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Twitter Fam, so alot of current interns have messaged me asking for advice about PGY2 year. I think this is the perfect time to share what I have learned so far. Here is yet another thread for the junior #MedTwitter, from my perspective...Let's go
#surgeryresidency
#yougotthis
#surgeryresidency
#yougotthis
1/
Going to refer to junior residents (PGY2 & PGY3).
Your #1 goal to master in junior years is CONSULTS.
Be efficient, purposeful & safe when dealing with a consult.
Remember when a team is consulting you, THEY NEED YOUR HELP.
So be nice to them and answer what they are asking!
Going to refer to junior residents (PGY2 & PGY3).
Your #1 goal to master in junior years is CONSULTS.
Be efficient, purposeful & safe when dealing with a consult.
Remember when a team is consulting you, THEY NEED YOUR HELP.
So be nice to them and answer what they are asking!
2/
Don't DAD a consult!
D= Delay/Deny
A= Avoid
D= Dump
No consult is a "stupid" consult.
You simply DON'T have the experience to say that.
Instead of focusing on DADing the consult, spend energy on effectively dealing with it.
Consults are a GREAT way to learn quickly.
Don't DAD a consult!
D= Delay/Deny
A= Avoid
D= Dump
No consult is a "stupid" consult.
You simply DON'T have the experience to say that.
Instead of focusing on DADing the consult, spend energy on effectively dealing with it.
Consults are a GREAT way to learn quickly.
3/
When you get a consult, obtain the "high yield" information and not the patients life story over the phone.
Don't waste time on stuff you can see for yourself in the EMR.
You have to know which consults are time sensitive, if unsure ASK a senior, don't sit on consults!!!
When you get a consult, obtain the "high yield" information and not the patients life story over the phone.
Don't waste time on stuff you can see for yourself in the EMR.
You have to know which consults are time sensitive, if unsure ASK a senior, don't sit on consults!!!
4/
Once you have the pertinent high yield info, go see the patient!
DONT diddle daddle in useless information in the chart.
You need to know the following four
of the time:
Pertinent History
Specific Exam (ALWAYS including vitals)
Labs/Radiology available
Any intervention done
Once you have the pertinent high yield info, go see the patient!
DONT diddle daddle in useless information in the chart.
You need to know the following four
of the time:Pertinent History
Specific Exam (ALWAYS including vitals)
Labs/Radiology available
Any intervention done
5/
With the above info, you are supposed to come up with an ASSESSMENT and a reasonable PLAN to tell the senior/attending.
THIS IS HOW YOU WILL LEARN THE MOST!
Use Uptodate, Medscape, any quick reference to understand what is a reasonable plan to execute.
Consults = your learning
With the above info, you are supposed to come up with an ASSESSMENT and a reasonable PLAN to tell the senior/attending.
THIS IS HOW YOU WILL LEARN THE MOST!
Use Uptodate, Medscape, any quick reference to understand what is a reasonable plan to execute.
Consults = your learning
6/
One last thing about consults.
Be nice to the person who is calling you!
Don't be rude, condescending or show attitude, that won't help your cause.
Thank the person for calling the consult, trust me it makes a HUGE difference.
Always circle back to tell them about the plan.
One last thing about consults.
Be nice to the person who is calling you!
Don't be rude, condescending or show attitude, that won't help your cause.
Thank the person for calling the consult, trust me it makes a HUGE difference.
Always circle back to tell them about the plan.
7/
Goal #2 in junior years is mastering SICU.
Every program will have the junior resident "leading" the SICU.
Get good at bedside procedures:
A-lines, CVL, Supra-pubic catheters, IV lines, Chest tubes, US exams, Intubations, Emergency dialysis catheters.
SICU Nurses are your BFFs
Goal #2 in junior years is mastering SICU.
Every program will have the junior resident "leading" the SICU.
Get good at bedside procedures:
A-lines, CVL, Supra-pubic catheters, IV lines, Chest tubes, US exams, Intubations, Emergency dialysis catheters.
SICU Nurses are your BFFs
8/
SICU follows a common theme, which is HEAD TO TOE.
Whenever you deal with a SICU patient just go from Head to Toe with:
history, exam --> assessment & plan.
Always go through the following:
Neuro
CV
Respo
GI
GU
MSK
Heme/ID
Endo
Lines
Misc
Round MULTIPLE times during the day
SICU follows a common theme, which is HEAD TO TOE.
Whenever you deal with a SICU patient just go from Head to Toe with:
history, exam --> assessment & plan.
Always go through the following:
Neuro
CV
Respo
GI
GU
MSK
Heme/ID
Endo
Lines
Misc
Round MULTIPLE times during the day
9/
Common issues you should be comfortable with:
Delirium/Agitation/unresponsive
Arrhythmias/code blue
Respiratory failure management
Feeding dilemmas
Sepsis
Anticogulation & its pertinent issues
Bleeding patient
PE/DVT
Pressors/Inotropes
DNR/DNI
Wounds
Troubleshooting lines
Common issues you should be comfortable with:
Delirium/Agitation/unresponsive
Arrhythmias/code blue
Respiratory failure management
Feeding dilemmas
Sepsis
Anticogulation & its pertinent issues
Bleeding patient
PE/DVT
Pressors/Inotropes
DNR/DNI
Wounds
Troubleshooting lines
10/
SICU rotation will set you up for success. It provides the solid knowledge base you will need later on so don't waste the opportunity.
Many great podcasts available to get good at managing critical care patients such as ventilator settings etc, The ICU Book is also good.
SICU rotation will set you up for success. It provides the solid knowledge base you will need later on so don't waste the opportunity.
Many great podcasts available to get good at managing critical care patients such as ventilator settings etc, The ICU Book is also good.
11/
Goal#3 should be develop good surgical habits.
You will be likely assisting at this stage.
Observe how one achieves the following:
Traction, counter-traction and exposure.
Safe surgery is one you should strive for, not a butchering blood bath.
Goal#3 should be develop good surgical habits.
You will be likely assisting at this stage.
Observe how one achieves the following:
Traction, counter-traction and exposure.
Safe surgery is one you should strive for, not a butchering blood bath.
12/
You should also watch videos of procedures and read up on the cases ideally BEFORE you go to the OR.
That way you will maximize your learning.
Surgery is nothing but a repetition of the same action --> muscle memory.
ASK questions in the OR if you see something new.
You should also watch videos of procedures and read up on the cases ideally BEFORE you go to the OR.
That way you will maximize your learning.
Surgery is nothing but a repetition of the same action --> muscle memory.
ASK questions in the OR if you see something new.
13/
Practice knot tying when you are sitting idle.
One handed, two handed, dominant hand, non-dominant hand, slip knot, fisherman's knot etc.
Practice Laparoscopy on FLS simulator(need to pass FLS).
Practice endoscopy on FES simulator
(need to pass FES).
Learn to PALM instruments
Practice knot tying when you are sitting idle.
One handed, two handed, dominant hand, non-dominant hand, slip knot, fisherman's knot etc.
Practice Laparoscopy on FLS simulator(need to pass FLS).
Practice endoscopy on FES simulator
(need to pass FES).
Learn to PALM instruments
14/
By the end of your junior years you should be comfortable doing common procedures:
lap chole, appy
Diagnostic lap, running bowel
Open ventral/umbilical/inguinal hernia
Hemorrhoids/Fissures/abscess
Breast & skin cases
Ex-lap, fascial closure
Chest tubes
Wound washouts
By the end of your junior years you should be comfortable doing common procedures:
lap chole, appy
Diagnostic lap, running bowel
Open ventral/umbilical/inguinal hernia
Hemorrhoids/Fissures/abscess
Breast & skin cases
Ex-lap, fascial closure
Chest tubes
Wound washouts
15/
You might lead rounds as a junior.
VERY IMPORTANT to stay focused on the patient at hand & not how long the list is.
Every patient you need to know the following:
Overnight issues
Current exam
Recent labs/radiology
Assessment & Plan
Sounds awfully similar?
Yes RE: consults
You might lead rounds as a junior.
VERY IMPORTANT to stay focused on the patient at hand & not how long the list is.
Every patient you need to know the following:
Overnight issues
Current exam
Recent labs/radiology
Assessment & Plan
Sounds awfully similar?
Yes RE: consults
16/
You are leading rounds and patients condition deteriorates...DONT TELL INTERN TO CALL ATTENDING/SENIOR.
YOU should immediately inform the senior/attending and carry out the plan.
This is NOT the time to delegate ,but is the time for you to ACT.
Don't dump stuff on interns!
You are leading rounds and patients condition deteriorates...DONT TELL INTERN TO CALL ATTENDING/SENIOR.
YOU should immediately inform the senior/attending and carry out the plan.
This is NOT the time to delegate ,but is the time for you to ACT.
Don't dump stuff on interns!
17/
As a junior resident, if you don't have any consults, OR, SICU, rounding responsibility...HELP OUT YOUR INTERN OUT!
No job is too small for you:
Change dressings
Call SW for dispo planning
Discharge patient
Update list
Teach medical students
If it's ""QUIET"" go study!
As a junior resident, if you don't have any consults, OR, SICU, rounding responsibility...HELP OUT YOUR INTERN OUT!
No job is too small for you:
Change dressings
Call SW for dispo planning
Discharge patient
Update list
Teach medical students
If it's ""QUIET"" go study!
18/
Junior years present its own set of challenges.
You are expected to:
Have basic surgical knowledge
Technical skills
Trustworthiness above interns
In these years you will transition from a resident that passes info on, to a resident that starts to process that info.
Junior years present its own set of challenges.
You are expected to:
Have basic surgical knowledge
Technical skills
Trustworthiness above interns
In these years you will transition from a resident that passes info on, to a resident that starts to process that info.
19/
wish you the best of luck navigating through the junior(PGY2 & PGY3)years of residency.
Just remember that after beginning your senior(PGY4 & PGY5)years, you will have a totally different set of challenges; can't have junior challenges linger on.
#almostsenior
#yougotthis
wish you the best of luck navigating through the junior(PGY2 & PGY3)years of residency.
Just remember that after beginning your senior(PGY4 & PGY5)years, you will have a totally different set of challenges; can't have junior challenges linger on.
#almostsenior
#yougotthis
20/
Lastly, join various surgical societies.
Get involved in research and submit abstracts to conferences.
You will be amazed with how much more you can learn from such events, also it's an awesome opportunity to see places like Vegas, Hawaii etc.
Work on improving your CV!!!
Lastly, join various surgical societies.
Get involved in research and submit abstracts to conferences.
You will be amazed with how much more you can learn from such events, also it's an awesome opportunity to see places like Vegas, Hawaii etc.
Work on improving your CV!!!
