Dare to lead. Master the transition to becoming a PGY2 with tips from expert educator Abby Spencer MD, MS, FACP, IM Residency Program Director and Vice Chair for Education for the Medicine Institute at Cleveland Clinic and Shreya Trivedi MD, GIM Fellow at NYU School of Medicine. Topics include: how to run work rounds, preparing your team for attendings rounds, how to teach on the fly, finding your leadership style, and what to read during residency. This is the first of three episodes that we’re co-developing with the American College of Physicians for their Resident Transitions Series.
Written and produced by: Shreya Trivedi MD
Graphics and Show Notes by: Hannah R Abrams
Hosts: Paul Williams MD, FACP; Stuart Brigham MD; Matthew Watto MD, FACP; Shreya Trivedi MD
Guest: Abby Spencer MD, MS, FACP
The Resident Transitions Series is brought to you by The American College of Physicians with support from its Council of Resident/Fellow Members. Visit acponline.org/resident to learn more about the benefits of Resident/Fellow Membership and join our proud internal medicine community today!
You’re not alone. It’s incredibly common to get to the end of intern year and feel like you’ve focused so much on getting things done that you haven’t read or prepared to teach. “As soon as you meet your July 1 intern, though, you’ll know how much you’ve learned and how much you have to teach.” -Dr. Spencer
Beware the curse of competence! Identify what your interns are able and willing to do, and help them do it. It’s easy for residents to do everything (themselves) because they know they can do it more efficiently, but resident leadership is about building that capacity in your team.
Prepared teaching or teach on the fly? Yes. Be ready to find teaching points during the day, but build a bank of 3-5 ‘canned’ talks during your PGY2 year that can serve you for the rest of your teaching career. Be creative– teaching moments can be physical exam, difficult conversations, or even reflecting on your own mistakes.
“Your job is to make the team look excellent.” Savvy attendings know that the best residents are the ones stepping back and letting the intern and students look good. Boost the intern’s confidence by thinking through the key nuances of the case with them; as a bonus, it will make them look great on rounds!
Leadership style isn’t about who we want to be, it’s about what our learners need from us. You likely have ideas of what leader you want to be like, or what styles you want to avoid. That said, the best team leaders will adapt their style to what their learners need in this point of their training. Our job is to see their potential and nurture it.
Studying after hours: The age old wisdom is true: read about your patients. Find a specific, answerable question that came up during the day. Or, do the MKSAP questions related to your patient’s diagnosis.
Day 1 is all about expectations and introductions, both from yourself and from your learners. Use these questions as a guide to find out what your team needs from you and make it clear what you expect from your team.
In the first day bustle, be purposeful about getting to know your learners as people and helping them set goals. A short amount of time on this will set your tone for the month.
Give clear and specific expectations to each team member upfront. It’s unfair and frustrating for students and interns when they fail to meet unspoken expectations.
First, pay attention to yourself during the day. What does ideal look like for you, and why? What needs to happen to get there?
Ask your interns: what’s worked for them in the past? Without telling any names, which seniors did they get the most from in the past? What are their pet peeves?
Have an explicit conversation around what you expect. No need for residents to hand out papers with their expectations, but be honest about what details you’re particular about.
“You’re getting your show ready. Your job is to make the team look excellent.” Remember, everybody’s job on the team is to set each other up for success. The best thing the intern can do is prep the student so that they can anticipate what the attending/resident is going to ask them. As a resident, boost the intern’s confidence by thinking through with the plan for each patient. Savvy attendings know that a resident who sits back and is quiet while the student and intern shine has worked really hard to prepare their team. A well run team provides excellent patient care, and everyone benefits.
It’s easy to feel pressure to have polished teaching modules or give talks on the fly, but really, good resident teaching is about understanding your learners and seizing the organic opportunities in the day, even if they don’t seem like traditional ‘teaching points.’
Yes. You can do both at the same time by building 3-5 ‘canned’ talks you have ready to go on something you’ve read a million times, or are really interested in (e.g. narrow complex tachycardia). When there’s a patient who fits that, you’ll be able to teach both ‘on the fly’ and smoothly. These talks will last you your whole teaching career!
Before you go into each room, think about why the team is going in and set a goal. It could be point out an interesting exam finding, have a difficult conversation, or elicit a piece of the history. Help your learners develop the skill of knowing what to focus on in each room.
There’s so much more than just the medical facts to teach—you can read Bates the night before and show them new parts of the physical exam. As Dr. Spencer points out, “you’re becoming better at your craft because you’re preparing to teach.” You can even set up your teammates e.g. empower your intern to teach and wow the med student: “Tomorrow you’re going to walk us through Ms. Smith’s lung exam.”
We teach and give feedback all day, but learners don’t always recognize those moments. Label the teaching point as it’s happening, and label feedback with “I’m going to give you feedback now” so that they know to pay attention.
Sometimes the best teaching you can do is create an environment that facilitates learning by admitting your own limitations. This instills the safety to be curious and not know, to ‘put their nickel down’ and be safe doing so. As Dr. Watto quotes, “Education is something that other people do to you, learning is something that you do to yourself”— inspiring them to learn is everything.
If there are four admissions in the morning, don’t be afraid to say “we can do a little more teaching in the afternoon,” or “I’ll send you an email with some teaching points.”
As a resident, it’s not about who you want to be, it’s about what your learners need from you. A lot of people come in to second year wanting to be like certain people, or not like other people. The best leadership, though, responds to where your learners are.
When tasks come up, understand where your learners are in terms of willingness and ability. Identify:
Let them do it! Always trust but verify.
Build confidence! Trust but verify.
Find what’s meaningful to them—“I really appreciate how much you care about patients and I know you wouldn’t want to hurt them”
Explore what’s meaningful to them.
“A leader is anybody who takes the responsibility to recognize the potential in people and processes and has the courage to nurture those processes.” (Brené Brown) Look for people’s potential and build it up in them.
Don’t label: A ‘good’ or ‘bad’ intern or colleague is situational. The all-star on Cardiology may be a nervous wreck on Nephrology. Our job is not to label them, but to see their potential, meet them where they are.
Dr Spencer’s recommends checking their insight. They may seen their own deficiencies and be praying for someone to bring them up…or they may have no idea.
Tie your daily reading to what you see clinically. Learn the basics before you try to keep up with the latest primary literature. That’s for attendings and fellows.
Have a specific, answerable question that came up during the day. Dr. Trivedi recommends keeping a notecard with your questions during the day— for example, don’t just look up bullous pemphigoid, look up “what are the medications we can use for pemphigoid?”
Push yourself and your team. Formulate clinical questions from the day and decide who is going to look them up. Caution: ALWAYS close the loop and ask them what they learned. They won’t do it next time if not held accountable .
A few tips to try out from Doctors Spencer and Trivedi:
The magic can happen when you can acknowledge what you don’t know.
Take-home points from Dr. Spencer’s favorite quotations:
“If your troops stop bringing you their problems, it means they think you don’t care or you can’t help” (Colin Powell): One of the most important things any resident can do is communicate effectively with their attendings, interns, and patients. You have to be approachable with problems. Struggling to show it? Try starting responses with, “Thank you, I’m so glad you brought this up.”
“You can’t go into battle if you think you look silly on a horse” (Attributed to Napoleon) You’re ready to lead– embrace it!
“Don’t worry about the efficiency or what you can do or you can’t do; just take care of the patients, and if you care deeply, you’re going to work even harder, and the rest will come.” (Dr. Spencer’s Residents) The transition to second year is really hard; remember to care and connect. Don’t lose the joy, and make sure you find meaning in the privileges and interactions you get to have.
Listeners will learn skills for learning, teaching and leading as they transition from the PGY1 to PGY2 year.
After listening to this episode listeners will…
Dr. Spencer reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.
Links from the show are included above.
Spencer, Abby. Guest expert. “Dare to Lead: Navigating the PGY1-2 Transition.” The Curbsiders Internal Medicine Podcasthttp://thecurbsiders.com. May 29, 2019.
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