To new MSIII's.... from your intern

Telemachus · May 30, 2006

Hi soon-to be MSIII's. I'm your intern, or at least I will be as of next month. I thought I might take this opportunity to tell you a few things about how this next year is going to work. These little gems are in no particular order.

1) I'm not your friend. I want that to be clear. I assume you have friends already. We're coworkers, colleagues, mentors/proteges, whatever. But not friends.

2) We should be friendly however. If I'm not civil, it may be because I am tired. It also may be because you are stupid, lazy, or a d!ckhead. I'll try not to be tired. What are you gonna do?

3) Don't adopt the attitude that you are paying tuition therefore you call the shots. I am "paying" in the form of opportunity cost by accepting this pittance of a salary, and I already paid my tuition, so spare me the drama. We are both in the midst of necessary training, so salary vs. tuition is just a technicality. Accept your role, play it well.

4) My first priority is patient care. PATIENT......CARE...... not teaching, not sleep or eating, not letting you do procedures. AFTER the patients come all of these other interests.

5) At worst, be on time. Ideally, be five minutes early, and don't act annoyed that eveyone else is five minutes late. Don't EVER be late yourself.

6) You will get what you deserve, good or bad. If you aren't getting what you deserve, I will try to intervene to make it so (see #8,9). Good OR bad. I'm no cheerleader, and no saboteur, but I will expend energy for the sake of fairness.

7) I should teach you stuff. And I will. But don't ask me a hundred questions during rounds. And if you do anything that remotely sounds like YOU are pimping ME, you will regret it forever. I promise.

8) Don't lie. Don't be a dick. Don't feud with anyone. The residents and attendings will discuss you behind your back, and their allegiance is to each other more than to you. Yes, even the a$$hole residents/attendings, because we have to work with each other longer than we have to work with you.

9) Work hard, be enthusiatic, volunteer to do things that make my life easier. I will care more about this than about the text book or journal you read last night. And if/when I'm happy, I'll create opportunities for you to show off what you've been reading about, opportunities to look like a star.

10) If I give you advice about how the chief or attending likes presentations, or how you should be writing your progress notes, just trust me and try it that way. If I haven't worked with them long enough to know their preferences, I wouldn't be telling you. And if I have, then you should listen. Bad presentations and crappy progress notes make everyones' lives more painful, and that pain will trickle down onto you.

11) We will notice if you look out for your fellow students, and if you don't. We like it when you do. I want my co-residents to have my back, and I want to protect theirs. If you aren't doing this now, how can I expect that you will be doing it a couple years from now?

12) Don't lie, it bears repeating. If you don't know a lab or vital or the PCA data, it's okay, don't make it up. If you want a day off, say so. Don't claim illness or the like. I will do whatever is reasonable to help you get what you want out of this clerkship, but I will BURY YOU if you lie to me about ANYTHING, no matter how inconsequential it seems to you.

I'm sure there's more, but that's what's off the top of my head right now. Any questions? Additions from other current or near-future interns?

flop · May 30, 2006

Another soon to be intern...

We're not all total a-holes.

babylonsister · May 30, 2006

Another soon to be intern here who is not a dick.
why are you trying to demoralize the Med IIIs already?
Don't you recall how very recently you were a Med III?
Medical teams are TEAMS.
Be nice to each other.
It's very simple. Good team morale translates to better patient care.
No one, not even your fellow residents will like you if you treat med students like crap.

VFTW · May 30, 2006

This piece of **** has obviously been waiting two years to get to dispense the same abuse on others that must have been dispensed on him/her. If you were NOT abused third year, then you really have no excuse for threatening to abuse others - not that there's an excuse for anybody at any time.

HoodyHoo · May 30, 2006

Well, I'm pretty sure you're not going to be my intern so with that you can kiss it.

toofache32 · May 30, 2006

This is interesting.....coming from someone who's place on the totem pole still isn't even above the ground yet.

If that's how you play....students can f*** a resident over just as easily as residents can f*** students.

Telemachus · May 30, 2006

babylonsister said:
Don't you recall how very recently you were a Med III?

That's why I posted this. Someone in the evaluation-comment thread said somethng like "if only I'd known...." Perhaps my comments seem antagonistic to some, but this is not their intended tone -- I'm just trying to be brutally honest so they don't have any surprises.

On a semi-regular basis I'd see classmates go down in flames because they were lazy, careless, acting entitled, selfish, dishonest, tardy, unaccepting of advice, or oblivious to social graces. In fact, each of my comments was based on a real-life incident(s) that I witnessed. It's all preventable for most people, if you know what the expectations are.

mysophobe · May 30, 2006

I just like how the post is directed to a specific audience, as if you know who is who on this board, and vice versa.

sophiejane · May 30, 2006

I wish I could also see into the future and know exactly how things are going to be when I'm an intern.

Where'd you get your crystal ball? Did it come with all that attitude?

Please tell the incoming 3rd years exactly where you will be an intern so they can all avoid you like the plague. Otherwise, your preemptive advice falls on deaf ears.

Telemachus · May 30, 2006

VFTW said:
This piece of **** has obviously been waiting two years to get to dispense the same abuse on others that must have been dispensed on him/her. If you were NOT abused third year, then you really have no excuse for threatening to abuse others - not that there's an excuse for anybody at any time.

Perhaps you are reading into it something that isn't there, or projecting your own issues onto it. The only "threat" of "abuse" I made was in #12 in regards to honesty, which is an absolute requirement, in my mind, in the environment we work in, something I have no reservation being ruthless about......

If perhaps, you refer to #7 or #10, those are predictions, not threats. They both stem from the same unfortunate co-student who repeatedly ran afoul with a chief surgical resident regarding a) an inappropriate presentation style that was never remedied despite much advice and direction, and b) arguing with a PGY3 during rounds about some minor points. That chief treated him inappropriately, but it was avoidable, and therein lies the tragedy. Perhaps not much of a tragedy since it was a surgery rotation and the student went into psych, but unecessary discomfort for the rest of the team nonetheless.

sophiejane · May 30, 2006

I think your post might have been better received if you had written it from the perspective of an outgoing 4th year rather than assuming you know how your team is going to work and how you are going to work with students. You are little more than a student now, so it seems extremely presumptive to assume you know how things will work in your intern year vis a vis students on your team.

Telemachus · May 30, 2006

sophiejane said:
I think your post might have been better received if you had written it from the perspective of an outgoing 4th year rather than assuming you know how your team is going to work and how you are going to work with students. You are little more than a student now, so it seems extremely presumptive to assume you know how things will work in your intern year vis a vis students on your team.

Ahhh.... are people here so literal as to assume that I was trying to make institution-specific advice? It was meant to be more general case, how to approach dealing with interns and residents.

And though I think the idea of me being an intern is as laughable as the next person, the only thing that separates me from that, thus keeping me "little more than a student" is a couple of hours in the hot sun, wearing a black robe and funny hat, and waiting for someone to hand me a fancy-looking piece of paper with my name on it. Hardly the stuff that makes a physician a physician.

Telemachus · May 30, 2006

toofache32 said:
If that's how you play....students can f*** a resident over just as easily as residents can f*** students.

Great analysis. Unfortunately I make multiple references to fairness and mutual beneficial behavior. Only a fool would choose two parties screwing each other over to two parties helping each other.

pillowhead · May 30, 2006

Telemachus said:
Hi soon-to be MSIII's. I'm your intern, or at least I will be as of next month. I thought I might take this opportunity to tell you a few things about how this next year is going to work. These little gems are in no particular order.

1) I'm not your friend. I want that to be clear. I assume you have friends already. We're coworkers, colleagues, mentors/proteges, whatever. But not friends.

This is just sad. Plenty of students and interns/residents at my school have hung out together outside of the hospital if for no other reason than a fun team dinner/let's celebrate the end of the month and have a drink. Dare I say that some peope have actually continued hanging out months after the rotation was finished

Plenty of new interns have just moved to new cities by themselves and quite frankly see no problem with making friends at work--even if those people are just lowly M3s.

Gfunk6 · May 30, 2006

As a future PGY-1 Prelim Medicine Intern myself, allow me to offer a bit of alternative advice.

1) I'm not your friend. I want that to be clear. I assume you have friends already. We're coworkers, colleagues, mentors/proteges, whatever. But not friends.

Honestly, I wouldn't mind being your friend. The fact is my intern workload will be high and my quality of life will likely suck. If I can pass the time w/ you with a pleasant conversation or a beer after hours, that would be sweet.

2) We should be friendly however. If I'm not civil, it may be because I am tired. It also may be because you are stupid, lazy, or a d!ckhead. I'll try not to be tired. What are you gonna do?

Unless you are a total lazy a-hole or an arrogrant prick, there is no reason for me not to treat you with the utmost respect. If you feel you are being brutalized by me or the other housestaff feel free to tell me and I will do what is in my power to help.

3) Don't adopt the attitude that you are paying tuition therefore you call the shots. I am "paying" in the form of opportunity cost by accepting this pittance of a salary, and I already paid my tuition, so spare me the drama. We are both in the midst of necessary training, so salary vs. tuition is just a technicality. Accept your role, play it well.

I kind of agree with this advice, though I have to say it is extraordinarily rare to see an MS-3 who is so conceited. See advice in #2.

4) My first priority is patient care. PATIENT......CARE...... not teaching, not sleep or eating, not letting you do procedures. AFTER the patients come all of these other interests.

While this is true, as a Medicine intern patient care is only rarely a true emergency (e.g. get out of the way MS-III, while I initiate ACLS protocol!). Most of the time, if you want to do a procedure you should ask. As long as I've done said procedure and am comfortable doing it, I certainly don't mind taking you through the paces.

5) At worst, be on time. Ideally, be five minutes early, and don't act annoyed that eveyone else is five minutes late. Don't EVER be late yourself.

Agreed. I was only late once as an MS-III (car broke down on cold day) and though my intern was totally cool with it, I felt like **** for letting the team down.

6) You will get what you deserve, good or bad. If you aren't getting what you deserve, I will try to intervene to make it so (see #8,9). Good OR bad. I'm no cheerleader, and no saboteur, but I will expend energy for the sake of fairness.

Though shelf exams can level the playing field, as an recent MS-III I can tell you that evaluations are often petty and arbitrary. If you are concerned about your grade I would suggest talking to me midway through the rotation and discussing your strengths/weaknesses. One of the things that impresses attendings/residents/interns the most is a student who is receptive to and responds well to constructive criticism. If you are pimped about the something the 2nd time and know the answer, then that's what we're looking for.

7) I should teach you stuff. And I will. But don't ask me a hundred questions during rounds. And if you do anything that remotely sounds like YOU are pimping ME, you will regret it forever. I promise.

Though you are a member of the team (sometimes doing a lot of scut

) your primary function is a learner. Feel free to ask me as many questions as you want. Of course, be appropriate as the OP stated. A barrage of queries in the middle of an LP or when I am falling over w/ exhaustion post-call will be likely met with silence.

8) Don't lie. Don't be a dick. Don't feud with anyone. The residents and attendings will discuss you behind your back, and their allegiance is to each other more than to you. Yes, even the a$$hole residents/attendings, because we have to work with each other longer than we have to work with you.

I agree. Lying is the WORST thing you can do as an MS-III, even about little things.

9) Work hard, be enthusiatic, volunteer to do things that make my life easier. I will care more about this than about the text book or journal you read last night. And if/when I'm happy, I'll create opportunities for you to show off what you've been reading about, opportunities to look like a star.

As far as I'm concerned, I will be happy if you just stay out of my way. If you actually contribute meaningfully to the team's efficiency, I promise you it will reflect well in your evaluation. Ditto for earnest attempts to learn.

10) If I give you advice about how the chief or attending likes presentations, or how you should be writing your progress notes, just trust me and try it that way. If I haven't worked with them long enough to know their preferences, I wouldn't be telling you. And if I have, then you should listen. Bad presentations and crappy progress notes make everyones' lives more painful, and that pain will trickle down onto you.

Agree. Also remember that attendings often have little interaction w/ MS-III's directly and rely on residents/interns for evaluations.

11) We will notice if you look out for your fellow students, and if you don't. We like it when you do. I want my co-residents to have my back, and I want to protect theirs. If you aren't doing this now, how can I expect that you will be doing it a couple years from now?

Good advice -- don't dick over your fellow students.

12) Don't lie, it bears repeating. If you don't know a lab or vital or the PCA data, it's okay, don't make it up. If you want a day off, say so. Don't claim illness or the like. I will do whatever is reasonable to help you get what you want out of this clerkship, but I will BURY YOU if you lie to me about ANYTHING, no matter how inconsequential it seems to you.

I don't think I would BURY you for a little white lie, but know you are taking a risky gamble if you do.

toofache32 · May 30, 2006

Telemachus said:
Great analysis. Unfortunately I make multiple references to fairness and mutual beneficial behavior. Only a fool would choose two parties screwing each other over to two parties helping each other.

Yeah, these threats sound really "mutually beneficial":

Telemachus said:
...It also may be because you are stupid, lazy, or a d!ckhead. I'll try not to be tired. What are you gonna do?...

...And if you do anything that remotely sounds like YOU are pimping ME, you will regret it forever. I promise....

...I will do whatever is reasonable to help you get what you want out of this clerkship, but I will BURY YOU if you lie to me about ANYTHING, no matter how inconsequential it seems to you...

Get over yourself. Your power trip is only in your own mind. My troll-dar is starting to buzz a little....

sophiejane · May 30, 2006

Telemachus said:
1) I'm not your friend. I want that to be clear. I assume you have friends already. We're coworkers, colleagues, mentors/proteges, whatever. But not friends.

Mentor??

A newly minted intern is a mentor? :laugh:

With all due respect for your soon to be exalted position in the medical hierarchy, I think most students look to folks a bit less wet behind the ears to MENTOR them.

I certainly will not have the audacity to assume I could mentor anyone while I am busy getting my butt kicked by my intern year.

Telemachus · May 30, 2006

sophiejane said:
Mentor??

A newly minted intern is a mentor?

With all due respect for your soon to be exalted position in the medical hierarchy, I think most students look to folks a bit less wet behind the ears to MENTOR them.

I certainly will not have the audacity to assume I could mentor anyone while I am busy getting my butt kicked by my intern year.

Actually, I think you've got it backwards. That term was included in the list because of all of the great advice and guidance I got as a med student from the interns I was working with, who I would gladly point to as mentors to me. If you want to rip on interns and belittle the benefits that can be derived from learning what they have to teach, I think you are doing a disservice to med students who might read your posts and then ignore a useful resource.

MacGyver · May 30, 2006

Telemachus said:
9) Work hard, be enthusiatic, volunteer to do things that make my life easier. I will care more about this than about the text book or journal you read last night. And if/when I'm happy, I'll create opportunities for you to show off what you've been reading about, opportunities to look like a star.

What constitutes "making your life easier?"

Running down lab results and radiology films?

what else

11) We will notice if you look out for your fellow students, and if you don't. We like it when you do. I want my co-residents to have my back, and I want to protect theirs. If you aren't doing this now, how can I expect that you will be doing it a couple years from now?

What does this mean explicitly?

Does this mean help to work up their patients? I thought that was a sign of an dingus gunner.

Caffeinated · May 30, 2006

Thanks, intern. Before I get started, here are some things you should know about me. It's been a few years since you were in my shoes, and not much has changed. Here are a few pointers to refresh your memory:

1. You may find it laughable and naive, but I am still at the point in my education where I am excited about becoming a doctor. Please try to leave a small fragment of that passion intact.

2. Patient care is also my number one priority. But I also care about my grade and passing this rotation. These ideals are not mutually exclusive. Please don't force me to choose between the two.

3. Don't ignore me. Please try to acknowledge my existence at least once every 2-3 days.

4. If you ask me what specialty I want to go into, do NOT make fun of my reply. You may think that your witty comment that berates my chosen specialty is novel. Trust me, I have heard it before. It's hard enough to choose a speciatly. Don't make it any harder.

5. If you ask me what specialty I want to go into, don't expect me to say your specialy just to make you feel good or as a way to bond with the team. While I am on this rotation, I will try my best to walk, talk, shoot, and **** like a member of your chosen specialty. But I expect you to realize that some med students will not choose your specialty, and expect you to deal with that fact in a mature way.

6. I realize that as the most junior member of the team, nothing is beneath me. I will do whatever you ask, but don't abuse this. I will chase down whatever you tell me to find. I will get food for the team whenever I am told. But if I lend you money, then pay me back, damnit.

7. I don't need your respect, I don't need your praise, and I don't need you to validate me as a person. But a simple "good job" when I do something right goes a long way. If you only acknowledge my existence when I screw up, this will bring out the worst in me.

8. You are an ambassador for your specialty. If you treat me like ****, then I will assume that everyone in your specialty are scum. Furthermore, this tactic will also tend to recruit more scum while decent people will be discouraged from applying to your program.

9. First Aid for Mind Reading is still on back order. So don't expect to me to automatically know how you like things done. If I do things different than you would like, it does not mean I am an idiot. It probably means that this is what was expected of me on my last rotation.

10. If I get an opportunity to learn, work hard, and feel good about being part of your team, then I will tell all of my colleagues that you are the world's greatest intern. I might even consider joining your specialty.

11. The next two years will strip me of most of my dignity. Go ahead and take your fair share of my dignity. But don't take any more than necessary. I would still like to have enough self-respect left to hold my head up and smile when they hand me my diploma.

Caffeinated, MS-III

p53 · May 30, 2006

STFU.

As an intern, you will not fill out evaluations so what you think means NOTHING.

Secondly, you better be good at hiding your lack of knowledge because you will have some sharp 3rd year students eat your tail during rounds. I love interns like yourself with a chip on his shoulder. This is how I Honored my Internal Medicine rotation. The law of contrast. I looked good because the intern was clueless. I will bet you $1000 that you will be shown up by a 3rd year in the 1st month. :laugh:

Thirdly, don't forget it is the 3rd years job to post lab values, current radiological findings, pathological results to make the intern look good to the upper resident during pre-rounds. Keep up the attitude and you will be kept out of the loop, and the medical students will laugh about your competence behind your back. You will be working with 3rd years the whole year. Your respect level will be zero, after rumors fly about you. There are interns at my school that are the butt of everyone's jokes in my 3rd year class. If you want respect, you have to earn it with knowledge and ability.

Confident people don't start threads like this. Let' face it. 4th year of medical school is a vacation. We both know that you don't know jack starting your intern year, and you are scared to death. Let's not use displacement to diffuse this frustration. Just because you had an asehole intern, it doesn't mean that you have to be one too.

Telemachus said:
Hi soon-to be MSIII's. I'm your intern, or at least I will be as of next month. I thought I might take this opportunity to tell you a few things about how this next year is going to work. These little gems are in no particular order.

1) I'm not your friend. I want that to be clear. I assume you have friends already. We're coworkers, colleagues, mentors/proteges, whatever. But not friends.

2) We should be friendly however. If I'm not civil, it may be because I am tired. It also may be because you are stupid, lazy, or a d!ckhead. I'll try not to be tired. What are you gonna do?

3) Don't adopt the attitude that you are paying tuition therefore you call the shots. I am "paying" in the form of opportunity cost by accepting this pittance of a salary, and I already paid my tuition, so spare me the drama. We are both in the midst of necessary training, so salary vs. tuition is just a technicality. Accept your role, play it well.

4) My first priority is patient care. PATIENT......CARE...... not teaching, not sleep or eating, not letting you do procedures. AFTER the patients come all of these other interests.

5) At worst, be on time. Ideally, be five minutes early, and don't act annoyed that eveyone else is five minutes late. Don't EVER be late yourself.

6) You will get what you deserve, good or bad. If you aren't getting what you deserve, I will try to intervene to make it so (see #8,9). Good OR bad. I'm no cheerleader, and no saboteur, but I will expend energy for the sake of fairness.

7) I should teach you stuff. And I will. But don't ask me a hundred questions during rounds. And if you do anything that remotely sounds like YOU are pimping ME, you will regret it forever. I promise.

8) Don't lie. Don't be a dick. Don't feud with anyone. The residents and attendings will discuss you behind your back, and their allegiance is to each other more than to you. Yes, even the a$$hole residents/attendings, because we have to work with each other longer than we have to work with you.

9) Work hard, be enthusiatic, volunteer to do things that make my life easier. I will care more about this than about the text book or journal you read last night. And if/when I'm happy, I'll create opportunities for you to show off what you've been reading about, opportunities to look like a star.

10) If I give you advice about how the chief or attending likes presentations, or how you should be writing your progress notes, just trust me and try it that way. If I haven't worked with them long enough to know their preferences, I wouldn't be telling you. And if I have, then you should listen. Bad presentations and crappy progress notes make everyones' lives more painful, and that pain will trickle down onto you.

11) We will notice if you look out for your fellow students, and if you don't. We like it when you do. I want my co-residents to have my back, and I want to protect theirs. If you aren't doing this now, how can I expect that you will be doing it a couple years from now?

12) Don't lie, it bears repeating. If you don't know a lab or vital or the PCA data, it's okay, don't make it up. If you want a day off, say so. Don't claim illness or the like. I will do whatever is reasonable to help you get what you want out of this clerkship, but I will BURY YOU if you lie to me about ANYTHING, no matter how inconsequential it seems to you.

I'm sure there's more, but that's what's off the top of my head right now. Any questions? Additions from other current or near-future interns?

Telemachus · May 30, 2006

MacGyver said:
What constitutes "making your life easier?"

Running down lab results and radiology films?

what else

What does this mean explicitly?

Does this mean help to work up their patients? I thought that was a sign of an dingus gunner.

Making life easier has nothing to do with fetching coffee or washing cars, it is like you surmised -- patient care issues. So that might mean checking for lab results that were pending or newly ordered, making sure imaging studies have been done and that the results are known, if there are dressings to be changed stash the appropriate materials in your coat pocket or next to the patient's bed, if we change important orders check later to see if the nurses are following the new orders. More often than not you won't actually be able to save the intern time or effort, because they are still responsible for "your" patients, but you can provide an extra layer of redundancy, or make things go more smoothly.

As for your fellow students, you are right that you shouldn't steal their patients on admission. But, for example, if you've discharged all of your patients but your co-student has so many rocks that they are struggling, offer to round on one or two the next morning. If they say no, at least you tried to help. If rounds are at a different time than usual one day, remind your fellow students when you part ways the evening before. Try to be flexible and fair in selecting days off, which may be left up to the students to work out amongst themselves. If they have to do a presentation one some topic and you've read a good review article on it, give them a copy (just don't make a big show about it). If they step out of the room for some reason, for goodness sake fill them in on what they missed at an opportune time. Basically just be a team player.

Pox in a box · May 30, 2006

Telemachus said:
Hi soon-to be MSIII's. I'm your intern, or at least I will be as of next month. I thought I might take this opportunity to tell you a few things about how this next year is going to work. These little gems are in no particular order.

1) I'm not your friend. I want that to be clear. I assume you have friends already. We're coworkers, colleagues, mentors/proteges, whatever. But not friends.

2) We should be friendly however. If I'm not civil, it may be because I am tired. It also may be because you are stupid, lazy, or a d!ckhead. I'll try not to be tired. What are you gonna do?

3) Don't adopt the attitude that you are paying tuition therefore you call the shots. I am "paying" in the form of opportunity cost by accepting this pittance of a salary, and I already paid my tuition, so spare me the drama. We are both in the midst of necessary training, so salary vs. tuition is just a technicality. Accept your role, play it well.

4) My first priority is patient care. PATIENT......CARE...... not teaching, not sleep or eating, not letting you do procedures. AFTER the patients come all of these other interests.

5) At worst, be on time. Ideally, be five minutes early, and don't act annoyed that eveyone else is five minutes late. Don't EVER be late yourself.

6) You will get what you deserve, good or bad. If you aren't getting what you deserve, I will try to intervene to make it so (see #8,9). Good OR bad. I'm no cheerleader, and no saboteur, but I will expend energy for the sake of fairness.

7) I should teach you stuff. And I will. But don't ask me a hundred questions during rounds. And if you do anything that remotely sounds like YOU are pimping ME, you will regret it forever. I promise.

8) Don't lie. Don't be a dick. Don't feud with anyone. The residents and attendings will discuss you behind your back, and their allegiance is to each other more than to you. Yes, even the a$$hole residents/attendings, because we have to work with each other longer than we have to work with you.

9) Work hard, be enthusiatic, volunteer to do things that make my life easier. I will care more about this than about the text book or journal you read last night. And if/when I'm happy, I'll create opportunities for you to show off what you've been reading about, opportunities to look like a star.

10) If I give you advice about how the chief or attending likes presentations, or how you should be writing your progress notes, just trust me and try it that way. If I haven't worked with them long enough to know their preferences, I wouldn't be telling you. And if I have, then you should listen. Bad presentations and crappy progress notes make everyones' lives more painful, and that pain will trickle down onto you.

11) We will notice if you look out for your fellow students, and if you don't. We like it when you do. I want my co-residents to have my back, and I want to protect theirs. If you aren't doing this now, how can I expect that you will be doing it a couple years from now?

12) Don't lie, it bears repeating. If you don't know a lab or vital or the PCA data, it's okay, don't make it up. If you want a day off, say so. Don't claim illness or the like. I will do whatever is reasonable to help you get what you want out of this clerkship, but I will BURY YOU if you lie to me about ANYTHING, no matter how inconsequential it seems to you.

I'm sure there's more, but that's what's off the top of my head right now. Any questions? Additions from other current or near-future interns?

You think your "co-residents" will "have your back"? You're in for a nice suprise with that pompous and cocky attitude. You are acting like you are on a pedestal now that you have some kind of medical degree (MD or DO)...I hate to tell you but there are a lot of people posting in the Step 1 forum right now who can knock you back to earth regarding clinical and basic science knowledge. You may be able to sign orders now but I guarantee you that your students will screw you and you won't even know it. Too bad interns don't evaluate students and vice versa. I'd rip you into shreds if you were my intern.

Telemachus · May 30, 2006

p53 said:
As an intern, you will not fill out evaluations so what you think means NOTHING.

Quite right that I don't do evals. I never said otherwise. Your reward for a job well done comes in talking you up to the residents/attendings, and giving you underhand pitches to smash out of the park. Like when we talk about some topic before rounds and then I "pimp" you right as rounds ends, and you look like a rock star.

p53 said:
I will bet you $1000 that you will be shown up by a 3rd year in the 1st month.

I won't have any MSIII's around me the 1st month, I know my schedule already. But thanks for the $1000!

p53 said:
Let's not use displacement to diffuse this frustration. Just because you had an asehole intern, it doesn't mean that you have to be one too.

I had awesome interns. I don't have a single complaint about them. It's the med students who were the a$$holes at my institution. Thus the advice.

Gfunk6 · May 30, 2006

Pox in a box said:
Too bad interns don't evaluate students and vice versa.

I've seen a lot of people posting this, but it's not true @ all institutions. At mine, MS-III's are evaluated by all interns, residents, and attendings they come in contact with in IM & Peds.

velo · May 30, 2006

p53 said:
Confident people don't start threads like this. Let' face it. 4th year of medical school is a vacation. We both know that you don't know jack starting your intern year, and you are scared to death. Let's not use displacement to diffuse this frustration. Just because you had an asehole intern, it doesn't mean that you have to be one too.

Bullseye

Good lord I hope this guy's not at my school. Furthermore I suspect he's scripting this advise going largely off of the experience he had as an egomaniac prick MSIII coming into contact with tired, frustrated house-staff.

Sammich81 · May 30, 2006

Despite the fact that the tone of the OPs post is abrasive and confrontational, as someone who is finishing the 3rd year, there is some valuable advice here.

1. The "I'm not your friend" bit: You do have to respect boundaries. There can be a false sense of intimacy b/c of how much time you spend with your team, but they're still evaluating you--talking in detail about your personal life can be detrimental.

2. "If I'm not civil..it may be b/c you are stupid lazy or a dickhead." Or it can be because your intern is a stupid, lazy dickhead. Either way don't take things too personally. On the other hand, if their bad mood seems to correlate directly with your failure to get any of the attending's pimp questions, maybe you have something to do with it.

3. "You will get what you deserve, good or bad...I'm no cheerleader or saboteur." This wasn't exactly my experience. No matter how smart a student was, and some of these people I know were smart as hell, you have to be outspoken enough and in the right way to get noticed. You have to be your own cheerleader without being obnoxious.

4. On relations with other med students: Yes, classmates step on toes, they do cutthroat things, they're sometimes annoying to work with. You cannot say anything bad about them to your residents! Kvetch all you like to your friends and family, but I think it's seen as a sign of disloyalty if you sell out one of your own. Even if the residents are trashing this person, it's best not to join in (no matter how cathartic it would be).

5. Work hard, be enthusiatic, volunteer to do things that make my life easier: Someone asked what this meant. Yes, it means taking care of the scut for your patients--making calls to the outside hospital to get records, bugging radiology to see when a study is going to get done, calling path to get a slide sent up. Not the most exciting thing ever, but it does keep your team happy, and it's legitimate work that needs doing. If you free up some time for your intern, maybe they'll teach you more.

6. "If I give you advice about how the chief or attending likes presentations, or how you should be writing your progress notes, just trust me and try it that way." Amazingly a lot of students don't seem to incorporate the feedback they get. One of my chiefs vented about how frustrating it was to try over and over to correct someone who doesn't apply it. It seems like you're not listening.

That being said, I hope the OP lightens up, or someone makes him a stiff drink.

Mayhem · May 31, 2006

Wow. I can't understand why everybody is getting all riled up. I read the post -- twice -- and I don't see anything to get offended by. He sounds like he'd be a fair intern. Ok maybe this line was a bit much: "And if you do anything that remotely sounds like YOU are pimping ME, you will regret it forever." But I'd never make that mistake.

Can someone point out this supposed arrogance because I'm truly not seeing it.

BlazerMed · May 31, 2006

Mayhem said:
Wow. I can't understand why everybody is getting all riled up. I read the post -- twice -- and I don't see anything to get offended by. He sounds like he'd be a fair intern. Ok maybe this line was a bit much: "And if you do anything that remotely sounds like YOU are pimping ME, you will regret it forever." But I'd never make that mistake.

Can someone point out this supposed arrogance because I'm truly not seeing it.

It was too much eye for an eye and not enough you scratch my back I'll scratch yours for an internet message board. No one's afraid of calling anyone out.

USArmyDoc · May 31, 2006

Wow....I did not know medicine was full of a bunch of a$$holes. I am an incoming med student and I am almost appalled at what was written. Wouldn't you want to formulate a strong friendship between the intern and students? I would think it would make for a more cooperative and better learning environment. Obviously, I was incorrect.

velo · May 31, 2006

Mayhem said:
Wow. I can't understand why everybody is getting all riled up. I read the post -- twice -- and I don't see anything to get offended by. He sounds like he'd be a fair intern. Ok maybe this line was a bit much: "And if you do anything that remotely sounds like YOU are pimping ME, you will regret it forever." But I'd never make that mistake.

Can someone point out this supposed arrogance because I'm truly not seeing it.

It was the "let me descend from my lofty heights to share my sacred wisdom with you, lowly 3rd year" attitude. Medicine is certainly a hierarchy, but that doesn't mean you should talk down to the people who are one rung beneath you. The only reason to do that is insecurity. Is he more experienced than the incoming 3rd years? Yes, hugely. But that doesn't mean the 3rd years are any worse than he was two years ago, or that he's any better than they will be in 2 years.

You should treat people how you would have liked to be treated when you were in their position. And you should not act as though, as their intern, you are their God. On the medical totem pole medical students and interns both still rank below dung beetle.

velo · May 31, 2006

Sammich81 said:
Despite the fact that the tone of the OPs post is abrasive and confrontational, as someone who is finishing the 3rd year, there is some valuable advice here.

Oh and I agree with you that somewhere, beneath the layers of self-satisfied ego stroking, there was good advice in that OP. Your post sums up most of that advice nicely, its how the OP should have been written.

MediCane2006 · May 31, 2006

Okay, so maybe the tone of Telemachus' post was a little high-and-mighty for a fledgling tern. But I agree with Sammich - I think that there are a lot of good points in there. As someone who will be starting a surgical internship myself....

1. Please remember, when you are tired, stressed out, hungry, and frustrated, that I am even more so. And no, the meager salary we get paid is not enough to compensate for that. The only way to make the day bearable is if we're all civil to each other. Even if it's 8 at night and you're so hungry and tired you think you're going to die, we still have to round. So while I'm not asking for ceaseless enthusiasm, let's both try to be pleasant. And I promise to cut you some slack on this if you'll do the same. I'm new at this too.

2. Despite the fact that I still feel like an MS-1 deep down inside, I am now supposed to be a doctor possessed of vast funds of knowledge and skill. This is scary and occasionally I worry that someone higher up the totem pole is going to find out how little I know. So as a general rule please don't pimp me in front of an attending or upper-level resident. There is always the admittedly remote possibility that I won't know the answer, which is horrendously embarrassing, or that I won't know the answer and you or another student will, which is worse. I will repay the favor by not pimping you unless I know you know the answer. Under this system I get to maintain some semblance of dignity and you get to look good in front of your evaluators. We both win. (While on the topic of pimping, please also refrain from pimping your fellow students in front of the attending. See more below).

3. Be nice, not only to me and the other residents, but to your students as well. A team on which everyone gets along can really be a thing of beauty. Yes, you may have gunners, slackers, or a$$holes in your group. But refrain from stooping to their level. Never, ever show up another student - this includes reading up on their patient, answering a question that wasn't directed to you, pimping a fellow student, or witholding information (i.e., a time change for rounds). If you are having issues with another student's behavior, address it with that student first - don't be a tattletale. Sometimes one student seems to get preferential treatment from the resident or attending. Sometimes evals aren't fair. These things are frustrating, but they happen. It's no excuse not to continue to work hard and do your best.

4. I was in your shoes not so long ago. I remember how hard it was to juggle clinical time with studying for shelf exams and oral exams. So I will try as hard as possible to make sure your time in the hospital is well-spent, and get you out of there as fast as I can. Let me know the procedures you want to do, and the stuff you want to see, and as much as I can, I will exert myself to make sure that your clinical experience is rewarding. But keep in mind that I am learning too, and there are some procedures (okay, a lot of them) that I need to become proficient at first before I can teach you.

5. Have fun! You're starting a very challenging, exciting year and taking a big step in your medical training!

TBforme · May 31, 2006

honestly, i have zero sympathy for interns/residents who walk around with a chip on their shoulder, who are terse and unpleasant all because they are overworked, underpaid, hungary and tired. we all should be allowed to be in a bad mood now and then, but this is not the case for many angry, unpleasant residents/interns (particularly in surgery)--they are like this all the time. now this seems somewhat obvious to me, but here we go: You chose this life! yes, you could have gone into derm, radiology, ophthalmalogy, path, family practice, pm&r, er, etc. but no you chose surgery or ob/gyn or medicine, knowing the hours and the demands, and now we should feel sorry for you. in fact, just in general you chose the field of medicine, you knew what it was going to be like to be a resident, come even my grandma has seen residents on the show ER. we all chose this life, some of you were even crazy enough to chose the life of a surgeon. is it unfortunate that surgical residents have to take q3 call for 5 years to learn their trade, yes it is. do i consider it an excuse to treat other people as if they were less than human? no, not at all.

DarksideAllstar · May 31, 2006

Its little reminders such as this that reinforce the fact that clinical medicine isnt a realm that I wish to dwell.

velo · May 31, 2006

MediCane2006 said:
Okay, so maybe the tone of Telemachus' post was a little high-and-mighty for a fledgling tern. But I agree with Sammich - I think that there are a lot of good points in there. As someone who will be starting a surgical internship myself....

Another great example of how the OP could have been written.

Well OP, since you're so keen on giving us advice, let me give you some advice. Now that you're an intern and you have that MD after your name you're expected to be a leader and a teacher to those below you. Medicine is filled with great and terrible leaders/teachers. And being a good leader isn't just about dispensing competent advice/wisdom/knowledge/whatever, its also about the way you do it.

You gave advice in a way that generated anger and resentment from the people you were trying to advise. Two others gave essentially the same advice in a way that was more appreciated.

Bottomline: they were effective in getting the message across and you weren't.

If you treat your med students the same way you treated us in your OP, not many of them are going to go out of their way to make your life easier. If you treat them the way the other two posters did you'll find that their appreciation will translate into an easier job for you.

neutropenic · May 31, 2006

Telemachus said:
I had awesome interns. I don't have a single complaint about them. It's the med students who were the a$$holes at my institution. Thus the advice.

I am glad that we generally only had 1 med student per team/preceptor and an uncompetitive P/F atmosphere. Was nice and got a lot of time with attendings sans residents/interns.

Red Beard · May 31, 2006

velo said:
You gave advice in a way that generated anger and resentment from the people you were trying to advise. Two others gave essentially the same advice in a way that was more appreciated.

Bottomline: they were effective in getting the message across and you weren't.

In the words of Yoda:

That is why you fail.

Mayhem · May 31, 2006

See I get what you're all saying but it still doesn't seem that offensive. He hasn't said anything that I haven't heard from one of my own residents or consultants.

Red Beard · May 31, 2006

Mayhem said:
See I get what you're all saying but it still doesn't seem that offensive. He hasn't said anything that I haven't heard from one of my own residents or consultants.

Its just the tone that rubs many people the wrong way--although perhaps not you. When people are confronted with this tone, they can't hear the important and useful message behind it. Given a choice of how to present the information, the OP has chosen to offer it in a package that is difficult for many to deal with.

This may or may not make him an a**hole--we are all responsible for our own reactions to things-- but it does make him a less effective teacher. And, whether he likes it or not, the system he is training in requires him to play the teacher role.

As an MS, I would prefer to have more effective teachers than less effective ones. I think most people would feel the same way.

BlazerMed · May 31, 2006

Red Beard said:
Its just the tone that rubs many people the wrong way--although perhaps not you. When people are confronted with this tone, they can't hear the important and useful message behind it. Given a choice of how to present the information, the OP has chosen to offer it in a package that is difficult for many to deal with.

This may or may not make him an a**hole--we are all responsible for our own reactions to things-- but it does make him a less effective teacher. And, whether he likes it or not, the system he is training in requires him to play the teacher role.

As an MS, I would prefer to have more effective teachers than less effective ones. I think most people would feel the same way.

And on top of all of this, we're on an internet message board. People that would normally keep their trap shut in real life for fear of their grade are going to preach to high heaven how he should be acting.

Zuwie · May 31, 2006

I totally agree with the not lying about ANYTHING advice. If your resident/intern gets you out of bed at 2 am to go make a copy, just be honest and say "F you, a-hole, I went to bed at 1:30 am and have to get up at 4:30 am to do that stupid "pre-rounding" thingy. Go make your own copy, what am I, your personal slave?" Never ever say "Sure, I'd be delighted" because then you'd be lying!

velo · May 31, 2006

BlazerMed said:
And on top of all of this, we're on an internet message board. People that would normally keep their trap shut in real life for fear of their grade are going to preach to high heaven how he should be acting.

Oh without a doubt. In real life I would smile, nod, take his advice, and do whatever I could to get along with the team and have a good clerkship-- that doesn't mean I wouldn't be thinking "geez, what a dick!"

Thanks to the anonymity of an internet message board however, we're free to let him know exactly what everyone is thinking when he strikes this high and mighty attitude. This cathartic truthfulness also will illuminate for him why next year's med students will go out of their way to help the other two interns who posted here, but not him. If I were on his team I'd pretty much only do something to make his life easier if I'm 100% sure there's something good in it for me. The other two, I like them, I'll help them out whenever I can.

sophiejane · May 31, 2006

Caffeinated said:
Thanks, intern. Before I get started, here are some things you should know about me. It's been a few years since you were in my shoes, and not much has changed. Here are a few pointers to refresh your memory:

1. You may find it laughable and naive, but I am still at the point in my education where I am excited about becoming a doctor. Please try to leave a small fragment of that passion intact.

2. Patient care is also my number one priority. But I also care about my grade and passing this rotation. These ideals are not mutually exclusive. Please don't force me to choose between the two.

3. Don't ignore me. Please try to acknowledge my existence at least once every 2-3 days.

4. If you ask me what specialty I want to go into, do NOT make fun of my reply. You may think that your witty comment that berates my chosen specialty is novel. Trust me, I have heard it before. It's hard enough to choose a speciatly. Don't make it any harder.

5. If you ask me what specialty I want to go into, don't expect me to say your specialy just to make you feel good or as a way to bond with the team. While I am on this rotation, I will try my best to walk, talk, shoot, and **** like a member of your chosen specialty. But I expect you to realize that some med students will not choose your specialty, and expect you to deal with that fact in a mature way.

6. I realize that as the most junior member of the team, nothing is beneath me. I will do whatever you ask, but don't abuse this. I will chase down whatever you tell me to find. I will get food for the team whenever I am told. But if I lend you money, then pay me back, damnit.

7. I don't need your respect, I don't need your praise, and I don't need you to validate me as a person. But a simple "good job" when I do something right goes a long way. If you only acknowledge my existence when I screw up, this will bring out the worst in me.

8. You are an ambassador for your specialty. If you treat me like ****, then I will assume that everyone in your specialty are scum. Furthermore, this tactic will also tend to recruit more scum while decent people will be discouraged from applying to your program.

9. First Aid for Mind Reading is still on back order. So don't expect to me to automatically know how you like things done. If I do things different than you would like, it does not mean I am an idiot. It probably means that this is what was expected of me on my last rotation.

10. If I get an opportunity to learn, work hard, and feel good about being part of your team, then I will tell all of my colleagues that you are the world's greatest intern. I might even consider joining your specialty.

11. The next two years will strip me of most of my dignity. Go ahead and take your fair share of my dignity. But don't take any more than necessary. I would still like to have enough self-respect left to hold my head up and smile when they hand me my diploma.

Caffeinated, MS-III

This is excellent. Thanks for voicing what so many of us feel....

footcramp · May 31, 2006

what i don't understand is why an ms4 is giving the advice of an intern.

anyway he's my ms3 advice as someone who just finished third year:

accept all scut enthusiastically.

anticipate what the intern needs and do it.

never, ever, EVER complain.

paying tuition doesn't mean that you twiddle your thumbs while the intern is running around looking up lab values or grabbing supplies.

never appear greedy, especially in regards to attending face time.

never call in sick the night before with a bogus excuse.

never be late.

act confident, speak with a purpose, don't be too afraid of attendings; they are people just like you, sort of.

never make stupid excuses for not doing your work.

never, EVER, lie about your patients. if you didn't do a pelvic exam, don't say you did. if you didn't listen to the heart, don't write RRR no m/r/g on your note.

bears repeating, but DO NOT COMPLAIN, no matter what, no matter how friendly you think others are, no matter how sympathetic they seem, no matter how much life sucks, do not complain. period. no exceptions. none. even if you are on call and you're dead tired in the morning, don't say how tired you are. if they ask if you're tired, you can say yes but say like, "yeah but i'll be ok".

hints:

staying late doesn't give you bonus points. everyone stays late when they first start out. if you stay late and just sit there, it looks worse than leaving early.

being the first to answer some question about the patient does not make you look better. for example if the chief is asking the intern what the creatinine level is, don't jump in and say the answer just because you know it. anyone can spout off numbers or spit back radiology reports. what is impressive is if you go the extra mile for things that are RELEVANT, or demonstrate good fund of knowledge. not this "i talk first" stuff.

working well as a team looks a hell of a lot better than trying to shine on your own. if you are smart your knowledge will be known. if you cover your own ass extensively but let your classmates falter, that will be noticed by your team. maybe not the attendings, but the interns and residents.

that's it for now. good luck to all.

ussdfiant · May 31, 2006

I have to admit, the OP's statement seems premature. I am going to be an intern soon and would never presume to advise an incoming MSIII as such. What I have done as an outgoing clinically savvy (yeah, right) MSIV is to pass on the pearls I have learned to some incoming MSIIIs. I agree with what others have posted that the OP does give some nuggets of wisdom that will serve students well, but the overall tone does seem adversarial and so the message may be lost.

toofache32 · May 31, 2006

Telemachus said:
...Like when we talk about some topic before rounds and then I "pimp" you right as rounds ends, and you look like a rock star....

Since when do all the residents and attendings stand around to listen to a f'in intern pimp someone who knows just about as much as the intern?

Happy613 · May 31, 2006

here is my "fresh off the msIII boat" advice:

1-don't ever lie

2-be on time

3-never make another student look bad

4-be nice to nurses and scrub techs, even when they are being not so nice to you.

5-pharm reps are your friends

6- grades are really arbitrary, if you are a generally nice and affable person you should do fine.

7-ONE LAST THING: when you get pimped on random or esoteric stuff, don't BS. If you know the answer great, if not just say "I don't know." Most of the time its a question your not expected to know, it shows a certian amount of "clinical maturity" to be able to admit to this. Also it shows that you DO know enough to realize its not something you would have ever learned.

third year is fun!

DOtobe · May 31, 2006

I was scared sh*tless when I started my internship year. I was scared about having medical students wanting to learn from me, because I was practically still a medical student myself. (It was really laughable that I started my internship with surgery, and they expected me to teach them surgery...I helped them look it up on UptoDate! :laugh:

)

After working with medical students for almost a year now, I feel like some of what the OP said is true (although it came across as condescending - I don't know if this was his/her intent or not).

Here is my advice to MS-3's (some may echo the OP, some may not):
- don't complain about how tired you are. Odds are, your intern is more tired. And as someone said, just because we are getting paid, it does not make up for intern year exhaustion.
- don't pimp me. I had a med student who would pimp me on my patients, and it just looked bad. For him and for me, especially when I didn't know the answer.

- be patient with your intern. Interns are usually doing 10-15 things at once. The more senior residents may be more helpful for teaching experiences.
- show up on time. (I am anal about being early, so I really hate when people are late.) It looks bad if you show up late for work often.
- don't BS your answers to pimp questions or your SOAP note. I don't even try to BS an answer if I don't know it...I just say "I don't know." As someone else said, don't write "RRR, no m/r/g" on your note if you didn't listen to the heart.

And now, advice for MS-4s that are soon to be interns:
- remember that you were an MS-3 and terrified of starting rotations once. Be patient with your med students if they have questions about how to write a SOAP note (I thought this was taught in all med schools in the pre-clinical years, but I guess not.) or other things that may seem trivial to you.
- don't get a high and mighty attitude with your med students. You're an intern, and we are pretty much near the bottom of the totem pole too.
- I disagree with the "we are not friends" thing. A lot of my med students were fun to talk to and we had a great relationship. It wasn't an "I'm your mentor" relationship. I find the thought of myself being anybody's mentor laughable too... :laugh:

- if you find time, give your med student "pearls" that you have learned throughout your studies that are common pimp questions. We all need to help each other out.

Okay, that was really long-winded. I'll stop typing now.

lattimer13 · May 31, 2006

don't listen to any of the above from the original poster...what a $lapdick. come next summer when i'm an intern i will be the MSIII's friend. point is it makes the working environment fun and you definitely learn more when you feel like your're wanted. plus i know from being an MS3 this year if you have 2 or more interns on the same team i definitely gravitated to the more friendly and approachable one and would rather pick up patients w/ this one and help them out more. i know i wasn't the only med student to do this. point is if you're a dick, i'd rather not have to waste my time if we're not going to be friends and you're not going to help me out in any way. i've definitely worked the hardest on the rotations where i was part of the team and felt appreciated and was actively learning.

maybe the OP will figure it out some day. :idea:

until then, good luck douchebag.

To new MSIII's.... from your intern

Telemachus

Junior Member

Junior Member

Member

Full Member

Full Member

Telemachus

Recovering Germophobe

Exhausted

Telemachus

Exhausted

Telemachus

Telemachus

Senior Member

And to think . . . I hesitated

Full Member

Exhausted

Telemachus

Membership Revoked

Army Strong

****** for F******

Telemachus

1K Member

Telemachus

And to think . . . I hesitated

bottom of the food chain

Senior Member

Scut Bear

King Arthur

Full Member

bottom of the food chain

bottom of the food chain

Living the dream

Member

you can pay me in bud

bottom of the food chain

no fresh flowers please

Full Member

Scut Bear

Full Member

King Arthur

Member

bottom of the food chain

Exhausted

Senior Member

Full Member

Full Member

Senior Member

Full Member

good boy!

Similar threads

for F