Resident Readiness General Surgery (6 page)

Recognize unhealthy coping skills, such as poor anger management or excessive alcohol use.

Good communication and a good work ethic can help ease some of the logistical issues regarding maternity leave as a resident.

Prioritizing family and friends is essential to maintaining good relationships while in residency.

COMPREHENSION QUESTIONS

1.
What challenges are
unique
to residency, which make life management more difficult?

A. Difficult personalities

B. Large amount of responsibility

C. Little to no flexibility regarding personal time

D. Not paid much

2.
Which of the following people could serve as a mentor for Bill, a surgical resident interested in vascular surgery?

A. The general surgery program director

B. A junior vascular surgery attending

C. A chief surgical resident who did research in neointimal hyperplasia

D. All of the above

3.
What are warning signs that residents may be overwhelmed and at risk of burnout?

A. Forgetting their mother’s birthdays

B. Frequently not showing up at get-togethers with friends because they are “too tired”

C. Blaming the nurse practitioner when an attending gets mad at the resident for forgetting to place an important order

D. Routinely late in paying rent and credit card bills

E. All of the above

4.
Which of the following is not a good coping strategy for stress?

A. Training for a marathon

B. Averaging 3 to 4 six packs of beer a week

C. Talking to a medical school friend at another residency on a weekly basis

D. Scheduling a monthly date night with your significant other

E. Taking your dog for a walk

5.
Which of the following is not an ABS-approved option for maternity leave(s) by a resident?

A. Taking 4 weeks as an intern plus 2 weeks’ vacation

B. Taking 5 weeks as a PGY4 plus 1 week away for fellowship interviews

C. Taking 6 weeks as a PGY2 and 6 weeks as a PGY5

D. Taking 6 weeks as a PGY1 and 6 weeks as a PGY3

Answers

1.
C
. It is important to remember that many other jobs have a lot of responsibility, pay poorly, and may involve difficult personalities, but most have more flexibility in regards to time off.

2.
D
. Mentors may come in many forms, and the most helpful mentor may not always be the most senior or well-known member of the field.

3.
E
. Overwhelmed residents may display unhappiness as disorganization, self-isolation, and quick tempers.

4.
B
. Although the occasional beer may be appropriate for stress relief, averaging 3 to 4 drinks a night is not. All the other options are excellent options for managing stress.

5.
D
. The ABS allows only one 6-week medical/maternity leave in the first 3 years and one in the last 2 years. The total time off any year can never exceed 4 weeks for regular leave or 6 weeks for medical/maternity leave.

How to Write a Note—Fast!

Teresa S. Kim, MD

KNOW YOUR PURPOSE; DEVELOP A SYSTEM; STICK TO IT

Surgical internship demands efficiency and neurotic attention to detail, 2 often opposing
modi operandi
. As the workhorse of the inpatient surgical team, you will need to perfect both. Toward this goal, we recommend you do the following:

Develop a system.
Develop a system—for patient care, daily rounds, whatever—and stick to it. If you follow your system, you will be able to work more efficiently, organize the chaos of the day, prioritize tasks and information, catch things you otherwise would have missed, and, most importantly, keep your head on your shoulders when others around you are panicking, for example, in the middle of a chaotic code. You will become a better doctor, and your patients and colleagues will benefit.

In this chapter, we provide 1 example of a systematic approach to patient encounters and note writing. Patient assessment and oral and written communication are grouped together because all 3 processes are integrally related. A written note is simply the end result of organized and thoughtful patient assessment.

Understand that the purpose of a note is to communicate pertinent data, impressions, and plans with other members of the care team.
A note is not just useless paperwork. Nor is it an arena to show off esoteric medical knowledge. Your notes will become a vital line of communication to other residents, attendings, nurses, and consults, and your handiwork will either facilitate or hinder patient care. You must learn how to write a useful note quickly for every situation that arises: admissions, consults, daily rounds, postoperative checks, acute events, and procedures. You do not need to adopt the exact approaches and templates presented in this chapter. But you must remember your purpose. And you must make and stick to a system to stay organized, thorough, and efficient.

GENERAL APPROACH

Whether admitting a patient from clinic, fielding a new consult, or assessing an unstable postoperative patient, our general approach is the following:

1.
Right now, before you start internship:

A. Program your brain:

   i. Ingrain the basic H+P and SOAP formats. Make it second nature. Be able to ascertain, process, and present complicated patient histories in minutes, in the right order, with all the right information. Soon, you will need to do this countless times per day under far less favorable conditions than medical school (picture your pager going off every 30 seconds, impatient colleagues, difficult families, crashing patients, etc). To get it right, every time, you need to learn and stick to a system.

B. Make yourself some templates:

   i. Make yourself some skeleton note templates (see examples,
Figures 5-1
to
5-4
) and store in a readily accessible e-mail or computer location.

Figure 5-1.
Sample template: admission/consult H+P. Highlighted areas indicate tips and fields to be filled in by the writer.

Figure 5-2.
Sample template: SOAP note. Highlighted areas indicate tips and fields to be filled in by the writer.