Gaming intern year

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Originally Posted by Asp

My bottleneck to the fun quotient outside the hospital has never been time. Typically it's money and the quality of my personal relationships.

You may be right in implying that your life outside the hospital is more exciting than mine, but that may be a blessing in disguise given the rigors of residency.

I think we all spend a lot of time with passive entertainment such as the Internet and television. This can be enjoyed in the hospital as well.

Personally I think the key to happiness is having some absolute experiential highs, but also elevating the floor. A minimax strategy if you will.

I also keep the joy quotient throttled voluntarily a little. The psyche adapts quickly. The shock of the new becomes passe. I don't want to peak too early. Life isn't a race to the end. You only get a few shots on goal.

This is a very strange post, and I'm beginning to understand the relevance of your abbreviated username.

Originally Posted by GuyWhoDoesStuff

This is a very strange post, and I'm beginning to understand the relevance of your abbreviated username.

Haha - touche.

To the OP:

Man, just do your f*ing job. Medicine is a hard job, if you aren't willing to put in the work/hours, I'm not sure why you chose it - there are plenty of people who wanted your spot. I can't stand slackers, it pisses me off enough when it's the ancillary staff but when it's a fellow physician it's just shameful. And beware, I (and most other seniors) can sense when someone is trying to slack off and get out of work and I give them twice as much.

Originally Posted by Asp

Medicine isn't complicated. It's easy.

:O

Then can you teach me all of medicine in one day? I want it to be as easy as freshmen too!

Originally Posted by Cerberus

To the OP:

Man, just do your f*ing job. Medicine is a hard job, if you aren't willing to put in the work/hours, I'm not sure why you chose it - there are plenty of people who wanted your spot. I can't stand slackers, it pisses me off enough when it's the ancillary staff but when it's a fellow physician it's just shameful. And beware, I (and most other seniors) can sense when someone is trying to slack off and get out of work and I give them twice as much.

I understand your frustration but here's a lil thought experiment...we have 3 interns.

You assign them each 10 pts of about equal complexity. One completes their work by 1pm, another by signout (let's say 4pm), and the last by 6pm. The first intern is seen hanging out in the lounge, eating a long lunch, texting his girlfriend, attending BS lectures, etc. to run the clock until signout. The second two interns are observed to be constantly working.

Perception: the first intern is lazy. The second intern is a good doctor. The third intern is really hard-working, puts his pts' needs above his own, and never wants to leave the hospital...a "professional workhorse scutmonkey."

Reality: the first intern is the most efficient and the best doctor. The second intern is barely making it. The third intern is incompetent and makes up for it with more time, routinely flirting with duty hour violations.

What's interesting is that, in my experience, the seasoned attendings are aware of this and quickly recognize that the first intern is the best. The problem arises when the first intern is punished with more work by residents because they are more efficient.

Originally Posted by Dumb

I understand your frustration but here's a lil thought experiment...we have 3 interns.

You assign them each 10 pts of about equal complexity. One completes their work by 1pm, another by signout (let's say 4pm), and the last by 6pm. The first intern is seen hanging out in the lounge, eating a long lunch, texting his girlfriend, attending BS lectures, etc. to run the clock until signout. The second two interns are observed to be constantly working.

Perception: the first intern is lazy. The second intern is a good doctor. The third intern is really hard-working, puts his pts' needs above his own, and never wants to leave the hospital...a "professional workhorse scutmonkey."

Reality: the first intern is the most efficient and the best doctor. The second intern is barely making it. The third intern is incompetent and makes up for it with more time, routinely flirting with duty hour violations.

What's interesting is that, in my experience, the seasoned attendings are aware of this and quickly recognize that the first intern is the best. The problem arises when the first intern is punished with more work by residents because they are more efficient.

I disagree that "the most efficient" is the same as the "best" doctor. When it comes to what we do, time shouldn't be the main measuring stick that we use. It may take longer to double-check, triple-check something, but that's worth it.

As a senior resident, if I had observed this, yes, I would have dinged the first intern. Not because he's efficient, but he's not helping the team along. Maybe the third intern is on the verge of quitting because he feels so overwhelmed. Maybe it would be great if the first intern could take 30 minutes out of his afternoon to help the third intern call a few consults, check on some lab values, talk to the radiologist. I'm not saying that intern #1 needs to take half of #3's patients...just half an hour or 45 minutes to help.

In this era of increasing midlevel encroachment in all fields, what will continue to distinguish physicians from NPs/PAs is that we are team leaders. We recognize how the TEAM could work better and we do it. And, in my view, an intern who doesn't learn to recognize that and doesn't start doing it on his own? Is a poor intern who is not a good doctor. And yes, as a senior resident or an attending, I will call them out on that.

Originally Posted by smq123

I disagree that "the most efficient" is the same as the "best" doctor. When it comes to what we do, time shouldn't be the main measuring stick that we use. It may take longer to double-check, triple-check something, but that's worth it.

As a senior resident, if I had observed this, yes, I would have dinged the first intern. Not because he's efficient, but he's not helping the team along. Maybe the third intern is on the verge of quitting because he feels so overwhelmed. Maybe it would be great if the first intern could take 30 minutes out of his afternoon to help the third intern call a few consults, check on some lab values, talk to the radiologist. I'm not saying that intern #1 needs to take half of #3's patients...just half an hour or 45 minutes to help.

In this era of increasing midlevel encroachment in all fields, what will continue to distinguish physicians from NPs/PAs is that we are team leaders. We recognize how the TEAM could work better and we do it. And, in my view, an intern who doesn't learn to recognize that and doesn't start doing it on his own? Is a poor intern who is not a good doctor. And yes, as a senior resident or an attending, I will call them out on that.

I disagree about punishing intern number 1 for not volunteering his time to help out the "team". I would be more apt to punish intern number 3 for not recognizing that he is in over his head. Failing to ask for help when you need it is a lot more dangerous than not volunteering to help someone who didn't ask.

We have differing philosophies, and these philosophies would find their way into the subjective evaluations of these interns. I'd make 3 look worse and you'd make 1 look worse.

I agree about time not being the measuring stick of quality in medicine, but that works both ways: the guy who spends the longest time may not be the best doctor, as the fastest guy may not be the worst. Overall its hard to measure what a good doctor is: is it the guy who knows all the pimp questions? Is it the person who gets his work done the fastest? The slowest? The most methodical? The one with the best "sense"? It's very subjective.

Intern 1 should offer to help and not be obnoxious about being more efficient, especially if intern 3 is struggling. Someone dropping out of the program benefits no one.

Particularly Intern 1 should pick up the slack if he/she is a categorical, that's how you get good recs and/or become chief.

Originally Posted by Dumb

I understand your frustration but here's a lil thought experiment...we have 3 interns.

You assign them each 10 pts of about equal complexity. One completes their work by 1pm, another by signout (let's say 4pm), and the last by 6pm. The first intern is seen hanging out in the lounge, eating a long lunch, texting his girlfriend, attending BS lectures, etc. to run the clock until signout. The second two interns are observed to be constantly working.

Perception: the first intern is lazy. The second intern is a good doctor. The third intern is really hard-working, puts his pts' needs above his own, and never wants to leave the hospital...a "professional workhorse scutmonkey."

Reality: the first intern is the most efficient and the best doctor. The second intern is barely making it. The third intern is incompetent and makes up for it with more time, routinely flirting with duty hour violations.

What's interesting is that, in my experience, the seasoned attendings are aware of this and quickly recognize that the first intern is the best. The problem arises when the first intern is punished with more work by residents because they are more efficient.

This is pretty accurate. Intern 1 may not be the "best" doctor, since being an intern is not like being an attending in private practice, but his efficiency is ideal given the stresses of internship. I don't know what metric you can use to define the "best" intern of a group other than reliability, trustworthiness and error rate. In that respect all 3 may be equivalent. Even if it takes intern 3 twice as long to complete the tasks, as long as his error rate is the same as intern 1 who cares how long it takes? It probably pisses off his resident that he's so slow and inefficient.

I disagree that intern 1 is obligated to help intern 3, but if he doesn't he may be criticized and thought of as lazy or selfish. The reality is as an intern we are pretty much on our own. I don't want to do someone else's discharge summary, and even if I did, I don't know my co-interns patients well enough to feel comfortable writing their notes or orders or anything else.

Originally Posted by RestoreSight

I disagree that intern 1 is obligated to help intern 3, but if he doesn't he may be criticized and thought of as lazy or selfish. The reality is as an intern we are pretty much on our own. I don't want to do someone else's discharge summary, and even if I did, I don't know my co-interns patients well enough to feel comfortable writing their notes or orders or anything else.

No one's saying that you have to do someone else's discharge summary, and honestly, intern #3 shouldn't accept an offer of help to do that. But small stuff - phone in a consult, call the lab, get radiology results, etc. - isn't that hard, but can help someone out tremendously.

Originally Posted by RestoreSight

I disagree that intern 1 is obligated to help intern 3, but if he doesn't he may be criticized and thought of as lazy or selfish. The reality is as an intern we are pretty much on our own. I don't want to do someone else's discharge summary, and even if I did, I don't know my co-interns patients well enough to feel comfortable writing their notes or orders or anything else.

Intern 1 isn't obligated to help intern 3 but he's not going to get the best grade if he doesn't. You are there to learn and you learn from each patient. If you can see more patients, you'll learn more. I know the future radiologist doesn't care but I do.

Second, if you're that intern who is never around when I walk in the team room, your **** better not stink. I'm going to be less forgiving of your inevitable errors because you had the time to catch them and chose not to. You could have spent that extra time *gasp* talking with our patients about their diseases, teaching them why compliance is important, getting to know their social situations. You've gotten "all" your work done only because you're unwilling to see that there is so much more you could do.

Look at it this way, you got the same amount of work done in the day as interns 2 and 3...so you deserve the same grade. If you'd done more, then you'd deserve better. You getting your day over faster is not a goal I care about.

When I get the sense that someone is gaming intern year, they pay the price for it. Slide all your days off onto days you would have presented in MR, figure out the easy patients from nightfloat and claim them, etc...I'll notice and you'll pay the price. The last intern who was particularly blatant about this had the pleasure of switching to night float on short notice when an intern went out sick. The chief asked me who I wanted to give up...easy money.

I can't help if you don't want intern year to be rewarding but you'd be wise not to give off that smug vibe around attendings like me.

Originally Posted by smq123

No one's saying that you have to do someone else's discharge summary, and honestly, intern #3 shouldn't accept an offer of help to do that. But small stuff - phone in a consult, call the lab, get radiology results, etc. - isn't that hard, but can help someone out tremendously.

In this era of constant sign outs, LISTEN on rounds and in the team room. Its not hard to know each other's patients at a basic level.

Originally Posted by Gastrapathy

I can't help if you don't want intern year to be rewarding but you'd be wise not to give off that smug vibe around attendings like me.

Nor around a Chief like me.

I agree with what you said.

I'll be honest in that I don't understand people who will willfully waste a year of their life learning as little as possible. Regardless of my understanding/empathy with someone who desires to slack off through intern year, if I get wind of it when you are under my watch, you'll be suffered to work. Some residents don't want to learn, but it's in the rest of our vested interest as physicians to make sure that they do, otherwise we are no better than midlevels.

Originally Posted by Cerberus

I'll be honest in that I don't understand people who will willfully waste a year of their life learning as little as possible. Regardless of my understanding/empathy with someone who desires to slack off through intern year, if I get wind of it when you are under my watch, you'll be suffered to work. Some residents don't want to learn, but it's in the rest of our vested interest as physicians to make sure that they do, otherwise we are no better than midlevels.

Agreed. Some people seem to think that Rad/Onc, Rads, Derm, Anesthesia etc are in a vacuum and isolated. Not true. Rads are constantly talking to those who are seeing the patient, and have a good understanding of clinical medicine is important for giving good reads and understanding what referrers are looking for. Also if you have any interest in interventional rads you better have some clinical skills.

It is sort of annoying seeing lazy interns and future residents. I've been around folks going into Anesthesiology during interview season talking about a program that is a "workhorse" because residents don't get out until 4pm due to lack of CRNAs. She said it would be a good program if they had a ton of CRNAs so they can get home early. Or an intern I know going into gas talking about doing 2 of his 4 required ICU months during his TY year because the ICU months in the TY are cush, no call, no weekends and having it count towards his residency ICU months. Really? Just become a CRNA if that is all you care about.

Not all interns are like this, but you definitely do run into a good number like this. It is unfortunate IMO.

Looking back at it, I wish I'd been more diligent in medical school because now as a "real" doctor I can't spend enough time in the hospital learning. My lack of knowledge does directly affect my patients, even with supervision at multiple levels above me.

The most stressful times I've had so far is not necessarily knowing the finer points of differential diagnosis or the biochemical pathways leading to a physiological lab value but knowing when to get my ass on the phone and bother my seniors for a patient that is deteriorating because the intern has no idea what is going on and what to do.

Originally Posted by badasshairday

Agreed. Some people seem to think that Rad/Onc, Rads, Derm, Anesthesia etc are in a vacuum and isolated. Not true. Rads are constantly talking to those who are seeing the patient, and have a good understanding of clinical medicine is important for giving good reads and understanding what referrers are looking for. Also if you have any interest in interventional rads you better have some clinical skills.

It is sort of annoying seeing lazy interns and future residents. I've been around folks going into Anesthesiology during interview season talking about a program that is a "workhorse" because residents don't get out until 4pm due to lack of CRNAs. She said it would be a good program if they had a ton of CRNAs so they can get home early. Or an intern I know going into gas talking about doing 2 of his 4 required ICU months during his TY year because the ICU months in the TY are cush, no call, no weekends and having it count towards his residency ICU months. Really? Just become a CRNA if that is all you care about.

Not all interns are like this, but you definitely do run into a good number like this. It is unfortunate IMO.

Yeah, radiology applicants are so much better!!!

I actually prefered a workhorse program; however, things have improved in terms of work hours due to the massive increase in CRNAs. I wonder sometimes if doing 2-2.5 cases/day is truly a good thing.

Originally Posted by Doctor4Life1769

Yeah, radiology applicants are so much better!!!

Umm, I wasn't trying to slight all anesthesia guys. Most of them, which are a lot of my friends, want to do hardcore icu months since it is important in being an anesthesiologist. I've just seen a select few like I stated above, and they exist across all specialties, but more so in the ROAD specialities.

Heck, the OP is going into radiology and wants to figure out how to avoid intern year work.

Originally Posted by Gastrapathy

Intern 1 isn't obligated to help intern 3 but he's not going to get the best grade if he doesn't. You are there to learn and you learn from each patient. If you can see more patients, you'll learn more. I know the future radiologist doesn't care but I do.

When I get the sense that someone is gaming intern year, they pay the price for it. Slide all your days off onto days you would have presented in MR, figure out the easy patients from nightfloat and claim them, etc...I'll notice and you'll pay the price. The last intern who was particularly blatant about this had the pleasure of switching to night float on short notice when an intern went out sick. The chief asked me who I wanted to give up...easy money.

I can't help if you don't want intern year to be rewarding but you'd be wise not to give off that smug vibe around attendings like me.

Speaking of smug vibes, have you read your own post?

It's attendings like you that create real problems for teams. You equate teaching to boring lectures, exhausting rounds, and 2 minute lectures on esoteric medical topics, but that's the worse kind of education because it's immediately forgotten by all involved and your team will hate you incessantly.

Your style of leadership is lousy. You would punish the the top performing intern because he is doing well? What are you aspiring to acheive? If your goal is a mediocre team you will reach your goal no question. Far better to take a step down from your pedestal and spend some of your free time (which you likely have in abundance) educating the weak link intern with your wealth of experience rather than shunting the task to an inexperienced co-intern.

Lmao how you speak of grades. You act like an intern is still in med school. Your opinion of my performance would be absolutely irrelevant. As an intern, it will have zero effect on my residency, fellowship placement or career in the short or long term. You should fear our evals of you much more given that consistent negative feedback from your team paints a picture of a lousy attending.

And strong work with the vindictive addition of extra nightfloat for the top performing member of your team. Not only is that unethical of you, but a perceptive intern might make the case against you that you are doing this deliberately (which you are). If you think your immune from ethics panels just because of your "status" you are seriously mistaken.

My advice to you is to look back to your internship and ask what kind of attending you wanted to become? If your answer is a lousy one, you've succeeded!

Originally Posted by choweee

So lucky. If it's not 6am/noon/6pm/midnight, we're drawing the labs... and I never drew blood in med school. Luckily one of my co-interns used to be a phlebotomist.

At my hospital it's 6am or 5pm. And half the time they call you because they "can't get it." What a WASTE of my time. At my med school we had phlebotomy that was available every hour- so I never learned. I hate this so much.

Good points all around. I prolly have the most cognitive resonance with RestoreSight, but I guess I can appreciate other perspectives. I realize "good doctor" and "best intern" are highly loaded terms, but of course the most efficient is the best. That's true of every profession, not just medicine. Some people seem to be confusing speed and efficiency.

Personally, I think it's obvious to everyone who the best interns are. At least at my program, the best interns are not only always done with their work early, but also seem to know the answer to every pimp question. When I was on the trail, PDs told me this outright...a TY would almost always win the "intern of the year" award.

As far as educational value, it should be obvious to everyone who's experienced the floors (whether at MGH or a community hospital) that intern year activities hold very little educational value. You'd have to be a very slow learner to find intern work educational after a few weeks.

I don't disagree about helping out teammates and have in fact done so quite a bit, but I'm not sure how that benefits the struggling intern long-term. If anything, it'll simply reinforce his behavior, deprive him of adaptive pressure, and put him further behind. As mentioned, you need real leadership by the attending to help a struggling intern, not someone to do random errands.

Regarding finishing early, attendings actually do care about that as a goal out of self-interest. If all of intern1's work is done early, the attendings will be able to read her note before writing their own or simply sign off on it. The attendings can also see that she has already done all of the orders and discharges instead of hoping that it will be done later in the case of interns 2&3.

Originally Posted by Dumb

As far as educational value, it should be obvious to everyone who's experienced the floors (whether at MGH or a community hospital) that intern year activities hold very little educational value. You'd have to be a very slow learner to find intern work educational after a few weeks.

I think this is where we have our irreconcilable difference. I've found the teaching to be excellent on my floor and ICU months >95% of the time so far. Once we master basic management issues, we move to the literature. Once we master the classic papers for each diagnosis (which I hardly believe you can do in one year), you can move to the art of medicine. There's so incredibly much to learn beyond "give 40mEq K if the K<3.5"; I hope you find that out over the course of the year.

Let's not fool ourselves into thinking internship is anything more glamorous than cheap labor.

The practical educational value of internship is only good during intern year. By the end of intern year, that knowledge is useless. You could learn more actual medicine by reading.

The real learning comes after internship.

Originally Posted by TheLesPaul

I think this is where we have our irreconcilable difference. I've found the teaching to be excellent on my floor and ICU months >95% of the time so far. Once we master basic management issues, we move to the literature. Once we master the classic papers for each diagnosis (which I hardly believe you can do in one year), you can move to the art of medicine. There's so incredibly much to learn beyond "give 40mEq K if the K<3.5"; I hope you find that out over the course of the year.

There is no irreconciliable difference. Good teaching is, by very definition, educational. Reading the literature, studying for step 3, doing questions, etc. is all obviously educational. None of these activities, however, are considered intern work.

I'd also note that it's more important for you as a future ophthalmologist to study how systemic diseases affect vision than to obsess about "classic papers" for chf or copd. Your approach to internship is pretty much the definition of low yield.

Just out of curiosity, what do you mean by "intern work" then? Because when I think of what I do all day, while there is some scut including:
- getting OSH records
- repleting lytes on the floor
- making sure people poop

there is also a lot of *medicine*, like:
- admitting my patient, thinking through why they're sick, and coming up with a reasonable plan that puts all their symptoms together
- figuring out how to translate my head knowledge into meaningful data-gathering during a history and physical exam
- figuring out when something is wrong, when a patient is "sick", or when things just don't fit quite right

These latter things I feel just all take practice, which is intern year. I have the rest of my life to focus on eyes, I feel like I need to be a good general doctor first... I dunno.

Originally Posted by Dumb

There is no irreconciliable difference. Good teaching is, by very definition, educational. Reading the literature, studying for step 3, doing questions, etc. is all obviously educational. None of these activities, however, are considered intern work.

I'd also note that it's more important for you as a future ophthalmologist to study how systemic diseases affect vision than to obsess about "classic papers" for chf or copd. Your approach to internship is pretty much the definition of low yield.

Reading and studying don't teach you how to recognize instinctively that your patient is about to crump, it doesn't teach you how to take charge and act like a physician rather than a medstudent, it doesn't teach you the nuances of patient care and diagnosis or the discrepancies between textbook presentation of disease and the more nuanced, varied presentation that we actually see in practice. Textbook treatment of disease is often outdated and no longer actually standard of care. Intern year is not useless unless you are the type that actively avoids making it a learning experience.

Originally Posted by Cerberus

Reading and studying don't teach you how to recognize instinctively that your patient is about to crump, it doesn't teach you how to take charge and act like a physician rather than a medstudent, it doesn't teach you the nuances of patient care and diagnosis or the discrepancies between textbook presentation of disease and the more nuanced, varied presentation that we actually see in practice. Textbook treatment of disease is often outdated and no longer actually standard of care. Intern year is not useless unless you are the type that actively avoids making it a learning experience.

Textbook learning may be behind, but keeping up to date with the NEJM etc certainly would not be.

If you are not at an academic center, I wouldn't expect anything close to EBM being practiced on the floors.

Medication reconciliations *shudder*
Harassing case management/consultants trying to get them to evaluate/process your patients before other peoples

These things have no educational value whatsoever but are an unfortunate, necessary, and time consuming evil.

Reading literature is not intern work. On the contrary, "intern work" takes time away from reading/learning.

Originally Posted by TheLesPaul

Just out of curiosity, what do you mean by "intern work" then? Because when I think of what I do all day, while there is some scut including:
- getting OSH records
- repleting lytes on the floor
- making sure people poop

there is also a lot of *medicine*, like:
- admitting my patient, thinking through why they're sick, and coming up with a reasonable plan that puts all their symptoms together
- figuring out how to translate my head knowledge into meaningful data-gathering during a history and physical exam
- figuring out when something is wrong, when a patient is "sick", or when things just don't fit quite right

These latter things I feel just all take practice, which is intern year. I have the rest of my life to focus on eyes, I feel like I need to be a good general doctor first... I dunno.

Originally Posted by TheLesPaul

Just out of curiosity, what do you mean by "intern work" then? Because when I think of what I do all day, while there is some scut including:
- getting OSH records
- repleting lytes on the floor
- making sure people poop

there is also a lot of *medicine*, like:
- admitting my patient, thinking through why they're sick, and coming up with a reasonable plan that puts all their symptoms together
- figuring out how to translate my head knowledge into meaningful data-gathering during a history and physical exam
- figuring out when something is wrong, when a patient is "sick", or when things just don't fit quite right

These latter things I feel just all take practice, which is intern year. I have the rest of my life to focus on eyes, I feel like I need to be a good general doctor first... I dunno.

I feel like the discussion is all about survival. There are two approaches being advocated. The first is the optimistic approach The Les Paul advocates. It involves seeing the year as an opportunity to apply all that medical knowledge in a practical setting, albeit accepting that scut is an unfortunate necessity for some reasonable standard of patient care. I admire, to some degree, those who are not categorical medicine residents seeing the year as an opportunity, but I personally cannot agree the structure makes any sense whatsoever.

Think about the current pace of technology and compare it to the medical structure we all have accepted. The idea of "internship" goes all the way back to William Osler at JH. I can see its application to general medical or surgical docs in his day, and probably to categorical docs today, but the idea that it still applies to TYs and prelims going into subspecialities is laughable. It would make far more sense to integrate internship into residency. 3 months each year of general medicine as part of a subspecialized residency would reinforce key concepts without having to experience burnout or be scutted out because each year you would rise on the hierarchy.

Is there opportunites to learn during intern year? Sure, but lets be real here. Life as an intern is about surviving any way you can the crap we deal with each day. It makes no difference to me if you want to survive as an eternal optimist or a realist, as long as you finish the year batting 1.000 with no deaths due to carelessness.

Idk, I'm at a community program for my TY and I think we practice more EBM than I ever did at the mothership academic hospital. I just finished an extremely busy rotation but probably spent an hour a day looking at the primary literature.

Originally Posted by drizzt3117

Idk, I'm at a community program for my TY and I think we practice more EBM than I ever did at the mothership academic hospital. I just finished an extremely busy rotation but probably spent an hour a day looking at the primary literature.

Sounds like a good community program. At my TY, I work with a lot of privates. It's amazing, the amount of useless, non-indicated studies and consults some of the older guys want, just to cover their asses. It translates into extra work for the intern, and I can only push back so much. I'm getting tired of starting my calls with, "I'm calling for a consult. Sorry in advance. Here's the story..."

Originally Posted by Cerberus

Reading and studying don't teach you how to recognize instinctively that your patient is about to crump,

Fair enough. You can't develop a sixth sense for impending pt crashes without some experience. However, knowing the subtle signs/symptoms and the relative specificities/sensitivities helps you practice medicine at a more technical level than instinctively.

it doesn't teach you how to take charge and act like a physician rather than a medstudent,

When I'm making decisions, my confidence level and willingness to take a leadership role depend almost entirely on my knowledge of the disease and its management. There have been many instances already where I've had very little real-world experience, but knew the disease so well that I was very confident in my management abilities.

it doesn't teach you the nuances of patient care and diagnosis or the discrepancies between textbook presentation of disease and the more nuanced, varied presentation that we actually see in practice.

Surely you jest...What did you think was the point of the literature?

Originally Posted by choweee

Sounds like a good community program. At my TY, I work with a lot of privates. It's amazing, the amount of useless, non-indicated studies and consults some of the older guys want, just to cover their asses. It translates into extra work for the intern, and I can only push back so much. I'm getting tired of starting my calls with, "I'm calling for a consult. Sorry in advance. Here's the story..."

Not only this. The residents order additional non-indicated studies and consults on top of the attendings to cover their own asses "just in case" they get in trouble for missing something. I constantly push back and get responses like, if we come back tomorrow and the patient was found to have x, they'll ask why we didn't order y.

I'm spending the month on an elective away rotation at a top notch academic center. It's a breath of fresh air seeing residents and attendings NOT ordering tests and NOT recommending intervention when they're clearly not indicated. And definitely very impressed seeing doctors dig deep into the primary literature for help with managing hard-to-manage patients.

Originally Posted by gasblaster

Subspecialty outpatient. 25hrs/wk. Actually doing something other than hanging out after morning report or before noon conference. 15hrs/wk.
Sorry guys. Tough to beat TY elective hours.

Agreed! And I have beat your record on one of my electives... 9 hrs/wk.

BUT even in TY one works hard on the floors and in the ICU/Stepdown. And I work as hard or harder than everyone else (I like to think of myself as a mostly honorable and moral person, and would never shove my workload on someone else's shoulders...) And also, a TY inter should never B$tch about how hard the floor months are - because one is surrounded by medicine/surgery interns, and their floors are NOT punctuated by the idyllic electives ... Ironically though, I spend quite a lot of time studying during the electives - and every time I go back on the floors I have more and more of actual knowledge... I like how this is working out.

Bottom line: get a TY if you can.

Originally Posted by Carotenoid

Agreed! And I have beat your record on one of my electives... 9 hrs/wk.

One of my co-interns spent all of 3 half-days of work during the entire month of an elective.

Originally Posted by choweee

Sounds like a good community program. At my TY, I work with a lot of privates. It's amazing, the amount of useless, non-indicated studies and consults some of the older guys want, just to cover their asses. It translates into extra work for the intern, and I can only push back so much. I'm getting tired of starting my calls with, "I'm calling for a consult. Sorry in advance. Here's the story..."

It's nice; in the ICU i would browse the literature for the newest studies/case reports/guidelines and we'd make the plan with them. Actually I have very few complaints about the experience here except the patient population that's inherent in internal medicine...

Hey guys...for those of you going on to advanced programs, how many electives are you doing in your advanced specialty during your prelim/TY?

Be careful about that part. Make sure your schedule conforms to the TY requirements for your specialty. See: http://dconnect.acgme.org/acWebsite/...entsPGYCBY.pdf

To answer your question, I rotated with the private practice group at the hospital, and then did a research away at my categorical program.

Originally Posted by Dumb

Hey guys...for those of you going on to advanced programs, how many electives are you doing in your advanced specialty during your prelim/TY?

Particularly since you are rads, be careful doing rads electives.

You can only do diagnostic radiology electives at institutions with an established radiology residency.

Originally Posted by Neuronix

Be careful about that part. Make sure your schedule conforms to the TY requirements for your specialty. See: http://dconnect.acgme.org/acWebsite/...entsPGYCBY.pdf

To answer your question, I rotated with the private practice group at the hospital, and then did a research away at my categorical program.

Hmm...it states that >2 rotations cannot be completed in "diagnostic radiology." Would it be excessive lawyering of that document to do 4 radiology rotations (2 "diagnostic" and 2 "interventional")? (This is what I have scheduled)

Originally Posted by Dumb

Hmm...it states that >2 rotations cannot be completed in "diagnostic radiology." Would it be excessive lawyering of that document to do 4 radiology rotations (2 "diagnostic" and 2 "interventional")? (This is what I have scheduled)

You also need to be careful - is there a radiology residency at your prelim program?

If not, even those two diagnostic months are too much.

Originally Posted by johnnydrama

You also need to be careful - is there a radiology residency at your prelim program?

If not, even those two diagnostic months are too much.

Luckily, this TY does have a residency so that's a non-issue. But do you think I would run into any problems if I did 2 diagnostic months and either 2 interventional months (or even 4)? In theory, based on that document, it seems like I could change my schedule so that I'm doing 2 DR and 4 IR without breaking the rules.

Originally Posted by Dumb

Luckily, this TY does have a residency so that's a non-issue. But do you think I would run into any problems if I did 2 diagnostic months and either 2 interventional months (or even 4)? In theory, based on that document, it seems like I could change my schedule so that I'm doing 2 DR and 4 IR without breaking the rules.

I think you're fine - pretty sure IR is irrelevant.

Originally Posted by Asp

Medicine isn't complicated. It's easy.

Upvote. I just wish people in medicine understood this. Unless if you are a neurosurgeon, cardiothoracic surgeon or neuro IR person, this business is easier than 5th grade in general Really.

It's just that the real-life emotional aspect, and human life on the line make things complicated.

Originally Posted by Dumb

Luckily, this TY does have a residency so that's a non-issue. But do you think I would run into any problems if I did 2 diagnostic months and either 2 interventional months (or even 4)? In theory, based on that document, it seems like I could change my schedule so that I'm doing 2 DR and 4 IR without breaking the rules.

You really want to spend a third of your internship doing radiology before going into radiology?

This is my last chance to see anything else so I'm trying to change it up before starting rads next year. I'm checking out all those random fields I never got to explore like allergy, rad onc, derm, path, etc.

Originally Posted by choweee

This is my last chance to see anything else so I'm trying to change it up before starting rads next year. I'm checking out all those random fields I never got to explore like allergy, rad onc, derm, path, etc.

Makes sense. I personally got that out of my system during fourth year but I get the whole "last chance" thing.

Only work hard