What does a residency without seniors look like?
In school, have you ever found yourself at the end of a long line of white coats? You have a question, but you aren’t sure when and where and how to ask it. You should probably ask the intern. If she doesn’t know, maybe she can ask the 2nd year resident. The senior resident looks pretty stressed today. Is this the attending that hates interruptions, or can you go ahead and ask your question now?
Our inaugural interns are more than half-way through this academic year, paving the path. Hospital rounds are generally one attending, one intern, a pharmacist +/- a pharmacy resident, and a third year medical student about half the time. They are light and lean, and often quick. We try to do some learning before walking or at bedside. But there isn’t a sea of white coats blocking the hospital corridors.
When residents have questions, they ask me. Or Dr. Gebhardt, or Dr. Harris, or Singh, or Dr. <fill-in-the-blank>. I have a whole little speech I’ve given at least six times now. “While I am your attending, I am also your senior this week. You need to be comfortable asking me the stupid questions that you would normally shout out at your senior resident sitting across the room, or co-intern, sitting next to you. I remember asking the stupid questions. The stupid questions all have to be asked a few dozen times. If I do not hear a stupid question every few minutes, I will start to worry about you.”
Isn’t it scary to communicate directly with attendings for every detail? I hope not. If that has been your experience, then I’d like you know that it can be better. Observe my text-message snippets from the past nine days:
> Table rounds first then see new guy OR see new guy then table rounds?
>>> You pick
> I’m gonna see if I can ninja speed see new guy
>>> :thumbsup:
—— —— ——
> what’s your favorite triple therapy inhaler for copd
> trelegy never gets covered right
>>> symbicort plus spirits
>>> spiriva
>>> not whiskey
—— —— ——
>>> leaving again. keep our people alive for 43 more minutes please
> no promises
>>> any news?
> yeah, list as all still alive
—— —— ——
>>> let’s plan on keeping 515 and wait on walk test until tomorrow. she lives alone with a small dog and 13 steps*
> sounds reasonable to me! chest ct came back for 224* showing multifocal pna. I started ceftriaxone, azithro, and got blood/sputum cx and mrsa nares
>>> :thumbsup:
* room #s and step count changed to keep me out of HIPAA prison. dog detail vitally important so I’ll risk HIPAA prison
—— —— ——
So you can decide if we have a culture that promotes open communication and safe learning. We call, message, and text throughout the day so interns feel supported. Everyone is approachable, and I always feel welcome to ask stupid questions in front of the team.
Rounding with no senior residents works remarkably well. We put a lot of thought and effort into making it so. We are trying to build a culture, and year 1 seems to be going great! Now when we have a full residency of senior and junior residents and interns, will the attendings be moody unapproachable dictators? I suppose we’ll have to vote on that when the time comes.