, compassionate, and skilled surgeons.

Thanks to my “gritty” residents for sharing the lessons they have learned.

 

Bruce H Campbell, MD FACS is a Professor in the Department of Otolaryngology & Communication Sciences and in the Institute for Health and Equity at MCW. He is editor-in-chief of the Transformational Times. 

Top Ten Tips for Thriving During M3 Clerkships

From the 7/9/2021 newsletter

 

Perspective/Opinion

  

Top Ten Tips for Thriving During M3 Clerkships

  

Compiled by Scott Lamm

 

 Mr. Lamm and his colleagues offer some sage advice to the incoming third-year medical students …

  

• Be proactive! Pay attention on rounds and create a to-do list for each patient. Instead of asking for tasks from your resident, let them know what tasks you are comfortable with doing and if it is okay for you to complete them.

•  For Surgery – invest in a pair of compression stockings. Your feet at the end of the day will thank you.

• It’s okay to say, “I Don’t Know.” No one knows everything, and this gives you an opportunity to do the research and look it up for the next time you are with your attending or residents that asked the question.

• Nurses and CNA’s are your best friends. They know the patients better than anyone. Talk with them each morning. Update them after rounds. They will be very appreciative.

• Know what you are charting! If you copy forward a note, ensure that everything in that note is something you did that day. You will most likely not do a comprehensive physical exam every morning, so ensure you only chart what you did.

• Children’s’ Cafeteria Buffalo Chicken Ranch Wrap is the best! On nights, you can get it toasted mmmmm… Also, Children’s’ breakfast is the best pick me up in the morning after a call day.

•  Learn from your patients – they are the experts in their own life experiences. You will have a lot more time to devote to each of your patients than the residents, so spend the time. You will be surprised at how a good relationship can help the team exponentially.

• Calling consults can be nerve-wracking – write down the most pertinent points, lab values, and imaging results so you don’t forget them. Consultants will be very impressed when you have this information right away instead of making them search the EMR after the call.

•  Make sure to eat! Time moves fast and it’s easy to forget about lunch. A working mind requires a happy belly. Bring snacks, meal prep.  Sometimes it may feel like there’s no time in between cases or after rounds, but two minutes is enough to scarf down a granola bar.

• Have fun! Third year is full of surprises. There will be good days and there will be bad days. Step back and reflect when you have the chance. The connections you will make with attendings, residents, and especially patients will transform you are a physician. Step into each rotation with an open mind.  And do not hesitate to ask for help.

 

Sincerely,

The Class of 2022

 

 

 

Scott Lamm is a fourth-year medical student at MCW and member of the Transformational Times editorial board.

 

Advice for Incoming Housestaff

From the 7/9/2021 newsletter

 

Perspective/Opinion

  

Advice for Incoming Housestaff

 

 By Jennifer Popies, MS, RN, CCRN-K, ACNS-BC; and Ashley Herman, BSN, RN, CNRN

 

 Ms. Popies and Ms. Herman give advice to incoming housestaff from the nursing perspective…

 

Jennifer Popies:

• DO ask the nurse caring for your patients about their perspective on what is going well and what any outstanding needs are that they see should be addressed – this goes a long way in building true collaboration!

• DO bring food for the nurses on the floor you are most frequently working with – this also goes a long way to building true collaboration J!

• DO use order sets to help guide your patient management – many disciplines have spent a long time on each one trying to help make sure best practices are incorporated.  You can always tailor it to your patient’s needs, but use it to your advantage to help ensure best care so things don’t get missed!

• DO clean up after yourself when performing bedside procedures.  Nursing staff does enough “cleanup” for other reasons in the process of patient care!

• DON’T be afraid to say you don’t know something!  Everyone is human and nurses (and others) will respect you more for knowing your limitations.

• DON’T forget to take care of yourself – and if you need to talk, you can reach out to a nurse, a social worker, a chaplain, etc….it doesn’t just have to be a fellow MD!

 

 

Ashley Herman:

 

Some advice to residents and fellows that come into the NICU that I have learned in the many years in the ICU:

• We are all about the “team” approach and want to do the best for our patients. It’s important to get a multidisciplinary approach to cares for a patient so that it is well-rounded care.

• Always give your rationale about things, especially if the nurse questions the reasoning for things. Most nurses just want to know the “why” behind things and aren’t just trying to be difficult. Nurses love new knowledge. Healthcare is always transforming, and nurses like to hear the most updated evidenced-based practice/research.

• Have open communication with different teams and welcome their expertise.

• Communicate any changes to the nurse if he/she isn’t in the room while you are updating families. Many times, the family/patient relies on the nurse to explain further about information and it’s always best when the nurse isn’t surprised hearing new information from the patient about what the doctor discussed.

• We all deserve respect…times can be tough and emotions can run high, especially in the ICU. If there is miscommunication or words spoken in the heat of the moment, it isn’t weakness to say, “I’m sorry.”

• You can always win nurses over with snacks, haha J.

• Keep things “light” when appropriate, laughing is always the best medicine when the shifts are long.

 

Thank you and welcome to everyone!

 

Jennifer Popies, MS, RN, CCRN-K, ACNS-BC, is a Clinical Nurse Specialist – CVICU at Froedtert & the Medical College of Wisconsin.

 

Ashley Herman, BSN, RN, CNRN, is a Neuro ICU Educator at Froedtert & The Medical College of Wisconsin.