Starting Internship

Leforte · Jun 7, 2004

So my official start is about 3 weeks away, and I went into the bookstore the other day and picked up a new pharmacopia, a new stanford and the surgical intern survival handbook.... Was flipping through the little red intern survival guide and realized just how much I've forgotten! The last time I did a real rotation was nearly 10 months ago (lets face it, radiology as a 4th year was cake) and my sub-I was in the SICU which is really more medicine with a ton of procedures! Heck, my surgery rotation was over a year ago and I honestly don't remember ever preop-ing anyone. Not to mention having forgotten the time course for drains, advancing diets, PCA orders, etc.

Obviously, I figure we're all in the same boat - and am resisting the temptation to reread stuff and stress over it. From what I hear it all comes back quickly and time is best spent relaxing and being prepared for the tidal wave when it comes!

Any insight from those who are nearly finished with their internship or those residents who haven't blocked it from their conscious!

Thanks!

njbmd · Jun 7, 2004

Leforte said:
So my official start is about 3 weeks away, and I went into the bookstore the other day and picked up a new pharmacopia, a new stanford and the surgical intern survival handbook.... Was flipping through the little red intern survival guide and realized just how much I've forgotten! The last time I did a real rotation was nearly 10 months ago (lets face it, radiology as a 4th year was cake) and my sub-I was in the SICU which is really more medicine with a ton of procedures! Heck, my surgery rotation was over a year ago and I honestly don't remember ever preop-ing anyone. Not to mention having forgotten the time course for drains, advancing diets, PCA orders, etc.

Obviously, I figure we're all in the same boat - and am resisting the temptation to reread stuff and stress over it. From what I hear it all comes back quickly and time is best spent relaxing and being prepared for the tidal wave when it comes!

Any insight from those who are nearly finished with their internship or those residents who haven't blocked it from their conscious!

Thanks!

Hi there,
1. Know how to work up and treat: A-fib, change in mental status, chest pain, wound dehis, under-resus, post-op fever and loss of pulse, color etc in any vascular patient.

2. Load the boat! Call your chief early if something is a problem. Don't guess at anything, call.

3. Take and keep meticulous notes. Follow-up on every lab test that you order and every radiographic study. Carry out all directions that were given on working rounds.

4. Treat your medical students kindly. Try to teach them things. They can be of tremendous help to you.

5. Treat the nurses kindly. Go and look at the patient if they call you. Listen to their suggestions because they have a little more experience than you at this point.

6. Go to the OR every chance that you can. No case is trivial at the intern level. Even peri-rectal abscesses can be instructive.

7. Try to read every day. It's difficult but force yourself to do this. ABSITE comes up every January so you can't afford to get bogged down in floor work.

8. Dictate your discharges immediately. If you let them pile up, it becomes a chore.

9. Be nice to everyone including the little folks who clean the call rooms. There was nothing nicer than a couple of extra blankets left by one of the little cleaning ladies that I always spoke to in the mornings.

10. Call your spouse, SO etc. Don't neglect the home duties and relationships. Internship can be miserable if you go home to misery too.

11. You are expected to learn this year. Your chief resident will direct patient care so listen and learn from them. Don't whine, most of us did internship when the 80-hour rule was not there so don't whine about the hours. We are all tired too.

12. There will always be a resident in house that is more experienced so don't be afraid to ask for help. If you are not familiar with a procedure, get some help.

Enjoy!

njbmd

supercut · Jun 7, 2004

Don't stress too much about knowing the small details such as timing for puling drains or advancing diets, etc at this point.

If you aren't sure you can always say on work rounds what you'd like to do and why. (eg "JP #1 put out 20 cc/24 hrs...I'd like to pull it")

Drains vary significantly by type of operation and by attending's personal preference. If you are at a program that doesn't allow resident autonomy, I wouldn't pull any drains without at least clearing it with your chief.

Diets are a bit easier. You can advance non abdominal surgey pts faster than those who had an abdominal procedure, and those who had their GI tract rearranged go the slowest of all. (and for these pts you'll also see some variation in speed of advancing according to attening). Get in the habit of asking every pt if they've had flatus and BM...those 2 things are usually a good guide for advancing diets.

Coupla things to add to njbmd's advice

HOME MEDS!!! Check and make sure that your pts have been put on all home meds both pre and post op (unless contraindicated...and keep track of those and restart when OK)

Also, you'll save yourself (and the other interns who cover your pts on call) a lot of hassle if you make sure that everybody has appropriate prn orders (pain meds, tylenol, antiemetics, etc). Sometimes (or often) if an upper level did the case and wrote the post op orders, they forget to write these things (they aren't getting called about it any more)

Start thinking about discharge early (eg is the pt going to need PT to get moving? Will they benefit from home health services? Will they need to go to nursing home and if so for long or short term?) Get the ball rolling early on these services....sometimes they take a while. It's not good for the pt or the team to have a pt linger on your service when they are just waiting for a nursing home bed.

review your bugs and drugs (post op fever workup can includue emperic abx...target your suspected source).

And realize that it will take you a few weeks just to learn how your new hospital works. Jot down the important phone numbers (pharmacy, radiology, etc) and other hospital specific things (computer passwords, protocols you need to use frequently). One of my biggest sources of frustration my first couple weeks was that when I knew WHAT to do, I didn't know HOW to get it done within the system. (eg: took me 30 minutes to figure out how to order SSI in our computer order system)

Otherwise, I think nmjmd gave great advice. My biggest regret, looking back, is that I wish I had read more. Not necessarily for ABSITE (I did OK, not great) but rather for pt care issues. I'm feeling that I don't know enough to become the primary consult resident (which I will be on most rotations upcoming). I guess the feeling that you don't know enough never goes away. (maybe that's good, though)

DadiyaMD · Jun 7, 2004

General question: Is the ABSITE exam the same for all residents? Do chiefs, 4, 3's, 2's, and interns take the same exam or is there a different exam for each year resident?

Pilot Doc · Jun 7, 2004

DadiyaMD said:
Is the ABSITE exam the same for all residents? Do chiefs, 4, 3's, 2's, and interns take the same exam ?

Yes. Your score is curved against your PGY level.

Bovie9 · Jun 9, 2004

Check out a previous post- something like "top 10 things to know as a starting intern." I asked the same question after the match, got some great responses.

FliteSurgn · Jun 9, 2004

Bovie9 said:
Check out a previous post- something like "top 10 things to know as a starting intern." I asked the same question after the match, got some great responses.

Here's a link to the thread mentioned:

http://forums.studentdoctor.net/showthread.php?t=110489&highlight=top+intern

Starting Internship

Leforte

Member

njbmd

supercut

Senior Member

DadiyaMD

Member

Pilot Doc

SDN Angel

Bovie9

Member

FliteSurgn

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