How to Kill A Resident: A Guide for Consultants

I’ve read nearly every Zombie survival guide out there, and can quite confidently state that when (not if) the Zombies arrive, arms grabbing and mouths gnawing, I will survive. While their dogged determination and sheer numbers have overwhelmed numerous B-rate celebrities in film after film, I have sorted out an algorithm of sorts, a protocol, to survive.

This protocol, the Zombie Apocalypse Protocol for Survival (ZAPS), is secret. I’m sorry – it’s nothing personal, but as you must know from 28 Days Later, displays of compassion during a Zombie Apocalypse will get you killed. I suppose you’re likely to come back from the dead as a human-eating Zombie, if that’s any consolation. Ok, fine, I’ll give you the basic components. You can try to fill in the blanks, and some of you (Brodie Nolan) are qualified to critique and collaborate on improving it.

AN ABBREVIATED GUIDE TO SURVIVING THE ZOMBIE APOCALYPSE
First, there is preparation.
Second, surveillance.
Third, rapid response, which has four prongs:
            1) Alert others as circumstances allow
            2) Evacuate if possible, else:
            3) Hide (for there are good hiding spots and bad).
            4) Fight (neuroanatomic disruption is the key)
And finally: Die heroically *in a fashion that excludes becoming a Zombie       
 *optional, depending on Zombie species.

How To Kill A Resident

With equal preparation to ZAPS, one could learn how to kill a resident. Residents are not Zombies, though if you stared into the eyes of a Resident post-call, you might mistake him or her for a creature from Resident Evil. Residents are, I feel the need to remind some of my Staff Consultants, humans. We have weaknesses, feelings, and insecurities. But since Residents are unlikely to attack you outside of the safety of their dreams, we could use their weaknesses to actually help residents live better, learn better, and be better.

There are four general ways you can kill a resident, none of which involve physical disruption of the central nervous system:

    Disengage them                Undermine their confidence
            Judge them to be incapable           Allow venomous commentary

And so, I present to you How to Kill A Resident, in the hopes that you will help inoculate us from these pitfalls of Mother Medicine and make us as invincible as the Zombies that will one day kill us all. Well, most of us.

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How to Kill A Resident #1: DISENGAGE THE RESIDENT

Don’t listen to what a resident is saying.
Teach the resident something they don’t want to be taught.

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Words, tone and body (or eye!) language should be listened to. If I am glazing over, staring off into the distance, or mesmerized by an environmental services worker’s mop movement, please stop teaching me how to work up cutaneous T-cell lymphoma. I DON’T CARE. Even if you think I should care, I don’t. So, either find an angle to get me to care or move on.

How do you find an angle? Treat me like an emergency resident, no matter what rotation I’m on. Find something that I need to know. Start your lesson with “here’s something that emerg docs get wrong all the time” or “let me tell you about a tragedy that could have been prevented”. No offence to consultants in internal medicine or surgery, but you don’t know what the Royal College expects me to prioritize in my Oral Board in 2020. What is important to you may not be important to me. Let’s work together to make my off-service rotation result in my development as an emergency specialist.

How To Kill a Resident #2: ASSUME THE RESIDENT IS INCAPABLE

Use the Law of Averages to think you know a Resident’s needs.
Lose patience and take over too soon.

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I am not Dr. Leo Spacemen. (Mom, google “30 Rock”)
Whenever I ask to do a procedure, I am asked “What PGY level are you?” My numeric response will determine if I am given what at the time seems to be the penultimate privilege in medical education (when in reality it is your job to supervise and guide me until I am competent in procedures). We all come from different backgrounds and through interest, chance or luck have different capabilities and experiences.

I suggest preceptors rephrase “What year are you in” to a more specific question: “how many times have you done this independently in the past? or “what step do you often have trouble with when doing this procedure?” It’s also totally fair to see if I have done my homework – “What are the contraindications to performing lumbar puncture” is a totally fair question if I ask you to let me stick a needle in someone’s spine.

Now that you’ve decided to give me a chance, I need you to be patient. Running through my checklist and fumbling with equipment takes time. It might even take another tray or pair of gloves if I break sterility. Help me prepare for success; I appreciate that screwing up is type of experiential learning, and I think it has value in simulators, but guiding me to success and following up afterwards with pearls and pitfalls is my preferred way to teach and be taught in a clinical environment.

How To Kill A Resident #3: UNDERMINE A RESIDENT’S (FRAGILE) CONFIDENCE

Show off.
Insult.

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Times have changed… is there a Grey’s Anatomy, Nurse Jackie or Scrubs equivalent?
Dear Non-ER Consultant: I am a new, junior emergency resident. I am not as smart as you, and I know it. Rather than show off your knowledge, show off your teaching skills. Find my level. Help me raise it a notch. Don’t start with “what’s the FiO2 of room air” and move on to “interpret this blood gas.” If I don’t know something, I am to blame. But the system has also let me get this far without filling that gap. Let’s be practical: fill the gap to accomplish the goal of “me not screwing up again.” This is also known as “teaching.” 

During laparoscopic surgery, you can yell at me for not being able to direct the camera at the Ligament of Treitz (“Did you even go to medical school?”) or you can recognize my limitations and feelings (“Julie, can you take over for Blair? He’s very nice, but they don’t do much laparoscopic surgery in the ER, and I need an experienced camera operator during this critical phase of surgery.”)

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A laparoscopic camera controller.  I learned where the focusing ring was while writing this blog post.  I wish I knew that last month.
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I challenge any staff physician to a laryngoscope duel, so long as the trachea we are duelling over is upside down in a flipped pick-up truck in a ditch during a snowstorm at night (just teasing!).    No seriously, bring it on.

A short guide to telling me to kick it up a notch:

My colleagues and MedEd heroes may disagree with this next part, but I think it has served me well as a preceptor of paramedics and as a learner. Save your below-the-belt punches for the end of the day. If my fragile confidence is shattered mid-shift, I might as well call it a day. Teach me what you can, and then sit me down before we part ways. “Blair, for someone who has been on this rotation for three weeks, you seemed to drop the ball quite a few times today. Is there anything you want to chatblog kick in the ass.jpg about?” is a fair way to call me out on poor performance while offering assistance. If I am below the mean, I appreciate being told “I’ve had a few other emerg residents recently, I would have expected your anatomy knowledge to have been stronger.” If I need a kick in the ass, kick me. Be obvious, be quick, and do it once. Please avoid the balls. I’ll do the rest. I am my own worst critic.

How to Kill A Resident #4: ALLOW VENOMOUS COMMENTARY

Allow trash-talking of residents
Give feedback badly
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Rupert and I take a post-call selfie after I bawled my eyes out one morning. Situation courtesy of a staff orthopedic surgeon.

It sounds obvious, but we can forget the basics of humanity when we are working in health care. We are not perfect, but we all want to provide perfect care to every person who we interact with.

We are all learning (and will continue to do so until we retire). We all struggle. We all believe certain dogma that may, or may not, be kind of, or not at all, true. We are all inspired by our love of medicine. So we do not put people down. We seek solutions to our challenges, we reflect on ourselves, and encourage others to reflect on themselves. We feedback to each other, we feed back to ourselves.

Feedback is mandatory if we wish to fulfill our central purpose: to deliver perfect care to people in need. Please give me feedback. It can be positive feedback, or it can be negative feedback. It can be filtered, refined, or blunt. I love it all. But please give it in a constructive manner with one objective in mind: to influence my practice so that I can be an excellent physician.

Give me feedback with the intent of hurting my feelings, undermining my confidence, or disabling my curiosity, and you will be attempting to extinguish the burning fire that gets me out of bed each morning. Without that fire, I will be, by definition, burnt out.

Burn me out, and you will have killed a resident.

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What do you think of my ideas? Please like, comment, share, tweet or use your rotary phone to dial your friends and tell them the URL of this page.

Feeling burnt out? Feel free to get in touch with me, the Doc Help Line 1800-851-6606, or check out this post here: Thoughts: On being less sad

2 Replies to “How to Kill A Resident: A Guide for Consultants”

    1. Totally agree, Josh. My favourite ER doc calls himself an “R23” – a resident of 23 years, because he’s learning new things each day. What a great mindset! Lifelong learning is mandatory in medicine.

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