- Keep up with core reading material. Prepare for scheduled conferences by reviewing appropriate sections.
- Become very familiar with key distinguishing attributes for the highest considerations on your patient’s differential.
- Read deeply about your patient’s diagnosis, including diagnostic criteria, treatments, and controversies.
- Access the literature to answer key questions about your patient’s situation.
- Write down key points or unknown items encountered on rounds. Look these up prior to the next day.
- Ask attendings questions which will help to integrate your fundamental knowledge towards patient care. Some attendings may not appreciate an excessive number of questions about basic topics which could be easily read upon.
Synthesis and application
- Participate productively to discussion on patients, and during conferences.
- Interconnect key components of the history, exam, labs, localization, and differential during your patient presentation.
- If you present a teaching topic, ensure it is concise, relevant to the patient, and has value for the team.
- Know everything about your patients. Be the team expert on your patient’s history and background.
- Review all the medical records to have all the details about prior medical problems.
- Seek additional informants to complete the history. Obtain data first-hand.
- Always pre-round on your patients, even if you have morning conference. Be aware of all active issues, including results for all tests, consultant notes, problems overnight, etc.
- Have all the necessary tools to do a good exam.
- Take your time when doing the examination. Recheck key findings and use alternate tests to ensure accuracy.
- Have your resident witness and provide written feedback on your exam technique.
- Have your H&P in the chart on the day of admission, before morning rounds if admitted overnight.
- Have your progress notes complete and ready to be evaluated by your resident by approximately noon.
- ALWAYS START with a neurological problem-based chief complaint.
- Five essential beginning elements: neurologic problem, age, gender, very most relevant past diagnoses, time course.
- Two beginning elements that are variably required: ethnicity and handedness.
- Do not read from your note, except in reference to medications or lab results.
- Prepare an index card outline to ensure oral presentations are organized, logical, concise, and preview the localization and differential through pertinent positives and negatives.
- Always include a localization, prioritized differential, and plan.
- A summary statement is not always necessary for a concise patient presentation.
- Present with enthusiasm, a clear voice, and varying eye contact.
Team work, communication, interpersonal relations
- Be pro-active and enthusiastic about accepting work.
- Always carry an active load of patients, starting on day 1.
- Appear engaged on rounds.
- Establish yourself as reliable to complete a task.
- Identify what needs to be done within your capacity. Some residents don’t appreciate being constantly asked, “What can I do?”
- Get sign-out list and write down tasks to ensure completion.
- If you hear about something that needs to be done during rounds, write it down on your daily to-do list. Don’t leave it to memory.
- Your resident should generally know where you are at all times.
- Be available and present to help.
- Page your resident as soon as you finish your patient. Do not be gone for many hours.
- Do not use your PDA during rounds or conference.
- Help to write orders, coordinate disposition and follow-up.
- Keep your patients informed. At least check-in with them at the end of the day.
- Use judgment about some results and considerations which may be preferentially discussed directly by attending.
- Advocate for your patient and ensure they have an efficient and safe hospital stay.
- Do not say anything derogatory about a patient, even if they are ‘difficult’. Try to empathize and understand why they are behaving in a way that provokes emotions.
- Be present for family discussions.
- Men should wear clean, well-fitting, and pressed dress shirt, slacks, and socks. Coat should be clean without overstuffed pockets. Tie and dress shoes are standard professional attire. Shave daily and keep hair neat and trimmed. Cover any tattoos. Shirt should be neat, tucked, and buttoned.
- Women should wear clean, well-fitting, and pressed dress shirts, slacks, skirts. Shirt should be tucked-in and long enough not to ride-up when bending. No skin should be showing between neck line and knees. Coat should be clean without overstuffed pockets. Dress shoes are standard. Keep hair neat and trimmed; jewelry should be in good, conservative taste. Cover any tattoos.
- If you disagree with the feedback, do not become upset or defensive. Thank the person, tell them you did not realize that was how you were being perceived, and ask how to remedy the situation.
- Convey a willingness to work hard and incorporate feedback. Be proactive about creating educational opportunities, particularly when things might seem slow or busy.