Learning & Growing in your HO year

19Sep2020| NigelFong

• Scribeduringrounds• Spendsomuchtimeonpaperwork.• Changesaredull– bloodcultures,IDCs,callingpeople&gettingscolded.• Can’tactuallymakedecisions… justerrandboy/girl• Justcopy/paste– noneedtore-clerkadmits.• Sobusyandtired… aimtosurviveandgohome

Itiseasytoenterminionmode…

Youaremuchmorethanthat.Butittakesdeliberateeffort

WheredoyouwanttobeattheendofHOship?

• Independentlymanageprimarycareandgeneralmedicalissues.• Independentlymanageon-callemergencies.• Beabletoworkwithinthehealthcaresystem• Recognizeyourlimits,knowwhenandhowtoreferforadditionalinput.• Personallife:Relationship?Spiritual?Otheraspects?

Howdoclinicianslearn?

David C. M. Taylor & Hossam Hamdy (2013) Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83, Medical Teacher, 35:11, e1561-e1572

• It’shardtolearnifyouarestrugglingtosurvive.• Thiswillgetbetterwithtime.Speeditupby• Learntomanageworkload– knowwhatisimportant.• Haveasystemtoorganizeyourwork.• It’sokaytoworkabitharder.• Tobecomegood,youfirsthavetodoalotof‘scut work’.• Takeinitiativetolearn– donotwaittobetaught

• Becomfortablebeinguncomfortable• Knowwhatyoudonotknow• Knowwhatarethesafetypitfalls• Uncertaintyispartofmedicine– learntodealwithit.

#1– Firstgetpast‘survivalmode’

Example:PhilosophyofCTSP

Critical Important Lowpriority

Examples CollapseLowBPDesaturation

Fever (normalBP)ChestpainNPUx8hoursAbnormallabresult

Hypocount=18Patientdidn’tBOPatientwantspanadolFamilywantsupdate

Goal Resuscitate Appropriatemanagement Savetime

Strategy Checkresus statusSupportphysiologyCall MOearlyEscalatetoHD/ICUInformfamily

AssesspatientThinkofddxInitialinx (and trace)AppropriatemanagementMonitorfordeterioration

EnsurenoemergencyHandleremotelyifpossibleLeave toprimaryteamnextday.

Pitfall Knowwhennot toresuscitateandDNRinstead!

Missingthesickpatient. Traps– e.g.ifpatientwantspanadol,assessfirstifunusualorseverepain

BADHABITS• Minion-mode• CopyA&Enotes• ‘Pre-clerk’&letMOclerk.• Donotseenewcases• Don’tthinkaboutpatient.• Nodiagnosisinmind.• Waitforbosstogiveplan.• Onlysettleimmediateissue.

#2– Takechargeofyourpatients.

LEARNTO…• Movefrom‘Reporter’to‘Interpreter’and’Manager’• Alwayshaveddx &volunteeryourplans,evenifeventuallywrongoryourbossjustfeedsyouplans.• Takeownershipofyourpatients- don’tjustdotheminimum.• Think2stepsahead– apartfromtheimmediateissue(e.g.fluidoverload),whatelseneedstobedone?(e.g.planfordialysis,optimise CVRF,stopsmoking,socialissues)

8

1. “HOsstillcopyandpastetheA&Ehistory”2. “Expectation..onceescalatedthecaseisnolonger[theHO’s]responsibility”3. “Unfairdocumentationaboutdiscussionswithseniors”

Example

• Welearnthemostfromourpatients• Followuponyourpatients– e.g.oncall,takenover>seewhetheryourdiagnosis&managementwasright!• Beinquisitive,ask‘why’.Don’tfollowplansblindly.• Youcanlearnalotfromblueletters.• Readup&aroundyourpatients.• Thingswillgobadlyfromtimetotime– learnfromthem!• Alwaysconsider:howcanIdobetternexttime?

#3– Reflectonyourpatients

• Feedbackmaynotbevolunteered– askforit.• Generalcommentse.g.“youareagoodHO”or“yousuck”aren’thelpfulforlearning.• Getspecificfeedback(e.g.discussonecaseyousaw&werenotsureaboutthediagnosis,anunexpecteddeterioriation).• Differencesinopinionareapartoflife– listentothedifferentviewpoints,read,anddecideonyourown.

#4– Getfeedback

1. Getpastsurvivalmode2. Takechargeofyourpatients3. Reflectonyourpatients4. Getfeedback

Bemorethanaminion…

Butalsoremember…• Donotforgetthesofteraspectse.g.comms.• HOisaphaseoflife– thingsgetbetter.• Beingadoctorisaprivilege– youtouchpeople&changelives.• Takecareofyourself(&lookoutforoneanother).

Thankyounigelfong@gmail.com