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Showing Up

1/22/2020

A lot of life can be made or broken by the simple act of showing up. I learned this during my second year as an attending. I had recently been tapped by Ed Merrens, my section chief, to be core faculty in the residency program. The weekly administrative meeting was on Wednesdays from 4:30-6; I was told I only had to attend the last hour.  I had been to the meeting three weeks in a row, and was planning to make excuses, and get home to spend time with my family.  I didn’t understand half of what was being discussed, and it felt tedious and boring. I wasn’t sure what I had gotten myself into.  I was packing up my bag when Ed stopped by my office at 4:20, saying he would walk upstairs with me.

"I don't have to be there until 5," I responded, realizing I was committing to showing up.

"No harm in showing up to the whole thing – you’ll probably learn something," he replied. We walked up together. The meeting made a whole lot more sense when I was there for the full 90 minutes.

Of all the things I have done, showing up, more than anything else, has been a persistently winning strategy. I showed up to meetings.  When assigned work, I showed up with a final product. When asked to attend a conference (or present at one), I showed up.

"Why is she sharing this?" you might be thinking. Well, unfortunately, due to the actions of a few, our residency program is developing a reputation for having residents who do not show up. In the past week, a physician from another department and a staff member have both approached me, asking why my residents don’t show up to their work. I was speechless – it did not feel good.

I want to nip this trend in the bud and be very clear about my expectations. If you are not on vacation, and you are not working nights, or unusual shifts (SAR, ICU, etc.), we expect you to be present and engaged during every weekday. If you are unable to be present, we expect you to notify the chiefs immediately. If you show up, and there is something wrong with your assignment, we expect you to speak to Ben and Darci, who will help you figure out what to do. This expectation applies to everyone on all rotations. I am hoping that this is intuitive to most of you!

I also want to be transparent and fair about what will happen should you not show up, and not notify the chiefs. If you miss one session, we will retroactively use a personal day for that missed session, and you will need to meet with me or one of the chiefs to explain how you came to not be present.  If you miss multiple sessions, your remediation plan will include losing the option of any non-clinical electives, and mandatory timely attendance at conferences (with attendance monitored by the chiefs).

Not showing up to clinical work is a serious professional violation with serious consequences. When we bill the VA or Medicare for your services and you do not show up, fraud is committed. In addition, being false about your whereabouts violates the Code of Ethical Conduct at Dartmouth-Hitchcock. We are one of the only residency programs at DHMC that does not take attendance at conference on a daily basis, because we believe you are all adults who are taking ownership and responsibility for your learning.  The rash of no-shows makes it hard for me to continue to justify my refusal to take attendance to the GME office.  So – let’s work together to turn this around!  Please show up to your work, encourage your friends and colleagues to show up to their work, and let us know if you feel a clinical opportunity is not educational.  If you show up, and let us know the quality of the experience is poor, we can do something about that! If you don’t show up, my hands are increasingly tied.

The first thing I accomplished as core faculty was to convince the PD to move the timing of that frustrating afternoon meeting to 11am, so that we could all get home to see our families a bit earlier.  Who knows what would have happened if I had resolved my frustration by just not showing up?

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