Want To Hear Seven Years Of Residency Wisdom In 40 Minutes?
For my chief resident grand rounds, I summarized the most high yield techniques I learned and applied to becoming a better resident and better human being. Many of the ideas were picked up from reading over 100 self-improvement books and applying the ideas specifically to my surgical training. Check out the video below and pick at least one idea to apply to your own training today.
Wish You Could Accomplish More In Less Time?
As surgeons, we spend a lot of time at work, and unfortunately, this leaves little time for anything else. So how can you accomplish everything you want to with limited time? This is the question I tried to answer last year and after learning and implementing a bunch of strategies, I found a few that are game changers.
The development of a morning routine tops that list. Think about it - when was the last time you skipped brushing your teeth in the morning? Probably never. Are your teeth really that important? Not really. So why are we so good at brushing our teeth and so bad at doing things that are even more important? Simple - because we haven't developed those things into habits. So last year, I decided to make reading a part of my daily routine. I read for just 15 minutes (from the Schwartz textbook) every single morning. The results were incredible! In the past 7 months, I read 700 pages (compared to 400 pages in the first 4 years of residency combined). Because this technique was so successful, I slowly grew my 15 minute routine into an elaborate 90 minute session that I perform every day (except on post call days). My current morning routine involves weight lifting, meditation, reading a surgical textbook, reviewing anatomy, practice suturing/knot tying, reading a journal article or reviewing a surgical procedure, and reading for self-improvement.
If I could go back to the start of residency and do only one thing differently, I would create this type of morning routine the day I started. This technique is incredibly effective, so no matter how far along you are in your training, I strongly encourage you to start your own morning routine. Here's how: start simply by deciding to read for a set amount of time from your favorite surgical textbook every single morning before you leave the house. It doesn't really matter how long you read for at first (5-15 minutes is enough - any longer and you likely won’t do it) - the key is just to develop the habit, which takes about one month (consistency is key - don't miss even one day!). Next, track your progress on a calendar- this gives you accountability and increases your chances of sticking with the routine. In a month, this will become your "keystone habit" and you can add on another activity to your morning routine, such as 5 minutes of exercise, with minimal difficulty. Be one of the few people who actually implements these ideas and you'll be dominating in no time. But as always, don't take my word for it. Try it yourself and judge by your own results. They will be game changing!
Each day is your life in miniature; what you accomplish today is what you accomplish in your lifetime.
If you want to learn more about these ideas, check out these phenomenal books:
The Compound Effect - by Darren Hardy
The Miracle Morning - by Hal Elrod
The Power of Habit - by Charles Duhigg
How To Dominate Rounds
If you've been a surgery resident for a few years, you've probably noticed one of the same recurrent issues as me. Interns will often show up to a service clueless on how to round on that service. Senior residents will often correct them when they make a mistake, but few have developed a specific system that they can simply teach to ensure smooth and efficient rounds each day. My question to you is "If you are going to round on patients almost every day for the rest of your life, wouldn't it make sense to create a simple and efficient system that you could follow every day?" Having your own system will save you time, keep you organized so you don't miss important information (like starting DVT prophylaxis on every patient), and allow your team to run smoothly even when you are not there. Furthermore, you will be teaching your junior residents an organized approach to taking care of patients that they can replicate in the future.
I've modified my rounding technique several times to create the highly efficient one I use today. I start by having the interns fill out my rounding template (14 patients per page - click the "MDM24X7 Rounding System" tab on the right to see my sheets), including the past 24 hours of vital signs, ins & outs and labs. In terms of subjective information, I want to know the exact same questions for every patient, in addition to any specific questions about their condition. These questions are:
-Is the patient's pain controlled?
-Do they have nausea or vomiting?
-Do they have flatus? When was their last bowel movement?
-What volume are they achieving on their incentive spirometer?
-Did they ambulate or get out of bed?
I don't need to waste time asking my interns or the patient these questions, because the answers are already written for me or reported to me in less than 10 seconds per patient. Multiply that time savings by 30 patients each day! The last three columns are my "to do" list. The first column is for morning rounds, the next one for evening rounds, and the final one for any unresolved issues at the end of the day. The next day, I place a new rounding template on top of yesterday's sheet. This gives me instant access to any pertinent patient information during the patient's entire hospital course (you will know the patient's potassium level from three days ago before most people can even log onto the EMR!).
In the evening, I review the orders for every patient. I keep a separate sheet for each patient that contains a summary of their current admission and past surgical history. On that sheet, I also organize (by system), the patient's past medical history, home meds, and current meds (see the template and sample sheet by clicking the "MDM24X7 Rounding System" tab on the right). This prevents me from forgetting to restart their home meds. That's my system in a nutshell. Try it out or create your own!