You already go on rounds with your attending. You already attend conferences, classes, and morning report. You already go to Grand Rounds. And you might already go to Boards prep courses.

Well, check this out… with one tweak, your learning experience can go from okay to phenomenal.

If you want to get this amazing pen, you can order it from Amazon.

If you are an institution (a medical school, a residency program, etc) and you would like to learn more about how this concept can help your organization go from good to completely awesome, then go to NapkinRounds.com.

By the way, if you haven’t seen the changes yet:

Well, this is the first step in that process. If you are a nurse, a patient, a caregiver, or really anyone who comes in contact with physicians, this is your opportunity to offer some advice. Over time, depending on the response, I will make this into a more robust, far-reaching project. I will select the best of them and redistribute them.

A word of caution… This is for sincere advice only. This is not a mouthpiece for attacking specific individuals, the healthcare industry or for lumping people into groups and labeling them. (There’s plenty of that in the news media) This is for sincere advice from one human to another.

Central Lines for Medical Students, Interns, & Residents

Placing central lines can be a pretty stressful part of medical school, internship, and residency… especially early on. Well, I’ve collected a bunch of videos and PDF files that you might find useful as you prepare for putting lines in yourself.

Let me know what you think of it.

Well, when this mentor pulled me aside, she gave me a new perspective on things. So, it was better than an individual tip or a single pearl… She gave me a strategy. And I’m giving that same perspective, that same strategy, that same insight today. Here’s the link:

Here’s the link:

Revisiting the Intern’s Survival Guide

And here’s what I posted in the comments section back in June:

Great post.

For many, the appearance of arrogance actually comes from an intense fear of failure and fear of being exposed as someone who somehow slipped through the medical education cracks.

Unfortunately, some people try to cover or hide the fear, rather than saying, “You know what? I’m nervous. This is new to me. What has been your experience?”

“Smart interns forge alliances with the nursing staff” – great quote. If interns and nurses don’t see their missions as the same, they’re missing the boat. There’s a difference between a mission and a role. Both play different roles in the same mission.

And yes, there are too many new docs who start internship with an air of arrogance and, at times, downright rudeness. But, there is also a large pool of nurses that start off assuming there’s a turf battle. And both of these continue the cycle.

This probably sounds a little fluffy, but it would all be a lot smoother if we assumed the best in others.

For interns:
– Don’t assume you have to know everything.
– Don’t be afraid to ask for help
– Nurses know their job better than your attendings
– Social workers know their job better than your attendings
– The more you understand others’ jobs, the better off you’ll be
– Ask
– And when you ask, be polite about it.
– Communication is everything… more than words said, communication is an exchange.

For nurses:
– Interns are nervous, & everyone expresses it differently
– Be patient with the new folks
– Be especially patient with new interns from other cultures
– Don’t start off assuming a turf battle… sure defend that last piece of pizza
– The more you understand about others’ jobs, the better off you’ll be
– Ask
– And when you ask, be polite about it.
– Communication is everything… more than words said, communication is an exchange.

Also, be on the look out for an awesome freebie coming from RookieDoctor.com… very soon. The quantities will be limited because I can only ship out so many (before I go broke .

Residency tips and pearls should be a little more accessible than having to ask all of the time. Especially because there are some questions people are reluctant to ask… like about stress. Here are some coping tips for internship and residency…

No baby yet, so I had time to address some questions… One question was posed (on a forum) about extreme levels of stress and anxiety in internship and residency. Here was my response. Some of these tips and pearls come from the free report you can signup for at the right (just put your name & email in there & follow the directions… easy-peasy). Some of the other tips & strategies come from RookieDoc members-only videos. And some of the others were specific to the questioner. Anyway, check out my response and let me know if it helps you.

Also, if you have a question for me, Just Ask.

What you have expressed is ultra-common. It is, by far, the biggest thing I deal with every year from May to about October. I give talks to and provide services for new interns… I’m not going to plug my stuff here, but I am going to give you some background and a little proof that it is common.

When I started internship, I came in pretty average or slightly below average. I felt like any minute I was going to be declared a fraud & that somehow this whole medical school thing was actually a mistake. I was also immensely fearful of hurting someone.

Because of those two things – harming someone & being declared a fraud – I was always the first one in… always the last one to leave… At night I was dreaming about my patients. During the day I had palpitations, fatigue, reflux, etc. And throughout the day I was dreading any situation in which I could be called on or humiliated. Now, I wasn’t paralyzed with fear and I did my best not to show it, but I was definitely burning out.

So much so, in fact, that there was an intervention. Two attendings pulled me aside and took me under their wings.

One & a half years later I was Resident of the Year, then Chief Resident, and now I hold a prestigious position at my institution. Now the unfortunate thing is that not everyone gets attendings to guide them through it all (despite the whole idea behind our training). The fact is, you’re right, many people do talk about specific interns behind their backs. Some even pigeon-hole them into categories and give them labels that stick with them throughout their training – passed from attending to attending.

So I started giving talks to new interns and started some web sites and services. In the process, I have interviewed or surveyed well over 1100 interns anonymously and as a coach/counselor.

And guess what? Most of them list those same two top fears that I said I had. (My surveys always ask for the 3 top fears… and these 2 are the most common) Fear of harming someone is always number one… and fear of being the weakest link or worst of your peers or exposed as a fraud – almost always number two.

So what you are feeling is more common than you think. Actually, it’s probably normal.

Now, is it as intense as you describe? Not usually.

Now, on to some things to help cope…

1 – You are not alone. You know when you’re sitting around with the whole team – the students, the interns, the residents, maybe fellows, and the attending? And you know when the attending starts throwing questions out to the group? At that moment, everyone is secretly hoping they’re not called on. Everyone is eager to blurt out an answer when they know it… because they want to be absolved from answering the ones they don’t know. (Incidentally, because of this fear, I always start with the students, then the interns, then the residents when I’m asking questions to my team)

2 – The 10-Year Litmus Test. Ask yourself, “10 years from now, will any of this matter?” And the answer is no. It will not.

3 – Strengthen Your Strengths. This might sound like an odd suggestion & maybe even unrelated, but it is not. Most people are worried sick about their weaknesses. But think about this… How are you going to stand out? How are you going to provide the most value to your program? How are you going to forge the career you want, that’s in line with your passions and goals? Do you think you will do these things by working on your weaknesses? No.

If you want to stand out… If you want the people around you to say good things when you’re not there… If you want to like the company you keep… and if you want to make an impact in your patients lives or even on the world at large…

Then you should strengthen your strengths. Provide value to your program and your patients and your fellow interns with the areas you are strong in. (Related to medicine or not)

4 – Compare Yourself To Yourself. Too many of us worry where we stand relative to someone else. Like you said, “i will compare myself to my class mates and convince myself that they are all so much better than i am”. You are comparing what you know of yourself to what you do not know of others. You have no idea what they are thinking… what their fears are… or even what attendings think of them… or the vibe that patients get from them… or whatever. The best comparison to make is “This is where I am now – am I better than a few months ago? And how much better do I want to become?”

5 – You Are Not At The End Of The Road. Just because you are a doctor doesn’t mean that you are done. You are not at the “end of your training journey”… you’re right in the middle of it. You’re in the middle of the process. Trust the process a little bit.

Thousands of interns have come before you and thousands will come after you. All have their strengths and their weaknesses. This process helps make those weaknesses into competencies (maybe even strengths depending on you and your program). But the ultra-successful ones will be the ones who leverage their strengths.

So trust the process and add value along the way.

6 – It’s All About Communication. It’s not about knowing the right answers or even ordering the right tests the first time around. Those things come with time.

The best doctors are the best communicators. (By the way, so are the best wives, husbands, parents, etc) More on this another time.

7 – Avoid Complainers – Steer clear of complainers. Complaining is infectious. And whining will get you nowhere.

8 – Avoid the backbiters.

9 – Laugh a little bit. Check out sites like GiggleMed.com’s Medical Humor Blog, Placebo Journal and Q-Fever. But find humor only in appropriate things related to work – not in individuals or demeaning things.

Anyway, I hope this helps.

I get hundreds of questions about residency training, internship, and the clinical years of medical school. Lately, it seems that I have been getting more & more questions pertaining to preparing for residency when you have babies at home.

Well, here’s one email response to such a question. This is Tip #29 from the Residency Tips Series.

If you’ve got a question of your own, just ask. (I will not publish your name or other personal identifiers unless you’re giving me a testimonial & you give me permission to use your name.) In fact, you can ask the questions anonymously if you want, but I won’t be able to get back to you unless you leave your email.

Anyway, on to Tip #29…

Hello

I received your question from the RookieDoctor.com site and I wanted to offer some insights.

(“I have an 11 month old baby, Would I be able to manage my work and my family?”)

First of all… congratulations on the baby

Is it possible to manage your work and your family with a little one in the house?… absolutely. However, it takes some planning and it will be a source of some stress at times.

My wife and I were in the same class in medical school. And we had a child at the beginning of our third year of med school, and another at the end of our internship, and yet another right before residency ended. So, we’ve dealt with a lot of the same things you are about to go through. That being said, your situation is unique to you.

The first thing would be to assess your support structure and your “allies”. Possible support includes your family, your spouse’s/significant other’s family, your spouse, close friends, your siblings, your parents. Again, I don’t know your situation. But, don’t assume that others are unable to help in some way. It may not be watching your child during the day or call-nights, but for some it may be as simple as picking them up from someone else’s house, or picking up diapers the next time they go to the store, etc. It will be difficult to ask for help in some cases, but you may just have to.

By assessing your allies, I mean people that you may not be close to right now, but can offer some support in some way. One ally might be an upper level resident who previously went through the same thing. They know the residency program you are in… they know who is easy to approach about this subject and who should never be approached… they know local resources… they may know of an attending that lets residents leave for family reasons, etc. You might say, well, I didn’t start yet and I don’t know these people. Guess what? A great resource for who is who is the department secretaries. They know the gossip. Ask them… “Has anyone recently gone through this program with a baby at home? I just need some tips.” You can also ask them, “What do you recommend?”

Another ally might be the chief resident… Let’s say you know your spouse has a particularly busy time of year coming up… you can ask for lighter schedule/electives around that time… Vice versa… if you know you’ll have more support at a particular time of year, then see if you can do your harder rotations during that time. Again, this takes planning. You’ll need to review your yearly block schedule and try your best to make arrangements as early as possible.

And the more stuff you have pre-packaged, the better. Let’s say you want to do a critical care rotation in December because you will have more support at home… well, look for someone that has critical care in December and ask them if they’d be open to switch (most would prefer not to have a call month near their holidays). If they are open to switching, then just mention that to the chief resident or whoever controls the block schedules. The less they have to do, the more likely you’re going to get what you want.

Another thing is… don’t waste any time. When you’re at work there is going to be downtime. You should take care of things you can during that time… you need to pay your bills, work on a presentation, arrange a doctor’s appointment, signing charts (if you have to dictate), filling out forms, etc. Surfing the internet, gossiping, etc are all completely a waste of time and will take you away from things that will free up time at home. Very important.

There are two very important things to prepare yourself for:

* Communication
* Guilt

Communication is of the utmost importance. Your non-medical family and friends (your support network) will not understand what you are going through. They won’t understand that even though you’re at the hospital or office a lot, you may have to come home and read or prepare a presentation, etc. They need to know this and they need to know why it is so stressful for you. And I mean a sit-down-heart-to-heart “Mom, I’m worried” “Honey, I’m scared.” etc.

Communicate with your co-residents and your chief resident. Apologize when you inconvenience someone. And don’t assume that you know the answer. You might surprised what happens when you just ask.

Guilt is probably the toughest. You will miss things like bedtime, bath time, important milestones, etc. You will have to deal with crying when you leave (your child and occasionally you).

I hope this is helpful.

Let me know if you need anything else.

Dr. Tori