{"id":3159,"date":"2021-04-14T07:56:07","date_gmt":"2021-04-14T11:56:07","guid":{"rendered":"https:\/\/blogs.nejm.org\/general-medicine\/?p=3159"},"modified":"2021-04-14T07:56:07","modified_gmt":"2021-04-14T11:56:07","slug":"top-21-thoughts-for-21","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2021\/04\/top-21-thoughts-for-21\/","title":{"rendered":"Top 21 Thoughts for \u201921"},"content":{"rendered":"
\"Sneha<\/a>

Dr. Shah is a Chief Resident in Internal Medicine at the University of Colorado.<\/p><\/div>\n

What I Wish I\u2019d Known<\/h4>\n

Here is my advice for medical students, interns, and senior residents. These are things I wish someone had told me. I write from the perspective of an outgoing Internal Medicine Chief. Many thanks to my co-chiefs for their input and their support throughout this year.<\/p>\n

Medical Students<\/h4>\n
    \n
  1. Be honest about your career interest. If you\u2019re a through-and-through surgeon on an internal medicine rotation, tell us you\u2019re going into surgery. Your team can then find ways to engage you in medicine from a surgical lens. We know not everyone will choose internal medicine.<\/li>\n
  2. Avoid discounting your skills by saying \u201cI\u2019m just a medical student.\u201d We all were medical students once. If you\u2019re genuinely trying (and not hurting patients), no one will fault you for being completely wrong.<\/li>\n
  3. If you are actively listening to your team, you\u2019ll never have to ask, \u201cwhat else can I do to help?\u201d Figure out what your senior needs, and do it. If it\u2019s unclear, a secret way to ask would be, \u201cwhat\u2019s left on your checklist that I can take over?\u201d<\/li>\n
  4. Don\u2019t answer questions directed at other learners. Don\u2019t interrupt presentations. If you\u2019re asked a difficult question, say,\u00a0\u201cI don\u2019t know, but let me look into it, and I can present it later.\u201d Then, do that!\"\"<\/li>\n
  5. Be in charge of the patient room! Write down team names and updates on the dry-erase board, return the tray-table and TV and blankets to their previous positions, ask whether the patient wants the door open or closed. These are little things, but we will notice you doing them. They matter more than you think.<\/li>\n
  6. I know everyone tells you this, but PUT YOUR NICKEL DOWN! Giving us three treatment options and choosing the wrong one is MUCH better than giving us three treatment options and stopping! For brownie points, tell us your clinical reasoning when choosing that treatment (wrong or right), and we\u2019ll be very impressed.<\/li>\n
  7. You want your evaluations to read, \u201che\/she worked at the level of an intern.\u201d Figure out what this means within your team, and strive for it.<\/li>\n<\/ol>\n

    Interns<\/a><\/h4>\n
      \n
    1. If someone offers you the chance to go home early, take it! It\u2019s not a trick.<\/li>\n
    2. Keep a log of all the patients you see (last name, first name, and date of birth will do the trick for all EMRs). If that\u2019s too much, at least keep track of all the patients you saw whose cases kept you up at night.<\/li>\n
    3. If your expectation<\/em> is to work hard, reality will certainly be easier. Those who expect a 40 hour\/week residency all the time are the unhappiest.<\/li>\n
    4. When picking up overnight admissions: read the H&P last. If you review the chart and come to the same conclusion as your colleague, chances are\u2026 you\u2019re both right.<\/li>\n
    5. Write less when pre-rounding. Try your best to present mostly from memory. As this gets easier to do, you\u2019ll know your clinical reasoning skills are improving. It is possible!<\/li>\n
    6. You\u2019ve never seen HHS, and you never will. Order the DKA protocol.<\/li>\n
    7. For prelims: Don\u2019t be known as the \u201cXYZ-prelim.\u201d Be known as the person we want to convince to stay in internal medicine.<\/li>\n<\/ol>\n

      Senior Residents<\/h4>\n
        \n
      1. The calmer you are, the more your interdisciplinary colleagues will listen. Take a deep breath, don\u2019t show your inner panic.<\/li>\n
      2. Start thinking about the patient\u2019s disposition location and outpatient medication reconciliation from day 1.<\/li>\n
      3. No talking behind the backs of your intern or medical student. No talking down about other specialties in front of your learners. If you need to vent, do it with a trusted peer or chief.<\/em><\/li>\n
      4. If you can afford it, buy your interns and students lunch one Sunday.<\/li>\n
      5. Most conflict arises from poorly set expectations. So set the tone for your team by setting expectations. If you can joke around within your team, work will become fun.<\/li>\n
      6. If you\u2019re frustrated by a system or situation, have a strategy to prevent that from affecting the care you\u2019re providing to the patient in front of you.<\/li>\n
      7. Take responsibility. Be there for your patients and colleagues on your bad days and your good.<\/li>\n<\/ol>\n

        Bonus: While there are no \u2018stupid questions,\u2019 seek an answer before<\/em> asking the question. Make an effort. Shed the helplessness.<\/p>\n

        \n

        Advice is seldom welcome, and those who need it the most, like it the least. \u2014 Lord Chesterfield<\/p><\/blockquote>\n

        What advice do you all have for us chief residents? Do you have any other \u2018must-get\u2019 advice that I missed?<\/p>\n","protected":false},"excerpt":{"rendered":"

        What I Wish I\u2019d Known Here is my advice for medical students, interns, and senior residents. These are things I wish someone had told me. I write from the perspective of an outgoing Internal Medicine Chief. Many thanks to my co-chiefs for their input and their support throughout this year. Medical Students Be honest about […]<\/p>\n","protected":false},"author":1306,"featured_media":3161,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[472,17,19,29,72,96,34,37,40],"class_list":["post-3159","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-about-residency","tag-career","tag-chief-resident","tag-communication","tag-internal-medicine","tag-medical-education","tag-medical-students","tag-residency","tag-resident-experience","tag-student-experience"],"yoast_head":"\nTop 21 Thoughts for \u201921 - Insights on Residency Training<\/title>\n<meta name=\"description\" content=\"Dr. Shah shares tips for making it through medical training, from medical school to Chief year.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2021\/04\/top-21-thoughts-for-21\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Top 21 Thoughts for \u201921\" \/>\n<meta property=\"og:description\" content=\"Dr. Shah shares tips for making it through medical training, from medical school to Chief year.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2021\/04\/top-21-thoughts-for-21\/\" \/>\n<meta property=\"og:site_name\" content=\"Insights on Residency Training\" \/>\n<meta property=\"article:published_time\" content=\"2021-04-14T11:56:07+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2021\/03\/Hindsight-1.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"957\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Sneha Shah, MD\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Sneha Shah, MD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2021\/04\/top-21-thoughts-for-21\/\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2021\/04\/top-21-thoughts-for-21\/\",\"name\":\"Top 21 Thoughts for \u201921 - Insights on Residency Training\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\"},\"datePublished\":\"2021-04-14T11:56:07+00:00\",\"dateModified\":\"2021-04-14T11:56:07+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/1ffa2dd16f3542a9070d80729adb14b5\"},\"description\":\"Dr. Shah shares tips for making it through medical training, from medical school to Chief year.\",\"breadcrumb\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2021\/04\/top-21-thoughts-for-21\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2021\/04\/top-21-thoughts-for-21\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2021\/04\/top-21-thoughts-for-21\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.nejm.org\/general-medicine\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Top 21 Thoughts for \u201921\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/\",\"name\":\"Insights on Residency Training\",\"description\":\"Observation of residents across diverse medical specialties\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/1ffa2dd16f3542a9070d80729adb14b5\",\"name\":\"Sneha Shah, MD\",\"description\":\"Sneha is a Chief Resident in Internal Medicine at the University of Colorado. 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