My intern is a nutcase!

[WorkaholicsAnon]

she whines about how hard she has to work, she gets mad when she is paged, is rude to the nurses, she cries and sobs when things get overwhelming to her (which is often, and for pretty minor things), and she is divving up the notes she has to write to me, her resident, saying "we should split up the notes FAIRLY." And if i offer her a suggestion for improvement, she gets upset and doesn't talk to me anymore.

I recall as an intern working much harder than she's had to (since i end up picking up her slack and doing most of the tasks myself since she has a serious problem with appropriate prioritization), without even thinking about feeling sorry for myself (ok maybe once or twice the whole year). Furthermore I would always be reluctant to even LET my resident do notes for me, not to mention the thought of MAKING my resident do notes for me never even crossed my mind!! This is how most of my colleagues have been as well. . .we face our challenges and get through them without whining!

Anyway, just a vent, and PLEASE interns, DO NOT BE LIKE THIS INTERN!!!

This is going to be a long month.

---

Members don't see this ad.

 

[gutonc]

Nip it in the bud right now. If you don't feel you can do it on your own, involve one of your chiefs, attending or one of the PDs in your program. A bad intern will become an even worse junior and senior resident. It's still early enough for this kind of behavior to be dealt with one way or another (remediation or, failing that, removal). Later in the year or, heaven forfend, next year, things will be much more difficult.

 

[WorkaholicsAnon]

At the risk of being a douche, what kind of resident are you that your intern behaves this way, or is willing to say things like that to you?

Um she has the reputation already, with other residents too. I just started working with her like 5 days ago. I dont think it's me. However, you're right, I've been a little too nice. I'm gonna nip it in the bud!

 

[Winged Scapula]

No doubt. People like this always develop a reputation really fast. And honestly, if she's struggling to hack it that badly two months in, doesn't seem likely that she'll stick around the whole residency.

But man, I can only imagine what I would have gotten as an intern if I had suggested to my residents that we "divide the notes fairly". At minimum it would have been an ass-chewing. But more likely a formal sitdown with my PD.

Seriously.

It was considered a major faux pas in my program to have anyone above a PGY-2 write anymore than "Agree with Above", write orders, or do any of that stuff. As for telling a more senior resident the way I think things should be run on the service, I agree...cause for a major "talking to".

Kids these days!

 

[elwademd]

Nip it in the bud right now. If you don't feel you can do it on your own, involve one of your chiefs, attending or one of the PDs in your program. A bad intern will become an even worse junior and senior resident. It's still early enough for this kind of behavior to be dealt with one way or another (remediation or, failing that, removal). Later in the year or, heaven forfend, next year, things will be much more difficult.

this intern may be in a preliminary position, and really not have much interest or care.

i swear i had the same exact intern my 2nd year of residency. she was a prelim (headed to neurology). my attending for that month spoke with her about it, but i don't feel like her attitude really changed. hopefully she's doing ok in her neuro program.

 

[elizabeth5863]

If she gets upset or cries when you try to give her critique face-to-face, the other option is trying to email her suggestions for improvement. Maybe that way, when she calms down a bit, she can absorb some of that feedback/critique.

Good luck! I hope the interns I'll be working with in the next few months at the VA won't be like that.

 

[chopper]

A little advice from a prior life: document, document, document.

I would sit her down and talk to her in a very professional manner. Go over what is expected, and what she needs to work on. Do it when things aren't rushed. Tell her some positive things. Then have it written out (if your dept has a form for this all the better), and have her sign that she understands what was talked about. Have a witness if possible. Let her know that if she improves, you rip up the letter. If not, it will be used to document a pattern of poor performance.

 

[buckley]

Hey...im sure not all prelims are like that...

 

[jdh71]

I've got a fellow intern this month who is such an effing pu$$y. All of last week he kept trying to pawn off work onto me, and I finally had to tell him to go outside and play hide go go eff himself. I also had to emphasize that we take turns admitting and picking up new patients in the morning. It is NOT my fault he's been lazy and unaggressive with discharge. Getting to the hospital at 5AM (medicine service) every morning for a week should cure him. He's starting to "man-up" about two weeks in - thank God. I've never asked my Sup's to write a note, or orders, even if occasionally sometimes they do . . . in fact, sometimes I have to politely ask them to not write orders, I remember what's going on much better if I write it myself (micro-managing b1tches . . . )

 

[WorkaholicsAnon]

Well thanks for the input everyone! I did nip it in the bud and was stern with her for a while, stressing the importance of her recognizing what intern responsibilities are. She is getting better. She ended up asking all the other residents how much they do for their interns before she finally conceded but they all told her the reality.

Note writing and prerounding is actually very beneficial for interns to do because it allows them to get to know their patients well, and indeed when she was not doing as much note writing or prerounding, people were commenting that she is clueless about her patients.

 

[dragonfly99]

How many patients is the intern following? When is rounds? If rounds are at 7am and she has 16 or 18 medicine patients by herself or something, I can understand why she might be upset that you don't want to help with any of the prerounding or note writing. Interns' speed at prerounding and note writing will get better in the next 2-3 months, but the first month or two are rough for some, especially those not expected to follow a lot of patients on their 4th year medicine sub-I (i.e. to go from following 3 to following 12-15 isn't that easy of a transition...).

 

[WorkaholicsAnon]

How many patients is the intern following? When is rounds? If rounds are at 7am and she has 16 or 18 medicine patients by herself or something, I can understand why she might be upset that you don't want to help with any of the prerounding or note writing. Interns' speed at prerounding and note writing will get better in the next 2-3 months, but the first month or two are rough for some, especially those not expected to follow a lot of patients on their 4th year medicine sub-I (i.e. to go from following 3 to following 12-15 isn't that easy of a transition...).

the cap is 12, and when it was up at 10-12 i would offer to preround on like 2-3 patients for her and obviously i'd write notes on them. She should be able to handle 8 patients comfortably at this point of her training imo. The other issue was that I was also having to handle all the tasks and geting things done, talking to patients and families (since she was often offensive to them), and she was also referring a lot of her pages to me whenever she didn't know how to deal with something. So, I had to do pretty much everything but most of the notes, and then she would leave a couple MORE notes undone by the time she had to leave, and on top of it all she was insisting that i do half the discharge summaries. she also had a superficial understanding of what was going on with patients since she didn't preround on a bunch and then didn't write notes on a few others.

 

[edmadison]

and on top of it all she was insisting that i do half the discharge summaries.

Wow, well I insist that you come to my clinic and do some of my work -- I expect you here at 9am tomorrow.

This person needs to be crushed. Your attending and PD should do it. You can also be sure she'll be the R2 who will NEVER help an intern. Oh I've seen it too many times. She's a passive-aggressive user.

Ed

 

[dragonfly99]

workaholics anon,
is it traditional in your program that interns do all the discharge summaries? At mine, it was actually expected that the resident would do all the discharge summaries...my interns actually got mad at me when I asked them to do one because my vacation started the day after our rotation ended, and was leaving town the next day. This was despite my covering for them/prerounding when they had days off or morning clinic. So much for gratitude
I guess the moral of this is there are a lot of people in the hospital trying to turf work. The problem is your intern doesn't have enough power to turf any work yet. She has to wait until next year.

But I agree with you she should be able to handle patients x 8. Would think that you can't tell if she's going to be a chronically bad house staffer or if she'll get a lot better in 3-4 months. In my experience how someone does the first 1-2 months or residency doesn't really correlate that well with what they look like a year later, but that is just with interns I have seen...

 

[dragonfly99]

Tired,
aren't you a surgical resident?
I might be wrong, but I'm pretty sure that at most hospitals (at least all 4 I've been a trainee at) usually the internal med resident does some or all of the discharge summaries. On surgical services, it's usually the intern who does them. For IM, the intern usually has long daily notes to write, a lot of orders and consults to call, while the PGY 2 or 3 usually doesn't have to do those things. The resident just has to show up, keep the intern(s) from screwing up, and write the occasional discharge summary. That's pretty much it. If it's a busy service you get to help with some admissions and note writing too as an upper level, but mostly you are protected from the daily work other than the discharge summaries.

 

[angel80]

At my institution (I'm an IM resident), the interns do the discharge summaries. Residents have to dictate an admit note. Sometimes, we'll admit and discharge a patient in the same day (usually if we don't agree with the ERs decision to admit). In that case, I'll usually dictate the admit and discharge all in one note, saving the intern one discharge summary.

 

[ekydrd]

I have had the unfortunate experience of a questionable intern twice as an upper level. The first was so concerned that the admissions be equally divided between the two interns (two different teams do long call/short call) that she would even ask the other intern how many patients they had just to double check what I told her, and was often not ready for rounds in the morning. In her defense we did have very high census that month, and even I was seeing patients and writing notes (not a common practice at my program unless the interns were capped). She has developed the reputation of being lazy, which persists despite all the work and improvement she has done this past year. She graduates this year, but I can't recall what she is doing next.

The next intern would disappear frequently (I'd usually find her in the unit talking wth her friend), leave consults uncalled, and missed a lot of little things about her patients. She has gotten better in the interim, but still leaves a little to be desired in the quality of her notes and work. I think she will eventually get a clue now that she is the upper level. I overheard her talking about one of her interns and the trouble she was having. What goes around comes around.