- Email: [email protected]
Attending–Resident Relations 101
ease the mind of an attending surgeon. This practice will continually cause senior-level residents to be noncompliant with the work-hour limit. If this regulation is enforced, everyone should attempt to make it function the way it was intended to function, and that means attending physicians working more closely with junior-level residents to provide the support that they need. The ultimate goal of surgical training is to ensure our success in post-residency years. Early guidance and exposure to academic and private practice is critical to our development as knowledgeable and well-rounded surgeons. An important component in our training that is lacking is an in-
structional class on what to look for in signing contacts, understanding the actual business of medicine, such as how to effectively bill and how to start a group practice. All attention is on patient care, which is most important, but there are other things to learn. There are many things that we as residents can improve on; however, there also things I would like to see my attendings consider and make an effort to change. I personally choose to focus my time and attention on things that I can control, and I encourage other residents to do the same. doi:10.1016/S0149-7944(03)00123-5
Attending–Resident Relations 101 Michael H. Fealk, DO, Department of Surgery, Maricopa Integrated Health System, Phoenix, Arizona “Dr. Jones has been consulted and would like you to see the patient and give him a call.” At 2 am in the morning, after a long day of work, your reaction is immediate: “this is a bogus consult; if I wasn’t here, he would not come in to see this patient; there isn’t even a note on the chart from the consulting physician.” This is a prime example of the stress placed on the relationship between the attending surgical staff (attendings) and the surgical residents. Residency is a complex situation. It is both an educational process, somewhat akin to medical school rotations, and it is also a job with an extremely heavy workload. Those responsible for teaching residents are also responsible for residents being up all night in the emergency room seeing patients instead of reading and reviewing the principals and practices of surgery. Between the long work hours, the immense amount of knowledge to be obtained, and the fact that patient lives are at stake on a daily basis, one is hard pressed to imagine a more stressful and complicated working environment. It is easy to criticize attendings; in fact, residents do it every day. Each resident must learn to interact with attending staff on an individual basis and make decisions regarding the appropriate means of communications and level of candor. The program director is pivotal in his role as an intermediary between residents and attendings. Program directors are entrusted with the task of balancing workload and educational opportunities and recognizing the crossover between the two. During training, residents are in a unique position to comment and improve on their residency program. A confidential system by which con-
Correspondence: Inquiries to Michael H. Fealk, DO, Department of Surgery, Maricopa Integrated Health System, 2601 E. Roosevelt Street, Phoenix, Arizona 85008; fax: (602) 344-5048; e-mail: [email protected]
546
Michael H. Fealk, DO
cerns as well as praises can be discussed is vital to every residency program. The primary goal of any surgical resident is to become the most proficient and competent practitioner possible within a 5-year time period. In a surgical residency utopia, residents would schedule their days to incorporate lecture and reading time in addition to their clinical responsibilities and experiences. All admissions, consults, clinic visits, and operative cases would be “interesting.” Scut work would be minimized if not eliminated. Work hours would be dictated by the availability of good cases, and the “80-hour work-week” would no longer be the focus of attention. Attending staff are also in a position to appreciate the “ideal residency” in that they were all residents at one time. It is a known fact that any surgeon that has completed a residency in
CURRENT SURGERY • Volume 60/Number 5 • September/October 2003
the past worked longer, harder, and for less money. However, each attending should seek to improve on those practices and teaching techniques that they felt hindered their training and promulgate those that facilitated their training. There is no bad admission, consult, or operative case. Unfortunately, effort is required by both attendings and residents to make this true; too often attendings simply use residents to collect data. Attendings should be able to find at least one teaching point in any patient encounter, whether it is directly related to that case or not. Furthermore, when a resident begins to show a significant knowledge base and the teaching points are more difficult to come by, increased autonomy is the ultimate teaching tool. Not all residents are created equal. Attendings need to adjust their efforts depending on the individual resident. Weaker residents may require special attention; attendings should not hesitate to work with these residents. At the same time, the stronger residents should not be taken for granted. All residents are deserving of the opportunity to increase their knowledge and skills. When attendings and residents appreciate each other’s situations, then working relations will improve. Often, attendings are so busy with their daily responsibilities that they lose track of the demands they place on residents and the significant resident workload. Periodic review of case loads, call schedules, consul-
tations, admissions, and resident evaluations is essential. Furthermore, by increasing resident participation in private attending staff offices and out-patient surgery centers, the residents will better appreciate the burdens that attendings face on a daily basis. Residents have a role in improving their education. Striving to be the “perfect resident” can only benefit relations with attendings. Looking for the learning opportunity in any task and seeking out attending input is crucial. Monitoring the way that we interact with medical students and using this as an example of the ideal attending–resident interaction is productive as well. Accepting responsibility and striving for independence reduces reliance on attending input, which may not always be available. Finally, throw a dog a bone. Attendings are in the habit of showing appreciation to their staff and consulting physician pool because it is good business. Unfortunately, residents’ efforts are easily taken for granted. Without a doubt, a competent resident is the most valuable asset in any attending’s arsenal. Even after a month of criticism and grueling hours on a demanding surgical service, a sincere compliment and a pat on the back can make it all worth while. We are all future colleagues and should treat each other as such. The residents of today are the attendings of tomorrow, as it has always been. doi:10.1016/S0149-7944(03)00125-9
Surgical Education and the Mentor–Student Relationship Anastasios K. Konstantakos, MD, Department of Surgery, Case Western Reserve University, Cleveland, Ohio To teach is to learn and to learn is to teach. In other words, education is a 2-way street. This certainly applies to the attending–resident/student relationship. I would propose that one key aspect of improving the resident/attending teaching interaction is facilitation of communication. This is often easier said than done. However, one suggestion I would propose is simple: follow the “Golden Rule”. In other words, attendings who have a clearer understanding of the resident’s perspective can better teach not only in the operating room but also outside of the operating room. Interestingly, this does not mean necessarily that the younger attendings who have a more recent perspective on residency are better able to relate to residents— even more experienced “gray-haired” surgeons have been capable of succeeding in this endeavor. Anastasios K. Konstantakos, MD Correspondence: Inquiries to Anastasios K. Konstantakos, MD, Department of Surgery, Case Western Reserve University, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106; fax: (216) 844-8201; e-mail: [email protected]
The traditional Socratic method of surgical education is a great starting point. Attendings can strongly stimulate thinking
CURRENT SURGERY • Volume 60/Number 5 • September/October 2003
547
structional class on what to look for in signing contacts, understanding the actual business of medicine, such as how to effectively bill and how to start a group practice. All attention is on patient care, which is most important, but there are other things to learn. There are many things that we as residents can improve on; however, there also things I would like to see my attendings consider and make an effort to change. I personally choose to focus my time and attention on things that I can control, and I encourage other residents to do the same. doi:10.1016/S0149-7944(03)00123-5
Attending–Resident Relations 101 Michael H. Fealk, DO, Department of Surgery, Maricopa Integrated Health System, Phoenix, Arizona “Dr. Jones has been consulted and would like you to see the patient and give him a call.” At 2 am in the morning, after a long day of work, your reaction is immediate: “this is a bogus consult; if I wasn’t here, he would not come in to see this patient; there isn’t even a note on the chart from the consulting physician.” This is a prime example of the stress placed on the relationship between the attending surgical staff (attendings) and the surgical residents. Residency is a complex situation. It is both an educational process, somewhat akin to medical school rotations, and it is also a job with an extremely heavy workload. Those responsible for teaching residents are also responsible for residents being up all night in the emergency room seeing patients instead of reading and reviewing the principals and practices of surgery. Between the long work hours, the immense amount of knowledge to be obtained, and the fact that patient lives are at stake on a daily basis, one is hard pressed to imagine a more stressful and complicated working environment. It is easy to criticize attendings; in fact, residents do it every day. Each resident must learn to interact with attending staff on an individual basis and make decisions regarding the appropriate means of communications and level of candor. The program director is pivotal in his role as an intermediary between residents and attendings. Program directors are entrusted with the task of balancing workload and educational opportunities and recognizing the crossover between the two. During training, residents are in a unique position to comment and improve on their residency program. A confidential system by which con-
Correspondence: Inquiries to Michael H. Fealk, DO, Department of Surgery, Maricopa Integrated Health System, 2601 E. Roosevelt Street, Phoenix, Arizona 85008; fax: (602) 344-5048; e-mail: [email protected]
546
Michael H. Fealk, DO
cerns as well as praises can be discussed is vital to every residency program. The primary goal of any surgical resident is to become the most proficient and competent practitioner possible within a 5-year time period. In a surgical residency utopia, residents would schedule their days to incorporate lecture and reading time in addition to their clinical responsibilities and experiences. All admissions, consults, clinic visits, and operative cases would be “interesting.” Scut work would be minimized if not eliminated. Work hours would be dictated by the availability of good cases, and the “80-hour work-week” would no longer be the focus of attention. Attending staff are also in a position to appreciate the “ideal residency” in that they were all residents at one time. It is a known fact that any surgeon that has completed a residency in
CURRENT SURGERY • Volume 60/Number 5 • September/October 2003
the past worked longer, harder, and for less money. However, each attending should seek to improve on those practices and teaching techniques that they felt hindered their training and promulgate those that facilitated their training. There is no bad admission, consult, or operative case. Unfortunately, effort is required by both attendings and residents to make this true; too often attendings simply use residents to collect data. Attendings should be able to find at least one teaching point in any patient encounter, whether it is directly related to that case or not. Furthermore, when a resident begins to show a significant knowledge base and the teaching points are more difficult to come by, increased autonomy is the ultimate teaching tool. Not all residents are created equal. Attendings need to adjust their efforts depending on the individual resident. Weaker residents may require special attention; attendings should not hesitate to work with these residents. At the same time, the stronger residents should not be taken for granted. All residents are deserving of the opportunity to increase their knowledge and skills. When attendings and residents appreciate each other’s situations, then working relations will improve. Often, attendings are so busy with their daily responsibilities that they lose track of the demands they place on residents and the significant resident workload. Periodic review of case loads, call schedules, consul-
tations, admissions, and resident evaluations is essential. Furthermore, by increasing resident participation in private attending staff offices and out-patient surgery centers, the residents will better appreciate the burdens that attendings face on a daily basis. Residents have a role in improving their education. Striving to be the “perfect resident” can only benefit relations with attendings. Looking for the learning opportunity in any task and seeking out attending input is crucial. Monitoring the way that we interact with medical students and using this as an example of the ideal attending–resident interaction is productive as well. Accepting responsibility and striving for independence reduces reliance on attending input, which may not always be available. Finally, throw a dog a bone. Attendings are in the habit of showing appreciation to their staff and consulting physician pool because it is good business. Unfortunately, residents’ efforts are easily taken for granted. Without a doubt, a competent resident is the most valuable asset in any attending’s arsenal. Even after a month of criticism and grueling hours on a demanding surgical service, a sincere compliment and a pat on the back can make it all worth while. We are all future colleagues and should treat each other as such. The residents of today are the attendings of tomorrow, as it has always been. doi:10.1016/S0149-7944(03)00125-9
Surgical Education and the Mentor–Student Relationship Anastasios K. Konstantakos, MD, Department of Surgery, Case Western Reserve University, Cleveland, Ohio To teach is to learn and to learn is to teach. In other words, education is a 2-way street. This certainly applies to the attending–resident/student relationship. I would propose that one key aspect of improving the resident/attending teaching interaction is facilitation of communication. This is often easier said than done. However, one suggestion I would propose is simple: follow the “Golden Rule”. In other words, attendings who have a clearer understanding of the resident’s perspective can better teach not only in the operating room but also outside of the operating room. Interestingly, this does not mean necessarily that the younger attendings who have a more recent perspective on residency are better able to relate to residents— even more experienced “gray-haired” surgeons have been capable of succeeding in this endeavor. Anastasios K. Konstantakos, MD Correspondence: Inquiries to Anastasios K. Konstantakos, MD, Department of Surgery, Case Western Reserve University, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106; fax: (216) 844-8201; e-mail: [email protected]
The traditional Socratic method of surgical education is a great starting point. Attendings can strongly stimulate thinking
CURRENT SURGERY • Volume 60/Number 5 • September/October 2003
547