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The Best Kind of Exhaustion

May 02, 2021
by Mark David Siegel

Hi everyone,

I just finished an exhausting week in the MICU. But it was the best kind of exhaustion. The team was superb: they diagnosed HLH, Wernicke’s encephalopathy, and chemotherapy-induced pulmonary eosinophilia. They saved lives and comforted distressed families. By Friday night, I was physically and emotionally spent, but grateful too.

It's easy to grow accustomed to working with extraordinary residents and fellows. Because the year is ending, I made the point of telling each one that they were ready to move up. The interns were ready to lead their own teams, the PGY2s to become true seniors, and the fellow to join faculty. Not that there was any doubt, but I assume it was good for them to hear.

This week, our Clinical Competency Committee will hold two marathon meetings, asking the same question of each of our 143 trainees: are they ready to move up? Are the interns ready to work without resident oversight? Are the PGY2s ready to become MICU Swings and Code Whisperers? Are the PGY3s ready to become attendings themselves?

As a program, these are the most important questions we ask ourselves, and society counts on us to get it right. Over the course of many hours, we assess every resident in each of the ACGME’s core domains: Medical Knowledge, Patient Care, Interpersonal and Communication Skills, Professionalism, Practice Based Learning and Improvement, and Systems-Based Practice. We rely on data from MedHub evaluations, ITE Scores, clinic preceptor reviews, and additional information from meeting attendees, which includes APDs, Chiefs, and Core faculty. The discussions are usually straightforward because most residents are thriving, though a smattering may need study plans to raise ITE scores or coaching to improve efficiency. Thankfully, professionalism and communication problems are rare.

These meetings will probably be similar to all the others: we’ll run the list, give our stamp of approval, and remind each other we don’t have time to gush about how great the residents are. By the time we’re done, I’m sure I’ll feel the same way I did last Friday night- physically and emotionally exhausted, and grateful to be your program director.

Take care and enjoy your Sunday. We’re heading to Harvest on Hudson to treat Heide to an early, restorative Mother’s Day Lunch.


PS: From yesterday’s bike ride on the Farmington Canal:


Submitted by Mark David Siegel on May 02, 2021