To BKN or any other residents, advice for an incoming intern

[Back34]

I wish I could enjoy my last two (cush) months of medical school, but my pessemistic nature has me looking at potential stumbling blocks. We're not expected to perform at an attending level from day #1, but are there certain skills (outside of the very basics (auscultation, history - taking, etc.)) that we absolutely have to be ready with when we start our internship? I'm o.k. with chest x-rays, EKG's, and can suture with the best of 'em, but I'm 0/5 with arterial sticks and my gyn skills are the pits (always wind up pinching something sensitive with the speculum, usually need help finding the cervix, never did a wet mount, closest I've come to catching a newborn was being allowed to stand in the same room). My biggest fear is the P.D. second guessing his decision to accept me. Any suggestions?

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[Seaglass]

You definitely need to have mad pelvic skills.

Also, depending on institution, you are expected to have had at least some hands-on training with the following:

Suturing
starting iVs and blood draws (very institution dependant)
CPR
bag-valve-mask airway
Abscess drainage
lumbar puncture
ACLS

 

[docB]

To BKN or any other residents...

Yeah BKN must be what, a third year by now

Seriously don't worry too much about your current skills. Just be ready to learn and admit when you need help on something. The interns who feel confident in all of their skills are kidding themselves and are more dangerous than the ones asking for help. The big rule of July of intern year is that if you think someone is actually sick go get someone higher than you.

 

[EctopicFetus]

I dont know I think he is just a really really smart 2nd yr

 

[EctopicFetus]

You definitely need to have mad pelvic skills.

Also, depending on institution, you are expected to have had at least some hands-on training with the following:

Suturing
starting iVs and blood draws (very institution dependant)
CPR
bag-valve-mask airway
Abscess drainage
lumbar puncture
ACLS

I want to reiterate what back said. I too am worried about my skills. While I have done 10 "real" pelvics between OB and EM I have not mastered the whole finding the cervix and not hurting the pt.. A big concern..

Also from the above list I have attempted a few LPs but I would def not say I am comfortable. And as far as ACLS goes Ill be taking that prior to the start of my intern yr.. Overall... I am most def concerned..

 

[kungfufishing]

I think BKN has a real shot at intern of the year IF he continues to read and works hard.

 

[basementbeastie]

i am confident you will hone your pelvic / cervix finding skills in no time!!! ask for help with LPs until you figure it out (hint: find the midline and stay there to avoid aortic biopsy). as for art sticks, femorals tend to be easy, radial can be very hard even with a bounding pulse. no worries, no worries.

 

[Back34]

i am confident you will hone your pelvic / cervix finding skills in no time!!! ask for help with LPs until you figure it out (hint: find the midline and stay there to avoid aortic biopsy). as for art sticks, femorals tend to be easy, radial can be very hard even with a bounding pulse. no worries, no worries.

Sage advice, thanks!

 

[GeneralVeers]

Chronic worrying must be a character trait selected for in med school, or else ingrained into med students.

Best advice is:

Don't worry

Enjoy the last few months of 4th year....take a trip, do fun things.

No one expects you to enter internship with all the necessary skills. If you had them, you wouldn't need residency.

 

[DrMom]

Chronic worrying must be a character trait selected for in med school, or else ingrained into med students.

Best advice is:

Don't worry

Enjoy the last few months of 4th year....take a trip, do fun things.

Can I take a trip and worry?

 

[trkd]

Yeah BKN must be what, a third year by now

Just saw BKN on another forum. Residency not going so well, I think he is looking to switch into family practice. What a shame .

 

[BKN]

Just saw BKN on another forum. Residency not going so well, I think he is looking to switch into family practice. What a shame .

I want to thank all of you for your confidence in my eventual success in whatever specialty I end up in.

Seriously Back and Fetus, educated is what you're supposed to be when you finish, not when you're just starting.

I know, I know how can I say you're just starting after 20 years of education? But them's the facts. Just do it. Ask when you need help (and that will be every patient for a while), read up on all of your patients as the opportunity presents itself. You'll do fine.

 

[GeneralVeers]

Can I take a trip and worry?

Nope, sorry. The two MUST be mutually exclusive.

Now residency and worrying is another matter...

 

[roja]

Would like to just reiterate the concept of being VERY open about what you are comfortable with and what you are not. As a senior (we constantly have interns presenting to us as we manage our own team), drawing to a close, I have a core of interns that I love to work with. One of them is not the most skilled or probably the 'smartest' but he is ALWAYS very honest about what he can do and what he can't do. ("I've done 25 subclavians but I have only done one LP and am not comfortable). Another is one who will start her presentation- if she isn't sure what is going on- with "I'm not really sure whats up with this one" (which is rare but still a great trait).

Other interns seem to try adn ride this line of never letting you know when they 'have' it and when they don't which makes me question everything.

If your 'superiors' know they can trust you to be honest about what you know and what you don't, you will get alot more respect. You will also probably not get lectured on things you know and instead will get focused teaching on where you need it.

And never never never lie. It can endanger patients.

And don't goon procedures from your classmates.. especially during intern year. You will end up giving yourself a reputation that will never leave

 

[Jeff698]

And don't goon procedures from your classmates..

'Goon' procedures?

I just love learning new words.

Speaking of things not to do, don't hand of anything that you wouldn't want handed off (assuming it is possible to avoid it, of course). Purely as a hypothetical example, don't, under penalty of death, leave pelvics or rectals for the oncoming resident.

They don't take long and it just isn't right to have someone who has never met the patient to walk in and introduce themselves by shoving their fingers somewhere they really aren't wanted. Poor form, indeed.

Take care,
Jeff

 

[The White Coat Investor]

Stick speculum in. If you can't see anything without ruggae, move it in a bit more. Once you're hubbed and still can't see anything, take it most of the way out (careful not to pinch) and reinsert aiming MORE POSTERIORLY. If you still get no luck, take the speculum out, and put your fingers in and find out where the thing is, then put the speculum back in and aim there.

Now, get your ass to Europe or something and quit worrying.