learning & growing in your ho year · • wait for boss to give plan. • only settle immediate...
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Learning & Growing in your HO year
19Sep2020| NigelFong
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• Scribeduringrounds• Spendsomuchtimeonpaperwork.• Changesaredull– bloodcultures,IDCs,callingpeople&gettingscolded.• Can’tactuallymakedecisions… justerrandboy/girl• Justcopy/paste– noneedtore-clerkadmits.• Sobusyandtired… aimtosurviveandgohome
Itiseasytoenterminionmode…
Youaremuchmorethanthat.Butittakesdeliberateeffort
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WheredoyouwanttobeattheendofHOship?
• Independentlymanageprimarycareandgeneralmedicalissues.• Independentlymanageon-callemergencies.• Beabletoworkwithinthehealthcaresystem• Recognizeyourlimits,knowwhenandhowtoreferforadditionalinput.• Personallife:Relationship?Spiritual?Otheraspects?
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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
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• It’shardtolearnifyouarestrugglingtosurvive.• Thiswillgetbetterwithtime.Speeditupby• Learntomanageworkload– knowwhatisimportant.• Haveasystemtoorganizeyourwork.• It’sokaytoworkabitharder.• Tobecomegood,youfirsthavetodoalotof‘scut work’.• Takeinitiativetolearn– donotwaittobetaught
• Becomfortablebeinguncomfortable• Knowwhatyoudonotknow• Knowwhatarethesafetypitfalls• Uncertaintyispartofmedicine– learntodealwithit.
#1– Firstgetpast‘survivalmode’
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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
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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)
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8
1. “HOsstillcopyandpastetheA&Ehistory”2. “Expectation..onceescalatedthecaseisnolonger[theHO’s]responsibility”3. “Unfairdocumentationaboutdiscussionswithseniors”
Example
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• Welearnthemostfromourpatients• Followuponyourpatients– e.g.oncall,takenover>seewhetheryourdiagnosis&managementwasright!• Beinquisitive,ask‘why’.Don’tfollowplansblindly.• Youcanlearnalotfromblueletters.• Readup&aroundyourpatients.• Thingswillgobadlyfromtimetotime– learnfromthem!• Alwaysconsider:howcanIdobetternexttime?
#3– Reflectonyourpatients
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• Feedbackmaynotbevolunteered– askforit.• Generalcommentse.g.“youareagoodHO”or“yousuck”aren’thelpfulforlearning.• Getspecificfeedback(e.g.discussonecaseyousaw&werenotsureaboutthediagnosis,anunexpecteddeterioriation).• Differencesinopinionareapartoflife– listentothedifferentviewpoints,read,anddecideonyourown.
#4– Getfeedback
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1. Getpastsurvivalmode2. Takechargeofyourpatients3. Reflectonyourpatients4. Getfeedback
Bemorethanaminion…
Butalsoremember…• Donotforgetthesofteraspectse.g.comms.• HOisaphaseoflife– thingsgetbetter.• Beingadoctorisaprivilege– youtouchpeople&changelives.• Takecareofyourself(&lookoutforoneanother).