The Shifts Before The “First Shift”

By Daniel Freess, MD, FACEP

Everyone feels anxious about their first shift on their own or at a new location. This is natural but can be greatly lessened by how one organizes and utilizes their orientation shifts. Most departments will have some orientation process (if they do not … beware). Typically, this will involve at least one or two shifts that involve being a shadow, having a current attending shadow you, or some form of shifts with reduced responsibility.

Many of us feel awkward in this role as we feel that we are wasting people’s time, not carrying our weight, or even wasting our own time. Instead, I encourage new Attendings to see these shifts as an opportunity. Below are ways to make good use of these shifts:

1. Ideally your first shift(s) should have no clinical responsibility. People often say, “There is no better way to learn than by doing,” but this is not always true. Having at least one whole shift without clinical responsibility allows you to truly look over the shoulder of another physician to see how they document, use the EMR, and structure their workflow. It also allows you to ask lots of questions without feeling that you are getting behind by taking the time to learn. If none of these shifts are offered as part of a “paid orientation,” consider doing one or two anyway just to be maximally prepared.
2. Either before or during your orientation shifts, take time to play with the EMR. Set up macros, order sets, and other personalizations in advance of your first real shift. If you are on a shadow shift, use the time while the person you are following is seeing patients to practice on the EMR. Many feel that they will set things up as they go once they are documenting on real patients, but this can be very burdensome and usually results in these setup processes being delayed by weeks or months.
3. Be nosy! Don’t just sit around during downtime while shadowing/orienting. You may feel awkward but investigate the entire department. Open random drawers, walk in random doors, follow nurses and techs around to see where they get things, check on random patients and ask if you can get them anything so that later you know where things are kept.
4. Make friends with the secretaries. Ask them how you can make their lives easier. Ask what phone calls they typically make versus calls they expect you to make. Ask open-ended questions like “what kinds of things do your favorite attendings do to help you out?”
5. Find out where the ED staff takes breaks and eats, then do the same. This advice extends beyond the orientation period, but it is particularly useful early on to make yourself part of the team by hanging out and eating in the staff “break room” rather then separately, even if most other attendings do not.