Intern year advice?

[AAATPase]

Hey everyone,

Incoming intern next year and looking for advice regarding first year scheduling. We have some (limited) say in the order our schedule happens and I was wondering if there is an order you would recommend. I have to include:

ED months (6 ish I think), Trauma month (tough and filled with scut), MICU month , Other ICU month, Ultrasound weeks, Ob Gyn Weeks, Anesthesia weeks, Ped EM month

My thinking is that I’ll be fresh after graduation so to put something like MICU or ED around start time, then some electives, another tough rotation, vacation and then the rest.


Other thoughts:

-I think OB-GYN is better later in the year when the ob.gyn interns have learned the basics of delivery and I won’t be competing as much with them.

-ultrasound perhaps earlier in the year? I don’t have much experience at all with it, and perhaps the sooner I take it the sooner I can integrate it into the ED?

-Anesthesia sometime before trauma? My program first year gives EM head of bed during trauma, so intubation practice before may help.

-Is there a time in your intern year where you really were feeling the burn, and would have liked a vacation week?



**I figure it probably all comes out in the wash at the end, but would love input**

---

Members don't see this ad.

 

[KetaMint]

If I could choose I would (but honestly didn't think it would matter much in the end):

1. Have ICU months early. Getting familiarized with the vent, the antibiotics, the orders, EMR, a taste of how the hospital works (Who does the Quinton - Renal or MICU? Who to consult for trach - ENT or Gen Surg? How does the massive transfusion protocol work? etc.) early in the year is helpful. Also surviving the high stress environment with interns from other services(who are just as clueless as you) is a great bonding experience. The relationship goes a long way.
2. Push GYN/Anesthesia all the way to the back especially if you anticipate multiple learners(medical students, Sub-I's, CRNA students) early in the year. If your hospital have dozens of ORs/GI labs that have cases running all day it might not matter.
3. Jan/Feb was when I really felt the burn. Therefore would recommend Ultrasound rotation at that time. More time for sleep and social life. You'll learn ultrasound during ED months, too.

 

[Rendar5]

If you’ve intubated before, then an aesthetic towards back so you’re not competing so much. If you’ve never intubated before (outside of a mannequin), then move it earlier in the year. Otherwise just mix it up so you don’t get too rusty w/ EM which can happen if you group all outside rotations together.

 

[SamtheWise]

It honestly doesn't matter for some things. Example: If you do MICU early in the year it will be nice because you'll start to get your feet wet and get used to sick patients, but if you do it later in the year it will be nice because you'll have a lot more experience with sick patients and procedures so you'll get more autonomy. Same with ED, do it early and you get good experience to start the year, but save it for later, you'll have more autonomy and have an easier transition into your role as a second year. Regarding OB, if you do it during warm months you'll be depressed because it's nice outside and instead of doing fun things you'll be trapped inside with every variety of angry OB resident, but if you do it during cold months you'll be depressed because you never see the sun and you're trapped inside with every variety of angry OB resident. Same exact thing with your surgery rotation, those are gonna suck no matter when you do them.

Having a single blocked month of peds will be frustrating, but probably the best time to do it is in spring or fall so you get a mix of respiratory illness and ortho trauma. If you do peds in July it's going to be all FOOSH all the time, but if you do it in January it's all croup/bronchiolitis/asthma-olitis/croup-olitis (and whatever other 'quirky' combinations of respiratory illnesses pediatricians come up with to sound twee). Anesthesia can definitely suffer from learner-overload. I did my anesthesia late in intern year which I thought would be beneficial because of the same thing as you (fewer learners). However, by the end of intern year I was super crispy and didn't give an F so I just abused the lack of oversight and cushy schedule and didn't get as many intubations as I could have had I been more, um, participatory.

Regarding vacation, personally, I would aim to put a week of vacation after your tough rotations, and try and save a good chunk of vacation for the second half of intern year, that way your second half of intern year feels easier with more vacation.

Ultimately though, your schedule is what it is, don't worry about it too much. You'll have a great time in the ED and in the MICU, you'll hate your life and develop a strong distaste for surgery residents on your trauma month, cultivate a simultaneous hatred and terror of pediatric patients no matter when you do your PEM month, etc.

 

[BoardEligibleEventually]

Regarding OB, if you do it during warm months you'll be depressed because it's nice outside and instead of doing fun things you'll be trapped inside with every variety of angry OB resident, but if you do it during cold months you'll be depressed because you never see the sun and you're trapped inside with every variety of angry OB resident.

L M A O

 

[citymd1234]

Advice: turn around and run. Find something else to do.

 

[enalli]

I think OB-GYN is better later in the year when the ob.gyn interns have learned the basics of delivery and I won’t be competing as much with them.

This is exactly right

ultrasound perhaps earlier in the year? I don’t have much experience at all with it, and perhaps the sooner I take it the sooner I can integrate it into the ED?

It's not essential to have it early. You'll learn ultrasound on the go in the department as an intern. The Ultrasound month tends to be a laid-back almost-vacation rotation. A lot of people tend to use this as the time to study and take Step 3.

Anesthesia sometime before trauma? My program first year gives EM head of bed during trauma, so intubation practice before may help.

Do Anesthesia as early as possible so you are ready to intubate. I would even advise for it to be your first rotation. Every day your hospital should have way more ORs going than the CA-1s can staff, so you should be able to get plenty of OR time. It's not like OB where there is a limited number of unpredictable deliveries for the interns.

**I figure it probably all comes out in the wash at the end, but would love input**

You're right about this. In the end it probably won't matter either way, so don't stress if your perfect schedule doesn't work out.

 

[GonnaBeADoc2222]

Advice: turn around and run. Find something else to do.

Yup. Agree. Too late for that though.

1) MICU and Trauma will likely be awful with
little autonomy (Trauma worse than MICU) and lots of in hospital time. I would put these in the winter months since you won't be seeing the sun anyway. This may apply to your OB month too. I was really lucky to have an OB experience where all I did was catch babies and had no exposure to the toxic obgyn resident culture which was awesome.

2) Totally agree with anesthesia at end of year. You want as much airway experience as possible. It's the most critical thing we do. Be super aggressive. No one is going to hand you tubes. I was shocked how many tubes I got by literally walking in the OR as they were inducing and asking politely. Pediatric anesthesiologists are annoying.

3) Peds. Whatever, it's peds. Colder months prob better so you get lots of exposure assessing work of breathing in virally kids.

4) Ultrasound. Put whenever you want to take step 3. You want to knock this out intern year.

4) Vacation. Try to space out as much as possible. Try not to have one too early.

 

[Darth Doc]

Find out from the current PGY-1s what the cushy months are for you. At our program OBGYN and Ortho are the lightest shift-wise, so I scheduled Step3 during one of them in October. I'm so glad I got it out of the way early. Some of my co-residents are studying for it now, and some of our PGY2s didn't take it until year 2. Why would you do that to yourself? It's so much easier closer to the beginning of intern year.

Also, one of my co-residents got super unlucky and had MICU and Trauma back to back as his first 2 months. He almost quit the program. The hours are the worst, and the surgery residents are generally miserable human beings. I would space things out more.

I really liked my schedule which seemed to end up in blocks of 3 which included a hard month, an easy month, and a moderate month. (When I say hard month, I mean in terms of the number of hours worked.)

 

[TooMuchResearch]

Do your blocks have built in vacation time?

That's how I made my choice.

 

[Spindrift11B4]

It's different for everyone, for me, I liked having the hours heavy rotations out of the way in the first half of the year. Spring has been a nice break as far as hours are concerned. I guess I'm the type that prefers to take a kick to the feel goods sooner rather than later. I definitely think having the first month in the ED is great, it helps you know what to expect, what to learn from off-service rotations, gets you familiar with some of the attendings and nurses, etc.

In terms of actual utility, I do think ultrasound, anesthesia, and critical care are all very useful to get through sooner rather than later. I also think OB should be pushed towards the end...unless you want to swallow that bitter pill and get it over with.