The best way to track attending preferences in residency
File preferences by attending, case type and specialty, not by date, and keep patient details out of them. The problem is retrieval, not recording: the note has to come back the night before, when the assignment goes up. In Capnolog notes link to an attending, case type or case, sit beside the log, and can be spoken aloud in anesthesiology.
By Christopher Cutler, MD, CA-1, anesthesiology
Every program runs on knowledge that is never written down. Which attending wants the room set up backwards, and who will not start until the block is documented. That is what actually gets you through a case with each of them. Here is how to stop re-learning it every year.
The problem is retrieval, not recording
Most residents already write this down somewhere. The notes app, a group chat, the back of a badge card. The reason it does not help is that none of those places can hand the note back to you at the moment you need it. That moment is the night before, when tomorrow's assignment goes up.
A note you have to remember to search for is a note you will not read. The fix is to file each note against the thing it is about. That way, being assigned to Dr X tomorrow is what surfaces the Dr X note, not something you have to recall from memory.
File by attending, case type, and specialty — not by date
Three axes cover almost everything worth keeping. The attending covers their preferences and quirks. The case type covers positioning, setup, equipment, and the reference you rebuilt from memory twice. The specialty or rotation covers the local rules of a place.
A note filed on all three is findable from any of them. A note titled "Tuesday" is findable from none. This one change does more than any amount of formatting discipline.
Keep patient details out of it, deliberately
Preference notes drift toward the clinical: an interesting airway, a difficult case, the patient it happened with. That is the moment a useful private note becomes an unmanaged record of someone's care sitting in a consumer notes app synced to who-knows-where.
Write the pattern, not the patient. "Wants the a-line before induction on redos" is the useful sentence, and it needs no name, no record number, and no date. If you are sharing notes at all — and you should be — this discipline is what makes it safe to.
The real value shows up when you hand it over
A preference card is worth something to you. A program's preference cards, waiting for the incoming class on the day they arrive, are worth something entirely different. The intern who starts with three years of accumulated judgment begins where the last class finished.
This is the part almost every program loses. The knowledge graduates with its owner, and each class rebuilds it from scratch. Whatever tool you pick, weight it heavily on whether one resident can hand their whole setup to another.
What we built, and why
In Capnolog, notes link to an attending, a case type, or a case, and they sit beside the log rather than in a separate app. In anesthesiology you can say a note out loud and it files itself under whichever attending and case you mentioned. Tomorrow's card can then ride on your Lock Screen.
They are encrypted on the device, behind Face ID or your fingerprint, and covered by the backup. That is end-to-end-encrypted iCloud on iPhone, an encrypted folder backup on Android — so three years of accumulated judgment does not die with a dropped phone. Sharing runs through a review step that strips identifiers before anything leaves the phone. A note worth passing on can be shared with your program, findable by the next resident on that service under the attending it belongs to.