I Can't Think of Any

November 12, 2017
by Mark David Siegel

Hi everyone:

All Yale residents are hardworking and talented, but all can improve.  Assuming you agree, you can appreciate my frustration when I see "Suggestions for Improvement" like these in MedHub: 

"Keep up the good work!"

"N/A"

"None!"

"Keep doing what you're doing"

"I can't think of any"

What’s the point of these suggestions?  Are they meant to flatter?  Do they reflect a lack of imagination?  Laziness? More likely, evaluators may not appreciate the value of specific suggestions, or perhaps they struggle to find ways to improve.  We all have skills to master, but we may not see them ourselves until they’re pointed out.  So here are some suggestions:

For interns:

  1. Avoid jargon- use words patients understand.
  2. Finish your notes early so consultants can read them
  3. Present from memory
  4. Share a teaching point on every patient you admit
  5. Lead rounds- prepare to be a PGY2
  6. Avoid asking residents what they think before making your own plans
  7. Write concise notes- delete old test results and needless detail
  8. Ask for explanations when you don’t understand
  9. Don't believe everything you hear; do your own research and feel free to debate
  10. When your work is done, see if anyone needs help, read, or spend time with your patients

For residents:

  1. Explain your thinking and don't assume your learners understand
  2. Give interns space to make their own decisions before advising them
  3. Bring original literature to rounds
  4. Lead attending rounds
  5. When things get busy, ask your interns if they need help
  6. Lead impromptu teaching sessions, for example on [ABG, EKG, CXR] interpretation
  7. Give feedback on learners' notes, exams, and presentations
  8. Let interns run codes and hold the admission pager
  9. Provide evidence to support your decisions
  10. Review goals and expectations at the beginning of each rotation and check in frequently to see how things are going

These lists are obviously incomplete and I'm sure you can think of more ideas yourselves.  We want every intern to be ready to lead a team well before the year ends, so if your interns aren't there yet, tell them what they should work on.  We want every resident to be ready for independent practice well before graduation, so if your residents aren’t there yet, make suggestions.  We want everyone to become role models, so consider what the best residents do and, if the person you’re evaluating hasn’t reached that level yet, help them get there. 

That's my suggestion for all of you. 

Enjoy your Sunday, everyone,

Mark

PS Recommended readings:

1) In follow up to last week's Program Director's Notes on duty hours and fatigue: 

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2653454?utm_medium=alert&utm_source=JAMA%20Intern%20MedLatestIssue&utm_campaign=06-11-2017 

2) In honor of our veterans:

https://www.nytimes.com/2017/11/10/opinion/travis-mills-veterans.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region®ion=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region

M

Submitted by Mark David Siegel on November 12, 2017