In the first article in our intern series, Bernie Little and Edd Pepperell shared their recent intern experience, speaking about the things they struggled with, at what point they began to feel settled, as well as the big lessons they learnt.
Here they have a host of extra tips to help you traverse some of those trickier areas (hello night shifts!) during your intern year.
Communicating with senior staff
Edd advises that when calling a registrar or consultant on another team, you make sure you set the call agenda straight away. Bernie also stresses the importance of having all the information they might need to accept the referral or to offer advice at hand. She suggests using ISBAR to guide you.
Determining when you need to refer to someone higher up
Bernie says it’s your job as an intern to know your patients well, and therefore be able to assess and identify when they may be deteriorating or need senior review. As an intern’s role is a supervised one, it’s a part of your job scope to inform your supervisor if you’re concerned.
“No one is going to criticise you for escalating concerns about a patient. What you will be criticised for is not updating your seniors about your patient’s condition and potentially missing a sick patient,” Bernie says.
When in doubt, Edd recommends one simple course of action – ask your registrar.
“They’ll be very quick to help you decide whether it’s something your team can fix or whether you need to refer to someone else,” he says.
“Even if you think the decision is obvious, your team needs to be in-the-loop for external consults. It’s a bad look for example, if the urology registrar calls your registrar to give advice, and your reg has no idea why they are calling.”
Getting through those night shifts
Both Edd and Bernie are big advocates of taking your allocated break, but acknowledge it can be hard in the fast-paced hospital environment. Whenever possible, try to take a few quick moments to have a breather, remembering to water and feed yourself too.
In preparation for night shifts, Edd suggests staying up as late as possible and then sleeping in to get a good eight or nine hours rest. On the shift itself, he says caffeine can be your friend, but it’s probably best to avoid it in the last few hours of your shift.
When you get home, black out your room as much as possible and keep it cool to help you get your requisite eight hours sleep. Edd says exercising regularly is also ideal, ‘but not at the expense of sleep!’
Keeping up with ward rounds
Edd recommends making a note about the patient’s age, reason for admission and vital signs in the iEMR before the round begins.
“This way when you actually see the patient, you only need to open your existing note, rather than endure 100 clicks on terrible software to open a new note while your team has already moved onto the next patient,” he explains.
He also suggests making it a practice to carry a printed list and pen to note down your to-do tasks for each patient, including consults/investigations. This also helps in keeping track of who is going home.
Bernie adds: “If you know a patient is leaving in the next few days, work on their discharge summary as you go. If possible, have their scripts completed and ready to go the day before too.”
Dealing with patients
Edd finds that for the most part, communicating with patients is one of the easiest parts about being an intern.
“Most patients appreciate that you’re the doctor that has made time to talk to them. You also have a nice security blanket as you’re allowed to say ‘I don’t know, but I can check with the team.”
Bernie says it’s also worth taking the time to explain why you’re ordering tests or treatments.
“Sometimes ward rounds are so quick, it leaves patients with many unanswered questions, Coming back later and giving them a bit of your time to answer them makes a big difference to the patient and their family, and that’s very rewarding,” she says.
Edd says the only problems you might encounter are angry or demanding patients, and overly chatty ones.
“With the former, you learn to be calm, acknowledge their concerns, and offer a solution. But this doesn’t mean saying yes to unreasonable demands. With the latter, you may have to politely interrupt and/or make an excuse to leave,” he smiles.
Transitioning to a new term
For both Edd and Bernie, it’s all about the handover, and meeting up with the current resident is key. Find out:
- Where to meet on day one
- Your general hours
- Meeting room locations
- Where to find forms etc.
- Overtime processes
- Any nuances in relation to bosses/nursing staff/admin staff
- Specific tips for ward rounds/clinics/theatre
In addition, Bernie suggests reading up on the common presentations for that specialty, as well as introducing yourself to everyone early.
“Taking the time to meet the people on your new ward not only helps you settle quickly, it also means staff will be more comfortable approaching you. That makes asking questions much easier!” she says.
- Don’t avoid certain presentations or clinical skills because you’re uncomfortable. You’re very well supported and taking on challenging presentations helps you to learn quickly and boosts your confidence.
- Brainstorm a management plan before you speak with your consultant. You’ll learn more this way instead of relying on your consultant to do the thinking for you. You might not always be correct, but it’s a great chance to ask your consultant how they’d approach it differently.
- Aim to give a succinct handover to a consultant or registrar ASAP after seeing a patient. Check your management plan with them. Order any relevant investigations and go back to the same person to update them as you get more information.
- Be aware of time management. While it’s inefficient to sit around for two hours with one patient waiting for results, don’t try to see four concurrently as you’ll end up with a mountain of results hitting you at once. Try to have one to two ‘pending’ patients, plus one you’re actively reviewing.
- Consider what barriers patients may face when being discharged, for example, do they need additional services in their home?
- Make allied health referrals early
- Be efficient on ward rounds
- Triage your post-ward round jobs
- Establish a structure for calling consults
- Fluid balance and electrolytes are extremely important and must be closely managed!
- Keep your running shoes on as surgery ward rounds are FAST! You may need to shorthand your notes and edit them later.
- In clinics, you generally see patients on your own, take a history and examine them, then handover to a senior staff member. Draft your note before calling the patient in, and print it out. Then jot down anything important from the consultation to share with your boss. That way, you have the name, age, URN, and key points with you, in case you get flustered when presenting.
In case you missed it, be sure to check out part one of our intern series.