Help!

wild said:

...How can I prepare myself for this residency? Where can I get info about the basic structure of the US hospitals (the hierarchy the night shifts etc)?...

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Best advise, relax. Each hospital has its own structure. Some programs rotate through multiple hospitals each with their own individual aspects. Others have just one hospital or something in between. Whatever your structure, each hospital will have some sort of orientation and then your program will have some sort of orientation. The best thing you can do is make sure you are present for all aspects of orientation and pay attention.

The hierarchy is simple.... you are an intern, all residents that started before you are above you. How exactly that is implemented will be program specific. Some programs are more rigid in the application of hierarchy and others are more fluid with a tendency of ~equality amongst residents. You could have an in-between where PGY1 & 2 years are considered a generally equal group. Keep in mind a simple dictum most programs use.... "If you arrive early, your on-time. If you arrive on-time, you are late."

Evening/weekend/holiday and/or on-call coverage and/or night shifts will also vary from program to program. It will be explained to you at your particular program.

wild said:

...Suggestions for educational prep in the month I have left: Should I read the ICU Book/ the Wash Manual? Where can I receive dictation advice? Should I review anatomy?

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Your best surgical education prep is a solid medical school education. "The Surgical Intern Pocket Survival Guide" (SISG) will likely be useful along with a pocket "pharmocopia". Some programs actually give these to incoming PGY1s. Having a "Marino" will be useful on your ICU rotations. As for dictation, SISG will help some and your PGY2 and above can provide you with sample dictations they have done for your attendings. You should always review anatomy.

wild said:

... Should I let my supervisors know about my intention?..

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When they ask and/or later in the year after they have a chance to appreciate your ability and/or potential. Telling them now is ~asking for something you have not demonstrated capacity for....

wild said:

...Should I take the ABSITE exam?...

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You won't have a choice. Further, a lack of a good score can go a long way to assuring you do NOT get a categorical position.

wild said:

...What else can I do??...

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Again, relax, get in the right mindset, be prepared to be the workhorse on the team, remember to study for the ABSITE and pre-read for any cases. Note, as an intern, you may not know well in advance of you case assignments.... So, pre-read according to the rotation.... read about amputations & anatomy for vascular rotations, gall bladder/appenicitis/inguinal hernias disease, anatomy, principles for GSurgery, etc.... For those basic surgical problems, your pre-reading should not wait for a case assignment.

wild said:

I'm a IMG w/o US clinical experience starting a Preliminary General Surgery residency program in a big city hospital next month.... needless to say, I need help!

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Yes you do! luckily you stumbled across me.

wild said:

I don't really know where to start.... I know the work is hard & am mentally ready for some a@# kicking!

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I wouldn't go in there handing out ass kickings the first day! Go easy and figure out who needs an ass kicking first then start the beat downs in week two.

wild said:

How can I prepare myself for this residency?

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Pushups. Lots of pushups. And squat thrusts. I find whole body strength to be a real benefit when Im at work.

wild said:

Where can I get info about the basic structure of the US hospitals (the hierarchy the night shifts etc)?

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You're near the bottom. Somewhere below the janitor but above the guy that collects your ticket in the parking booth. Everyone yells at you and you yell at no one. Ask JAD about this.
Don't be a "disruptive physician"! which means don't disrupt the nurse's private phone conversations by asking questions about your patients. And don't disrupt the rads tech while they read people magazine so you can get your cxr in a timely fashion. Just sit there like a good little doc and be quite till thier done.

wild said:

Suggestions for educational prep in the month I have left: Should I read the ICU Book/ the Wash Manual?

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sure, why not?

wild said:

Where can I receive dictation advice?

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3rd floor. Take the west elevators then turn right, left then right again. It at the end of the hall by radiology. Ask for pete. And bring your own corded phone.

wild said:

Should I review anatomy?

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maybe, are you bad at anatomy?

wild said:

Drug doses?

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Yes

wild said:

Radiology, Cardio etc..???

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No

wild said:

My goal is to enter a Cat position in the same hospital so I need to excel...
I would also appreciate advice as to how to go about this goal. Should I let my supervisors know about my intention?

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Yes, and ask A LOT of questions. You'll find that surgeons love people that fire out a lot of questions all the time. I have a feeling you're gonna have no problem here.

wild said:

Should I take the ABSITE exam?

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it will be a little ackward if you miss it so, yeah...I'd show up. But the benefits of having the morning off are pretty notable to so its a balance. Let your heart guide you on this one.

wild said:

What else can I do??

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Pray.

wild said:

Thanks! 🙂

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Hey, no problem.

dynx said:

Yes you do! luckily you stumbled across me.



I wouldn't go in there handing out ass kickings the first day! Go easy and figure out who needs an ass kicking first then start the beat downs in week two.



Pushups. Lots of pushups. And squat thrusts. I find whole body strength to be a real benefit when Im at work.



......

3rd floor. Take the west elevators then turn right, left then right again. It at the end of the hall by radiology. Ask for pete. And bring your own corded phone.
.......

Hey, no problem.

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Awesome post.

I also believe squat thrusts are an essential portion of surgical training.

wild said:

JackaDeli- What's a "Marino"?

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"The ICU Book", 3rd edition by Paul L. Marino..... there may be a newer edition.

Is your program a large one? Does it have residents doing research in the lab?

If so, that would help your chances a bit at getting a categorical spot...more flexibility in the numbers.

And as alluded to earlier, does your program have a history of taking IMG/FMG prelims into its categorical spots?

Having sat in on the ranking discussions about visiting FMGs/prelims, the key to being an impressive intern is essentially:

1) WORK HARD (you should beat your senior residents there in the morning and leave after they do...you'd be surprised how many times I had to wait for my ICU/night interns to show up to sign out)
2) see #1
3) Be permanently happy and cheerful, like you'd rather do nothing else other than unwrap smelly gangrenous toes at 4 AM
4) Offer to help your other interns, residents, etc. to see consults, fix the list, etc.
5) Read read read for the ABSITE...get a SESAP if you can (read other posts on how to do well on the ABSITE)
6) re: #3...be ESPECIALLY nice to nurses. they have sway.
7) ask ask ask if you don't know (again, nurses have a lot of experience...at least the ones who have been around..I'd trust my 50 yo ICU RN veterans often over my brand new intern for many things)
8) be prepared for your case/rotation. Read the anatomy of the case you are doing the night before, know basic complications, pathphys. DON'T show up for a colectomy if you don't know the blood supply to the colon (as one of my interns did - guess what?? she didn't get to do the case)

Don't worry about dictating (interns will rarely have the responsibility, except maybe at the VA).

Our program has interns shadow the week before they start...if your program doesn't offer this, ask them if you can.

Know the hospital down cold before you start...memorize important phone numbers, figure out the electronic medical record (assuming you have one), know how to put in basic admit orders in under 5 minutes...

re: drug doses...sure. pain meds, peri-op abx is a good place to start.

Ask the residency coordinator if there is a particularly friendly, patient resident who can help show you around, give some advice. Hit a research resident up maybe. They are generally better rested = nicer.

Get a good surgical textbook (there are also other posts on this...but I like Sabiston).

Good luck! It will be okay. There is a spot somewhere. Believe it or not, a good attitude and personality beat out technical skill most of the time. I've seen residents/students not ranked for being "weird" or arrogant, even with stunning absites/board scores.

Is it weird that I always read these kind of posts in my head as if they were written by Borat?

"In Kazakhstan, three main issues: economic, social, and Jew"

Pompacil said:

Is it weird that I always read these kind of posts in my head as if they were written by Borat?

"In Kazakhstan, three main issues: economic, social, and Jew"

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That made my hangover a little easier to tolerate this morning... And your signature is probably my favorite line from the GI Joe parodies . Well played, sir.