Signout is hospital slang for the transfer of information between patient care teams. It is also the name of this blog, which represents one of the less dysfunctional ways in which Dr. Signout copes with her participation in a U.S. medical residency program.
Running a resident team on the general medicine wards is not a simple thing, especially at this time of year. The medical students are new to clinical work, and are painfully self-conscious. The interns are new to the hospital, and are scared of their own shadows. The upper-level residents are new to running teams, and are not completely sure what it means to be in charge.
That's not to say we don't understand our responsibilities. As one of those upper-levels, it is my job to set the team's priorities, which means I determine the order of rounding and delegate work to different members of the team. It's also my job to maintain communication with attending physicians, so I make a lot of phone calls and read a lot of notes. I see it as my responsibility to help the students and the intern learn to organize their time, so at the risk of micromanaging, I check in with them frequently. And because I remember the misery of being an ignored medical student, I try to see as many patients as possible with the team, to listen to and provide feedback on student and intern presentations, and to teach even small points around individual patients when I can. All of these responsibilities are organized around nearly constant educational conferences, and with the hopes that at some point, I actually take care of my patients.
It's hard--but not impossible--to fulfill most or all of these responsibilities without actually convincing the team you are in charge. At this time of year, the anxiety level is so high that the other team members are focused on their personal goals like laser beams, with the interns trying their darndest to not kill anyone and the medical students intent on getting good evaluations. Our first week together was occasionally uncomfortable; with me unsure how exactly to lead the team, redirecting them was sometimes awkward.
With the help of some friends, I regrouped over the weekend. Then, during rounds on Monday, I delegated a task to the fourth-year medical student on our team. He turned to the intern for her approval and said, "It's up to you." I interjected: "No, it's actually up to me, and I'd like you to do it."
I can't say I now know exactly what I'm doing at all times, but I can say that things have gotten better since then. Who knew that taking charge could be as simple as saying, "I am now taking charge?"
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Comments
SNAP.
Don't forget that, these days, medical students who are no longer new to clinical work don't care so much anymore, or at least don't need to be at the absolute top of their game, adding to the interesting dynamic.
Posted by: nosugrefneb | August 8, 2007 10:59 AM
Don't forget that, these days, medical students who are no longer new to clinical work don't care so much anymore, or at least don't need to be at the absolute top of their game, adding to the interesting dynamic.
What hippy med school are you at??? 30% of my class matched into ENT, derm, or ophthy, so I can't imagine a school where med students didn't jump when their residents said "jump." Or even acted like they *might* THINK "jump."
Posted by: Garrett | August 8, 2007 11:25 AM
Sure, that happens, but from what I gather it's nothing like third-year when grades and impressions have to be in tip-top shape (aside from sub-I's, that is). It's a bit more relaxed, no?
Posted by: nosugrefneb | August 8, 2007 12:26 PM
Right, but 4th years aren't typically on the wards except for sub-is unless on a consult service, and this time of the year is well before ERAS apps have been submitted, and those clinical grades still completely matter.
I'd be hard pressed to believe that "these days" are any different from the "old days."
Posted by: Garrett | August 8, 2007 10:59 PM
Unfortunately for the fourth-year student described here, Garrett is right: performance in a sub-internship does matter when it's done before applications are submitted. The sub-I is a time for a student to prove to themselves and their evaluators that they're able to do what a good intern can do, only on a smaller scale.
I'd have liked to have seen this student do more jumping (figuratively, of course) and less acting all like he owned the place. Future medical students be warned: Entitlement is the least attractive quality a medical student can manifest.
Too bad, so sad.
Posted by: Signout | August 8, 2007 11:31 PM
No, I was saying that fourth-year, in my estimation, tends to be more lax outside of sub-I times. Otherwise, sure, I can see how you're just as closely scrutinized, if not moreso, during a sub-I as you are during third-year.
Of course, I should say that I'm still years away from getting to the clinical years, but it seems like my school is notorious for having a lax fourth-year. The mentality seems to change so much as soon as third-year is over. Maybe it's a product of going back to a pass-fail grading system. Maybe, Garrett, I do go to a hippy school. :)
Posted by: nosugrefneb | August 9, 2007 7:41 AM
"I can't say I now know exactly what I'm doing at all times[.]"
You never will. Just like in all professions, if you are ambitious, your responsibilities will increase at a rate that keeps them at least slightly beyond your comfort zone.
Posted by: PhysioProf | August 9, 2007 4:13 PM
Good for you signout. I like a doctor who knows how to take charge.
My daughter was hospitalized for the last three months and I have to tell you one of the best doctors I met was a first year resident. That meant she had been a doctor for all of about three weeks when I met her.
After a few days I figured out she was not a senior resident but what she lacked in experience she more than made up for in intelligence and good common sense as well as 'bedside manner' aka personality.
So what I am sayin in this long way is maybe the rank of the student matters less than their attitude.
Posted by: lisa b | August 9, 2007 8:49 PM
I'm also a new upper level. I micromanage everything, and I trust nobody. At this point in the year, I doubt anybody could blame me.
Posted by: Trifling Jester | August 9, 2007 10:24 PM
More reasons it might not be in your best interests to get sick in July!
Posted by: Thomas Robey | August 13, 2007 4:23 AM
I can imagine following a slow moving shopper after THIS.
Posted by: A.L. | August 19, 2007 9:40 AM