Tips for IM Attendings – Chapter 7 – Communicating Expectations

The domain communicating expectations included a few concepts that do not fit as neatly.  These two were highly rated. Stating expectations for residents/students (6) Allow team some independence in decision-making (7) The first concept seems obvious at first, but likely appears because it does not occur frequently enough.  As attending physicians we have the responsibility to make clear how we want things done.  That includes presentation style, daily reporting style and time expectations. Although not explicitly included, many colleagues will ask the learners to express their expectations of the rounding process. Independence in decision-making as a concept becomes a recurrent theme especially with residents.  As attending physicians how do we balance our patient care responsibility with resident growth.  My former chairman often used the term graduated responsibility.  Ask yourself if you really encourage residents to have appropriate independence. Residents seek management without micro-management.  How do we avoid micro-management? A few examples might help. On day 5 of the patient’s admission, she complains of constipation.  Do you tell the intern and resident how to treat the constipation, or do you ask them to develop a plan? Another patient has a potassium level of 2.5.  You look at the IV fluids and see D5/NS with 20 mEq KCL running at 100 cc/hr.  What do you do? 1. Tell the team to add 50 mEq instead of 20 mEq. 2. Ask the team what the potassium defi...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs