Scheduling PGY1 year

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For current residents/attendings out there, what are your thoughts on how to schedule intern year? Better to start off with an easier rotation (anesthesia/US) or just dive in to the ED? I'll be at a new hospital, so starting off with a lighter schedule would allow time to get used to the new system, EMR, etc... I definitely don't want to start off with ICU.

Originally Posted by b-real

I'll be at a new hospital, so starting off with a lighter schedule would allow time to get used to the new system, EMR, etc... I definitely don't want to start off with ICU.

FWIW (and coming from an IM person, perhaps it's not worth much), I started internship in the ICU, was scared s***less (didn't do ICU as a student) and it was far and away the best way to get up to speed in a big damn hurry.

You'll learn the hospital system quickly. You'll be consulting or getting admits/transfers from essentially every service in the hospital (including the ED) so you'll very quickly learn which of those groups is useful/less, who you can trust, who you can't, etc. The nurses in most ICUs (and most EDs) are the best you'll find in the hospital which will take a bit of the load off of you. And you'll get (at least partially) over the completely reasonable fear of how to deal with sick/crashing patients.

Id start with the ED. Everyone will be willing to help you out and it will be understood you dont know all the ins and outs of the EMR yet. Plus I like to split up my ED rotations throughout the year--ie it would be nice to have that light anesthesia/US rotation after you have gotten your butt kicked for a bit in the ED.

Depends on the situation. If you are in the ED by yourself (no other residents/interns) and you are expected to carry a decent load, don't start there. We are in that situation at my place and we don't have any interns until after they are at least 3 months in, sometimes more. It helps them learn the hospital ways and common medication dosing before getting in the ED. It worked out well this year.

You may not have a choice in how to schedule it. We are allowed to ask for certain rotations during certain months (as you can only take vacation during certain rotations), but we don't get to "schedule" our rotations a la med school.

Originally Posted by Emergency!

You may not have a choice in how to schedule it. We are allowed to ask for certain rotations during certain months (as you can only take vacation during certain rotations), but we don't get to "schedule" our rotations a la med school.

I asked because he have some flexibility in choosing a schedule for the year.

I don't know, I think there's something to be said about starting out in a place that scares you $h!tless. For me, that would have been the ICU. The earlier you are in your intern year, the less is expected of you - and I don't mean this in a bad way, but I think it would make it easier for you to ask as many questions as you want and really get your feet wet without being expected to know everything yet.

Just an argument for starting with a hard month.

There is also an argument for starting on the hard stuff early when you are fresh. Going into an ICU month when you haven't had any vacation in 6 months and you are already behind on the sleep can be tough.

The truth is there are pluses and minuses however you do it, so in some ways it doesn't matter. Like if you have a lot of off service months early you come into the ER being solid on procedures like central lines, but a little lost on bread and butter EM. Flip side is if your off service is later you are able to handle emergencies in the ICU better, more solid on EM, but you are running around the ER not feeling so good about procedures and critical care.

I think it's more important to look at outside life stuff. Like "I want anesthesia in the winter because I know I have weekends off and skiing is important to me." or "I don't want OB in this month because I'll be on sick call then."

You are at a 3 or 4 year program?

-I started with ICU intern year and wish I had it later. The focus on your first rotation will be learning a new computer system, learning where everything is, learning who is who, policies, etc. And it will take away from your education in the ICU. Early on your seniors may be in need of a few last procedures that would possibly go to you later in the year.

-You will probably feel the "fire" wherever you are.

-I would try to do EM by 2nd or 3rd block otherwise you come in at 4th block or later as the FNG with a lot of people assuming you know how things run in the department and you may feel behind your peers who have 1-2 EM blocks under their belt. You don't want to be the last person someone asks to do something because you are the FNG late in the game, but this depends on the culture of your EM dept.

-Anesthesiology I'd try to do early if you're not comfortable with or never done laryngoscopy.

-I'd start with trauma since you will see the ED,med/peds floors, ICU, and maybe OR. Meet the surgery team, Medicine/peds team, social workers, SLPs, Nutrition, clergy, etc. Get one of the more life draining rotations out the way early. Learn how the whole hospital works. Feel The FIRE depending on your institution as it will be summer or late spring. Take care of some sick patients. Learn to submit a death certificate.

-Peds do it in summer months especially if you work in area with high prevalence of asthma.

-All the comments here are great. I agree with Jbar's last comments. You need to know the blocks where you get crushed schedule wise and avoid them during important times you anticipate as an intern.

If it were up to me in hindsight mode 1.) ED or trauma - prefer trauma 2) ED or trauma -doing the block you did NOT do in block 1 3)anesthesia/US...peds last 1-2 months


-Honestly if I did ICU last maybe I'd be on here telling you to do it first.

Good advice everyone, thanks!

I just got my PGY-1 schedule and found out that my first rotation is in the MICU. Any recommendations for good books/resources to use ?

Thanks !

I like "the ICU book."

http://www.amazon.com/dp/078174802X/...hvptwo=&hvqmt=

Chapters short enough to read.

I also highly recommend writing our or printing some sort of template if you are somewhere that handwrites notes. When you are trying to preround on like 5 ICU patients in an hour you need to save all the time you can, much easier to fill in the labs for all your patients, and then the vitals or whatever rather than trying to do each note at a time.

I got my schedule too. I have ICU as the last rotation of intern year. I guess we can offer advice next year on pros/cons of first vs. last.

It's better to start EM early. At the beginning everyone expects you to be clueless. As the months pass and your co-residents start to learn whats up, how to approach ED problems, and how the system works, not everyone will understand that although it's the 4th month of internship, it's your first month in the ED.