Being a senior resident is not as easy as interns may think…

I broke this up into PGY2 and PGY3 tips, but I recommend reviewing both and skimming my tips for interns as well. If you have more use the tags #TipsForSrResidents on Twitter, or comment below.

Tips for PGY2s

  • Don’t be late. Don’t be late, but if you will be CALL – don’t text – your co senior ASAP, and give a REAL ETA, not the fake one you’d give your mom.
  • Make a team plan. Before inpatient block starts text or call your co-senior about how you two want to run the team together.
  • Make a learning plan. Figure out what you know about senior tasks, and discuss with your PGY3 or attending, so you quickly find out what tasks you’ve never done or are known to need to work on
  • Take care of your interns. Make sure your interns hydrate, pee, snack and have lunch. You are their boss. BE A GOOD ONE and take care of them, even if your seniors were jerks who didn’t do it for you.
    • Hold your interns phone/pager so they can pee.
  • Be a GREAT senior. If your intern asks you to come see a patient don’t ask why. They may not even know. GO AND SEE THE PATIENT. (I never forgot how my seniors did this for me, and was told several times how grateful an intern was when I did this for them.)
  • Work smart. When an intern (or med student) asks you a question you don’t know you can either:
    • Admit you don’t know, and look it up together
    • Tell them it’s a good question, and you’ll talk about it later. Then write it on your to do list, read on uptodate about it and make sure to discuss with them. (This can be done in a 10-15 min period if things aren’t too crazy)
    • Be a crap senior, and tell them to look it up and present on it later.
  • Teach! This year you’ll need to take on more of a teaching role. Set a personal goal for teaching on inpatient, even if it’s one five minute afternoon pearl per week. Build your inpatient pearl repetoir. Unsure how? Use TEACH cards to help you!
  • Communication. Aim to do closed loop communication, so the entire team knows what’s going on. This prevents multiple seniors from entering orders, too.
    • Intern presents they want to start 12.5mg carvedilol
    • You confirm “Start 12.5mg carvedilol on Ms. Warren?”
    • Intern agrees, you place order and state “Ok, I ordered it”
  • Don’t gang up on the interns! We always split the team in the AM, so although both seniors know the whole team, during rounds only one senior talks to the intern. Keeps from feeling like you’re ganging up on them. Stick to your split. Swap the next day.
    • Always hold the pager/phone during rounds, you’re not an intern presenting and can do so. (Because of the point above, we would swap the phone back and forth so one senior was dealing with calls, while the other paid attention to the plan/did orders. If one of us would be in clinic that PM they got stuck on phone duty all of rounds, it was just easier.
  • Lead by example. Tell an intern you’re going to call a consult on their patient, discuss how you prepare, then make the call while they listen (at least to your end). Afterwards, discuss any surprises you had, and how you dealt with them. Let them see this a few times before having them do it (in some programs calling consults is a senior role, in which case this is advice for PGY3s leading PGY2s)
  • CYB. It’s great to cover for a friend in need, but you still have to keep the Chief Residents and PD in the loop. If you violate duty hours without a prior blessing all hell will break loose.
  • Pandemic. It’s already too late to change your vacation. Plan your pandemic stay at home vacay as best you can. Sorry, but getting your hopes up when the first wave is re-surging is silly. No real vacations for the next year.

Tips for PGY3s

  • Don’t be late. You are the most senior, set the example.
  • Really, don’t be late. Fine. If you’re late, CALL – don’t text – your co-senior ASAP, and give a REAL ETA, not the fake one you’d give your mom.
  • Make a team plan. Before inpatient block starts text or call your co-senior about how you two want to run the team together.
  • Step back. Sure, you can run the whole team yourself. And yes, that PGY2 was just an intern. But treat them as your equal and give them responsibility as they’re ready.
  • Be the BEST senior. If a PGY2 calls to ask you to see a patient you better RUN, they know a lot and this is a red flag. Every time my PGY2s did it meant 1) possibly running a code 2) or calling ICU for a decompensating patient
  • Family rounds are great! It’s okay for seniors to do family rounds together. The patient doesn’t need more than 2 wake-ups today. You don’t both have to touch them, but you do both need to see them.
  • Be a leader, and a teacher. You may be expected to lead rounds as PGY3, but you’re also teaching your PGY2(s) how to senior.
    • Teach them how to contact case management, ensure timely discharge, safely admit and when it’s (rarely) appropriate to block an admit (ie: way too sick for floor, must be in ICU).
    • Try to teach your PGY2 only a few major points a day, and accept that it’ll take a few repeats to stick, even if you remember yourself getting it flawlessly the first time.
  • Advocate for your team. You are the one responsible for interfacing with the attending on behalf of the team. If they are leaving you in a lurch, or if they’re overly present and micromanaging, it’s your responsibility to broach it. Don’t punt to the PD, talk to them yourself.
  • Managing med students. If you’re concerned about a med students skills its okay to discuss with the attending or a co-senior – but remember you still HAVE to talk to the student. Too often seniors feel good about discussing the “problem” and fail to have the conversation with the one person who needs to hear it.
  • Cover Yer Butt. Things are going to be messed up this year, and it may affect your graduation. TRACK EVERYTHING. If an attending or even your PD says you can miss something, get it in writing. You will want proof in EMAIL (not text), because 11.5 months from now when they’re asking why you didn’t do X, it will be on YOU to prove it was permitted.
    • If they say it as a verbal? Ok, send a quick email to them confirming what you just discussed. If you’re worried it’s very sketch, CC/BCC your program director.
    • If it is coming from your PD and you have concerns, BCC someone in the GME office.

I hope these tips help you be a better senior, but feel free to reach out via the website or on Twitter if you have questions. My DMs are open.

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