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The Wrong Kind of Helpful

January 26, 2020
by Mark David Siegel

Hi Everyone,

Yale residents and attendings are incredibly helpful to their interns, and we should be proud of that. But sometimes I think we’re helpful in the wrong way. Consider what some interns have told me recently:

“I‘d like to make more of my own decisions.”

“I wish my residents would let me do histories and physicals by myself.”

“Before next year starts, I want to prove to myself that I can run my own team.”

These comments expose the underbelly of helpfulness. Like helicopter parents swooping down to rescue their kids at the first hint of trouble, we may think we’re helping when we’re really not. Kids can’t grow when you smother them, and neither can interns.

In just five months, the interns will become PGY2s. They’ll be leading rounds and supervising their own interns. They’ll be making big decisions in the dark of night and they’ll be running codes. This is where the right kind of help, right now, is crucial. I know all the interns will be ready to be PGY2s, but how will they know it if we don’t let them prove it to themselves? How will they build confidence if we make all the key decisions? How will they learn to lead if we do all the leading?

I know the interns are ready to take it to the next level, so please consider these suggestions, starting now:

  1. Rounds: Put the intern in charge. Let them lead bedside rounds. Ask students to present to the intern, not the resident.
  2. Admissions: Let the interns do histories and physicals on their own, without the resident in the room. Encourage interns to commit to their own plans.
  3. Tasks: Focus on helping interns hone efficiencies rather than taking on their work (this does not apply to emergencies and lists that would overwhelm anyone). By next year, interns will need to admit large numbers of patients overnight at the VA, resitern on their interns’ days off, and get through the night independently on Klatskin, Duffy, and Oncology.
  4. Procedures: Let interns master procedures such as paracenteses, ultrasound-guided peripheral IVs, and NG tubes.
  5. Codes: Review the ACLS algorithms with the interns and put them in charge. The PGY2 can be the code whisperer. The PGY3 can gaze upon their protégés in utter amazement.
  6. Problem solving: When nurses call for help, let the interns respond first. Residents should resist the urge to take over unless absolutely necessary.
  7. Care coordination: Let the interns meet with care coordinators so they can learn how discharge planning works.
  8. Discharge summaries: Let the interns write a few. Provide feedback.
  9. Teaching rounds: Encourage interns to give white board talks and teach physical exam skills.
  10. Flip roles: This is a big request but an important one. Residents: would you be willing to switch roles with your interns for a day or two? Would you be willing to write a few notes and call some consults so the interns can take on the big picture role? I’m sure they’d bring you coffee and a muffin in return.

It’s usually great to be helpful and there will undoubtedly be times when residents and attendings have to take over. But those situations are rare. In the long run, the wrong kind of help is counterproductive. Let’s show the interns we believe in them. Let’s support their independence. Let’s resist helping when our help isn’t needed. Let’s let them show us—and, more importantly, show themselves—that they’re ready for next year.

Enjoy your Sunday, everyone. I’ll be ranking, ranking, ranking,

Mark

PS A very special thank you to Rebecca Slotkin for raising the critical issue of workplace violence at last week’s Medical Grand Rounds. Her work, in partnership with Andrew Levin, is already groundbreaking. By amplifying the voices of our residents, we’ve learned that all trainees are potential victims, no matter how hard they work and no matter how much dedication and empathy they show. By educating us, Rebecca and Andrew have captured the attention of Hospital and Department leaders, which is the necessary first step towards making our workplace consistently safe and consistently free of violence.

MDS

PPS Thank you to all the trainees and faculty who contributed to last Friday’s Arts Night (my favorite night of the year). The art on display and the performances were beyond magnificent.


Submitted by Mark David Siegel on January 26, 2020