What interns should know day 1.

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Wolf02

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Dear all the kind generous seniors and attendings that roam these forums,

I'm going into an amazing family medicine program that I love but I'm scared and nervous that I know nothing and have forgotten everything. I know interns are considered empty vessels that the programs fill with knowledge, but what do you want/need your interns to be able to do day one of residency do i can focus on that.

Thanks!

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Congrats on your match!! It's very likely that your program will have something set up during orientation to help get you and your classmates up to par on the basics, procedure-wise. Otherwise, getting back in the habit of reading every day is a good plan. You can stick to the resources you used as a fourth year for now- wait to buy bigger textbooks until you see what your program recommends (or buys for you).
 
Dear all the kind generous seniors and attendings that roam these forums,

I'm going into an amazing family medicine program that I love but I'm scared and nervous that I know nothing and have forgotten everything. I know interns are considered empty vessels that the programs fill with knowledge, but what do you want/need your interns to be able to do day one of residency do i can focus on that.

Thanks!
Know where your head and your ass are and don't go home until your senior tells you to. Anything above that is gravy.
 
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Dear all the kind generous seniors and attendings that roam these forums,

I'm going into an amazing family medicine program that I love but I'm scared and nervous that I know nothing and have forgotten everything. I know interns are considered empty vessels that the programs fill with knowledge, but what do you want/need your interns to be able to do day one of residency do i can focus on that.

Thanks!

Many family med programs have very long orientation programs - to not just acclimate you to the hospital, but to the clinic as well. You'll be fine.
 
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but what do you want/need your interns to be able to do day one of residency do i can focus on that.

Memorize your senior's pager number so you can call them... frequently.
Also memorize the pharmacy's number so you can call them about drug dosing and interactions.
Memorize the hospital layout so you can get to the different wards quickly when you get called.
 
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Know what you don't know. Know that no matter what kind of preparation you get, nothing can prepare you for day one of intern year.... not a million Sub I's, a million days of orientation, etc. Don't worry you will get better as time goes on.
 
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Memorize your senior's pager number so you can call them... frequently.
Also memorize the pharmacy's number so you can call them about drug dosing and interactions.
Memorize the hospital layout so you can get to the different wards quickly when you get called.

Yep exactly. When you don't know something (even if it's dumb ****) look it up or ask someone (or do both).

Guessing is what gets you into trouble. Far far better to be safe and slow as an intern than try to be fast and hurt someone.
 
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Don't ever get into the habit of acting like you know something because you feel like you should. Always ask. If you don't, I guarantee you it will come back to bite you later.
 
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Never let your pride (or ignorance) put a patient in danger. If you don't know what to do then CALL. The upper residents should be with you on the first few night calls, etc. You are not expected to know anything, but you are expected to be intelligent and safe when it comes to the patients.
 
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Where the good bathrooms are
 
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And I prefer my lists printed double sided with the staple in the upper right hand corner.

I read this and was like...whoa, whoa flashback to surgery clerkship and then saw it was posted by SouthernSurgeon --> ooohhh. :laugh:
 
Given that no useful information is likely to arise from this thread, I'll offer a couple other rules. These may or may not only apply on services I run:
(2) Do not be seen eating. I'm only half joking about this. Being seen eating was a hanging offense when I was a med student and intern. I don't know when this changed.

(7) I have never told you what time to come in or what time to leave, so if I see that you reported an hours violation, you can explain to me (and our PD) in detail how that occurred. And once you make that report, expect to never ever do a reduction, procedure, or operative case again during the rotation.

So IV nutrition and never report more than 80 hours regardless of number of hours worked? Got it.
 
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Seriously, day 1 all you need to do is show up, find out where the bathrooms and cafeteria are, and don't kill anybody. On day 2, learn something else new, and keep doing that everyday.

And smile. It's contagious, and cynicism sticks with you for a lifetime.
 
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Don't ever get into the habit of acting like you know something because you feel like you should. Always ask. If you don't, I guarantee you it will come back to bite you later.


Great Advice. When you are a med student, you want to show that you are smart, and so you shy away from revealing your don't know something. It is actually one of the coolest things about being an intern, is that you are finally free to look your attending in the eye and say with full confidence

"I don't have the slightest clue"

Liberating really.

P.S. it is best when those situations occur that you go home and learn about that subject, because it is never acceptable to not know something over and over.
 
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Given that no useful information is likely to arise from this thread, I'll offer a couple other rules. These may or may not only apply on services I run:

(1) No smiling. Smiling suggests that you feel happy. If you have time to be feeling things, you're probably not working efficiently enough.

(2) Do not be seen eating. I'm only half joking about this. Being seen eating was a hanging offense when I was a med student and intern. I don't know when this changed.

(3) Answer your pages quickly. Within seconds. Answer it before it actually goes off. Anticipate that a page is coming and call them before they finish dialing you. Because every time you take longer than a few minutes to answer a page, they call me.

(4) When I ask you to go to Radiology to get a copy of some films, do not let your next sentence be, "How do I get there?" You ought to be able to figure that out yourself.

(5) The list belongs to you. Take some pride in it. Mis-spellings, random formatting changes, different fonts drive me nuts, and makes the staff think that you're not doing a good job.

(6) If I know a patient is dead before you do, we have a problem.

(7) I have never told you what time to come in or what time to leave, so if I see that you reported an hours violation, you can explain to me (and our PD) in detail how that occurred. And once you make that report, expect to never ever do a reduction, procedure, or operative case again during the rotation.

(8) Everyone knows you have the crappiest job in the hospital, so there is no reason to remind us. I did that job once. Everyone did. Suck it up for a while, and then someone else will take over for you.


A Retort

1. I encourage smiling. Medicine is serious business, but NEVER take yourself too seriously, like the above poster clearly does

2. Make sure you get something to eat. Very important. Take 15 minutes. Don't take 60.

3. No one should ever ask you to go to radiology for films. What is a film anyway? This is 2015 for God's Sake.

4. Everyone will know a patient is dead before you. It is because they page the attending first. In fact, the attending will know most things before you do, that is why they are the attending. On another note, attendings do not like to be surprised in front of the patient, so make them look good.

5. The hours violations are no joke. It is best if you just write 80 for the week if you know what I mean. On another note, most people you interact with are not as vindictive as this guy is. Never doing a case again? Melodramatic much?
 
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I wish there was a font or symbol for sarcasm. Sigh
 
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A Retort

1. I encourage smiling. Medicine is serious business, but NEVER take yourself too seriously, like the above poster clearly does

2. Make sure you get something to eat. Very important. Take 15 minutes. Don't take 60.

3. No one should ever ask you to go to radiology for films. What is a film anyway? This is 2015 for God's Sake.

4. Everyone will know a patient is dead before you. It is because they page the attending first. In fact, the attending will know most things before you do, that is why they are the attending. On another note, attendings do not like to be surprised in front of the patient, so make them look good.

5. The hours violations are no joke. It is best if you just write 80 for the week if you know what I mean. On another note, most people you interact with are not as vindictive as this guy is. Never doing a case again? Melodramatic much?

I'm pretty sure Tired's post was tongue in cheek.
 
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True dat, except (a) I really don't understand when the "being seen eating is okay" thing started, and (b) I was serious about the death issue. I don't know what teaching hospital pages the attending directly for anything, but at mine it goes through residents first. If I find out a patient died before the intern, it means either the intern didn't answer a page, or they're not spending enough time up on the ward.

Not necessarily. The nurses know the interns are brand new in July, so it is possible they could be paging the PGY2 about that particular patient first. Lots of times in my program, in the first week or two, nurses just found it easier to directly page us upper-levels rather than the intern.

Anyway, there's only really two things I expect from interns on day 1 in July. Know when you're in over your head, and know when to call your senior for help.
 
True dat, except (a) I really don't understand when the "being seen eating is okay" thing started, and (b) I was serious about the death issue. I don't know what teaching hospital pages the attending directly for anything, but at mine it goes through residents first. If I find out a patient died before the intern, it means either the intern didn't answer a page, or they're not spending enough time up on the ward.

You meaning by the public, by other residents/attendings, in general? And if disappear for 2 mins to scarf down a burrito, between the resident room and the bathroom would that be okay.
 
By senior residents/attendings. And I'm not talking about eating out of your pockets. We all do that. I meant sitting in the cafeteria having a meal.
Oh, what about eating in front of a computer while writing notes?
 
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By senior residents/attendings. And I'm not talking about eating out of your pockets. We all do that. I meant sitting in the cafeteria having a meal.
Oh...now I get it. This whole food obsession of yours never made any sense to me until now.

Yeah, if you're going to be eating, you need to be eating with the whole team, including the Chief/Senior and if possible, the attending. That's the only time I ever "got caught eating" on an inpatient rotation as a student or a resident.
 
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Realize that people are going to be hard on you just because they can. Don't let that get to you. Do your best. You made it through medical school and matched into a residency, so chances are your best is going to be good enough.
 
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4. Everyone will know a patient is dead before you. It is because they page the attending first. In fact, the attending will know most things before you do, that is why they are the attending. On another note, attendings do not like to be surprised in front of the patient, so make them look good.


I definitely disagree with this. When a nurse pages my attending before me (which happens on occasion) I make a point to go find that nurse and ask why she paged my attending and politely remind her that calls should go through me first. Usually their response is "oh I didn't know who to page" because they are too lazy to look at the chart to see who is putting in orders and writing notes.

At my hospital, and I thought this was the case for most teaching hospitals, when a patient is crashing/coding the calls go intern -> upper level -> fellow -> and then we usually call the attending to tell them the patient died/coded.
 
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Just showing up... BS.

-You need a survival kit.

-Always have something edible in your pocket, even if it's just a little thing of peanut butter you swiped from the supply area or a packet of sugar.

-You can learn to eat almost right in front of someone without them ever knowing if you have something bite sized you can swallow whole and you learn some magic sleight of hand technique.

-Correct that no one should see you eat ever except for another resident, and keep it to the call room if you can't pull off the magic trick.

-But don't eat anything particularly appealing (ie go to the cafeteria for a nice hot plate) unless you've asked others what they wanted you to bring back for them.

-If it's something from home or you had on you, keep it simple to minimize jealousy, or else bring enough to share.

-Feeding fellow residents makes life 20% better.

-In general, you will see what the culture of eating is at your program. Just because the attending is eating does not mean you can. Follow an upper's lead.

-It's supposed to be unethical to use med students to get food, but if you are allowed to let med students eat/piss, I tell them that anytime they need to do this, I would like for them to speak up and do so (unless you know clinic has a lunch hour), and if they lose the group to just page me and I will help them find their way.

-By giving them permission to eat, then you can say "Gosh med student, are you hungry? You must be starving? Do you want coffee?"

-If they take the bait, then you can say, "Well, what do you say, if you're headed that way would you mind grabbing me something while you're there? why don't I give you this (badge or money), my treat? I don't mean to scut you out."

-You need only do this once with the med student of average intelligence, from this point on when they are hungry they will announce that they are going to the cafeteria and would you like anything, and at this point since it is now their idea it is no longer unethically asking them to gopher for you, and I can say I was BEYOND thrilled as a med student to be able to say I was hungry and be rewarded with free food while making my resident well fed / happy.

-This is the happiest and most noble arrangement of co-survival between resident and med student in my opinion.

-This still works on long call admit days if the student is with you, the intern, because while they go eat a real meal, they can still bring you a latte to gargle down a cookie while you walk through the hospital (trying not to be seen eating).

If you can, have in the workroom/locker/bag/coat pocket:
On your person:

-Multiple caffeine sources,
-some that need no prep, pills or the shot bottles,
-or maybe tea or instant coffee if you can spoil yourself with a cup and tap water

-APAP or NSAID

-Breath mints (all docs seem to have coffee halitosis breath, I prefer to not be one of them despite the lattes I guzzle)

-If your specialty has a white coat field bible, like PocketMedicine

-Any other pocket reference for whatever essential topic you feel the most insecure about in your knowledge base (be it EKG, abx, whatever)

-I always have the Sanford guide to abx, unless you feel really confident about abx stuff

-Dosing guide if you're not having your hand held by Epic

-At least like 2 colors of pen I would say, maybe a highlighter

-ACLS cards - yeah, it's not likely you'll need them, but better safe than sorry, plus there's some stuff in there that's always helped me w/ stroke admits

-Travel toothbrush, toothpaste,
-Facewash, comb,
-extra undies, socks, shirt (you can get away with rewearing slacks or have a spare set)

-It's better to appear on time to work and then slip away to brush your teeth than be 5 min late because you did it at home, and assuming no body fluid accidents it's still good to have extra clothes in case you need to sleep at the hospital.

-Seriously, please find somewhere to sleep there if there is any chance you are too tired to drive home safely.

-Ditto learn the layout of the hospital.

-Scour the residency program materials/website about anything that's actually practical:

-ESPECIALLY PHONE/PAGER NUMBERS!

-Expectations about notes,
-where to find templates,
-standard order sets

-Anything about your program's EMR, like signing in, if you have a desktop

-Accessing email, how to get email on your phone

-Usually there's a website with a lot of stuff like this, make it your wonderland

-Play with your pager until you know how to operate its every function in your sleep

-Depending on what your first rotation is, find a survival manual geared for that. That's helpful for ICU, night float, wards.

-For FM I guess I would say there must be something about the top problems you'll see and basic plans for that.

-Phone apps that might be helpful:
-Epocrates,
-since you're doing FM the USPTF I don't know the acronym guidelines,
-other med calculators like for DVT, PE risk, strep, etc

-Have a system in place for organizing scut sheets, lab values, your presentations, and to-do's, or at least have thought about this by reviewing what's out there

-Most of this stuff is more useful for wards, but I hope some of this helps you with FM.

-It's true, the key is just figuring out where you are supposed to be when you're supposed to be there, and making love to your pager.

-Be humble,

-always choose being likable over looking smart,

-don't bitch,

-offer to help someone with their work if you're not on the edge of death and have one more note or order left in you,

-do as you're told,

-bite your tongue as much as you can, turn it into a challenge to yourself to do so at every opportunity.

-Only point out or correct someone above you in the most tactful, humble, polite, I'm almost phrasing this as a question kind of way, and only because it will really truly largely make a difference in management.

-I can't ethically tell you to lie about duty hours....

-Remember, the fastest note wins. It is better to be told that your notes are ugly as hell (while containing the bare minimum, never do less than the bare minimum) than to be told they need to be done faster. Your number one job is writing notes. Followed by answering pages.

-Remember: you are a note monkey making love to a pager. Seriously.
 
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For me, and I imagine for FM, I would want to be sure I had a good resource/had a handle on w/u and plans for:
reading EKGs and chest xrays
Rx'ing abx for the basic stuff, UTIs uncomplicated vs complicated, PNA and it subtypes, when do to abx for URI, sinus infxns, abscesses, etc
COPD and asthma basic tx regimens
CHF stuff
post-MI management
anticoagulation stuff (aspirin vs warfarin vs heparin)
cholesterol and BP management (there's apps)
most common musculoskeletal complaints - differential, w/u if needed
preventative med stuff (USPTF or other guideline smartphone apps, like who needs what screening when, keeping track of vaccines (definitely a resource for peds))
Pap/STD guidelines (the Pap and HPV management is so complicated at this point you should find the algorithms online)
rashes, eczema, psoriasis
how to do a good neuro exam and succinctly document it (maybe already have a template created you will be able to cut and paste into your EHR note template when you start)

If you show up day 1 with quick handy reference/algorithm resources & have a basic grasp of differentials, w/u and plans covering the above topics (not **** you may have as a tidy brain package from the drain that was med school), and can write fast succinct notes, get an H&P outta someone fast, organize to do's, and really work on good quick presentations, you will look like a rockstar
(or at least have good resources at the tips of your fingers to look less dumb while you flounder about just trying to keep up and figure out how to do ANYTHING, even print a stupid Rx and find it out of the printer)
 
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Lord Jesus how did I ever forget the die-a-bet-is, (how your patients pronounce it) diabetes management, like cut-offs, diagnosis, monitoring, tx regimens stepwise therapy in type 2, and insulin types and regimens, and the routine screening
 
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