Advice for new interns

Discussion in 'Veterinary' started by Kpowell14, May 17, 2017.

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  1. Kpowell14

    Kpowell14 Mizzou c/o 2017 2+ Year Member

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    Hey Guys!

    In less than a month I will be starting an internship at an academic institution and I'm excited, but a bit nervous. I was hoping those of you that have gone through internships could share some insight, encouraging words of wisdom, or just things you wish you would've known going into your intern year. These things could be medical (things you wish you would've reviewed etc.), things to make medical records easier, or just life things. Did you carry around a notebook to keep track of cases similar to when you were a student? Did you create a nerd-book? Did you utilize any cool apps on your phone? Any tips for sleeping better during the day on ER or how to adjust back to days after working nights? Pretty much anything is relevant!

    Signed, scared soon-to-be rotating intern
     
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  3. SocialStigma

    SocialStigma OVC c/o 2015 7+ Year Member

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    My intern experience will be different from yours since I did mine at a private practice (where we had no students or residents, so interns did everything), but I think most of this is still applicable. Bringing all of my meals (breakfast, lunch, and dinner + snacks) to work everyday was the best decision I made as an intern because then I could power through all my paperwork at the end of the day without having to leave to get food. You won't be doing much paperwork as an intern at an academic institution except on ER, but I would definitely recommend bringing multiple meals to work when you're rotating through ER. Even if your scheduled shift is 8am-8pm (or whatever), you will often end up staying for hours afterwards rounding your patients off to the next clinician and finishing up paperwork, calling owners back about labwork, etc.

    I did have a notebook to put patient stickers in and keep track of things that are pending/still needed to be completed for each one. Makes rounding a lot easier!

    Make sure you have earplugs, a sleep mask, and some sort of window covering (blackout curtains would be ideal) for sleeping during the day. Depending on your sensitivity to caffeine (if you drink it at all), don't have caffeine too close to when you're supposed to be sleeping. I would have only 1 coffee at the very beginning of my overnight shift and then no more caffeine for the rest of the night. It made staying awake for 7am rounds hard, but going to bed at 9-10am super easy. Also wearing sunglasses on the way home helps. For the transition from nights to days, I would have a short nap (3 hours max) during the day after my last night shift, and then force myself to stay up until 9-10pm before going to bed again.

    Do things to bond with your internmates! Having a cohesive intern group can really make a difference in how much you enjoy your internship.

    Enjoy your intern year! It goes by faster than you think and it was honestly one of the best years of my life. I miss it sometimes lol.
     
    Last edited: May 17, 2017
  4. JaynaAli

    JaynaAli Need it STAT or want it STAT? They're different. Bronze Donor 2+ Year Member

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    Know how to do a good neuro exam. Way more ER cases ended up being neuro (like little dogs with neck pain) than I expected.

    My internmates kept notebooks. I would make a daily sticky note of the patients I saw and the paperwork I needed to complete for each one. I'd put something like this:
    Duffy txsheet [ ] MR [x] discharges [ ] call rdvm [x] sx-report [ ] PM update [ ] tomorrow-txsheet [ ]
    Roscoe txsheet [ ] MR [ ] discharges [ ] call rdvm [ ]
    Princess txsheet [x] MR [x] discharges [x] call rdvm [x]
    ...on and on and on and check them off one at a time. Then when I checked off everything for that patient, I'd put a huge line through the entire entry like shown. Made me feel good.


    I second the recommendation to bring all your meals. I also kept a secret stash on non-perishable food in my desk. Granola bars, dried fruits, crackers, ramen, etc. Occasionally internmates raided it, but it was nice to have food around for days I forgot or needed to stress eat my feelings really quick.

    I have an exceptionally good memory for people/animals names, so I was able to copy and paste a lot of records/discharges. My best hint for that is the minute you paste a template from one animal's record into another's...do control+H, find and replace. Let Word or whatever replace every instance of Fluffy with Princess. You can also change the he/hims to she/hers that way if you make sure to put " she " and " he " with the spaces, but you have to use the spaces or else words like sheltie will turn into ssheltie, hematochezia to shematocshezia, etc.

    I used the plumb's app on my phone. Stretched the truth and said I was a student so I could get it free for a year. I also used an anesthesia calculator app I forgot the name of to calculate drops per second (because we didn't have enough MR safe fluid pumps). I started the first month making a quick reference of drugs and the clinician's preferred doses (dr. X prefers 4 mg/kg of drug A, dr. Y prefers 2.5 mg/kg type of thing) but I quickly learned what they liked and made up my own after about a month.
    I worked on call for years so sleeping was never a problem for me.

    There are ACVIM concensus statements on a lot of internal med/cardio/neuro stuff. Read them at some point. The VIN getting through the night stuff saved my butt a few times. But there are very few instances where you don't have five minutes to go look something up in a book. I even did it with clients in the back watching me look stuff up and call a clinician...they were grateful I was checking with others.
    I'm sure I'll think of others later on.

    Edit: The ASPCA poision helpline is amazing. They'll tell you exactly what to expect and what to do and you can call them as many times as you want after the first fee is paid. If you tell a client to call them before they arrive to see you, warn them there is a fee but it's legit or else they'll think it's a scam and hang up. Well worth the money.
     
  5. jmo1012

    jmo1012 SGU (NCSU) c/o 2015! 5+ Year Member

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    • Make time for you and the things that are important, it's easy to spend every last minute of off time sleeping and while some of that is good, spending time on yourself is also necessary
    • Vin has a new grad getting through the night emergency rounds during g the summer, good review
    • There are many ways to do most things, internship is about trying out everyone's styles and adapting them to make your own
    • Some rotations you may only feel like a slave, but it's just a couple of weeks of your life
    • Even if you dont feel confident, faking it (not obnoxious or overconfident) will do you a world of good because your clients, techs, and team will trust you, and ultimately eben if you dont know what you are doing, you have the resources to figure it out
    • Embrace your mistakes, and learn from those made by others
     
  6. Kpowell14

    Kpowell14 Mizzou c/o 2017 2+ Year Member

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    Ah, These are all really good tips!!!

    @Rwwilliams do you have any specific questions or heard any good tips lately?
     
  7. Kpowell14

    Kpowell14 Mizzou c/o 2017 2+ Year Member

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  8. orca2011

    orca2011 PennWe c/o 2016!!! 5+ Year Member

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    - I second the bringing as many meals/stashing snacks in your drawer. Especially anything you can quickly grab and shove in your mouth in between exams on a busy overnight. It will save you.
    - Second reading through Vin's "Getting through the Night." I haven't actually made it all the way through it, but it is super helpful. Has a bunch of useful drug dosages.
    - I have a clip board with common drug doses written on a sheet. I referenced it a lot initially, but so much of it is by memory now. I also had an old copy of Angel's Intern Manual that I had bound and kept in that clipboard. It was a nice quick reference for a lot of your typical emergencies and I still use it from time to time although I do have the 15-16 edition as well.
    - Agree of faking the confidence. It took me a while to get used to doing this but I think it's honestly what has helped me a lot in the second half of my internship or so. At first I was really struggling and now not so much.
    - If rounds are like they are here in the mornings, there will be a lot of " Monday morning quarterbacking" which can be annoying when coming off and overnight and you just want to get out of there and go to bed. Majority of the time, it's because of personal preferences and not necessarily anything you did wrong. You're goal is keep patients alive, and just remember that. If you do make a mistake, learn from it. It'll happen, just make sure you grow from it.
    - To keep track of my stuff to do, I made a word document with patient name, ID number and location, and boxes for SOAP, PE, owner update, plan, fax rdvm and discharge.
    - As for adjusting from days to overnights and vice versa, you just kind of do it. We often only get like 12 hours off after overnight (by the time you get home) and then you're on days for like the next 4 days afterwards. That first day shift is effing rough and you feel drunk most of the time, but you make it through it.
    - Make male/female versions of some really common ER cases you can just change the name for the discharges and get them out the door.


    And I think reading the consensus statements is a really great idea. I hadn't realized that they were all available until I got to my internship and I've been trying to make my way through them.
     
  9. Kpowell14

    Kpowell14 Mizzou c/o 2017 2+ Year Member

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    Is the Angell intern manual a doc or PDF that you could share with me- sounds like a great resource!

    Yes! I started saving discharges as a student for the common things I saw on ER, hopefully that will come in handy and save me some time!
     
  10. jmo1012

    jmo1012 SGU (NCSU) c/o 2015! 5+ Year Member

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    Also a big fan of bring the meals. In fact, this year to save even more time, I just bring the weeks worth of whatever in 1 container and dish out every day rather than separating stuff into more dishes to be washed. This means 5 more minutes of sleep and less dishes. I will do just about anything for 5 more minutes of sleep haha
     
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  11. orca2011

    orca2011 PennWe c/o 2016!!! 5+ Year Member

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    I'll have to transfer the most recent one I think from work but I can send it your way. Just PM me an email.
     
  12. Rwwilliams

    Rwwilliams 2+ Year Member

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    The tip I hear repeated time and time again is to not cry in front of clinicians. I had a couple faculty members tell me that this week lol.

    I've come across some advice like, remember that you're just keeping stuff alive when you're on overnights, not necessarily solving every problem. One dose of lasix hardly ever kills anything. It never hurts to intubate or put something in oxygen. Getting a nova is never a bad idea. Unless something is actively dying and you're running a code, you'll have time to consult Google, or Pubmed, or old notes. To anyone starting an internship that hasn't read through Getting Through the Night yet, I think you should. I know I haven't started yet, so my advice isn't worth much, but just reading those transcripts has made me feel a lot more confident to tackle things I'm otherwise unprepared for.

    Does anyone have a good way to search the consensus statements? Just go to the college and search for "consensus"? I've found a couple in the last few years that were really helpful, but I never considered reading through all of them.
     
  13. JaynaAli

    JaynaAli Need it STAT or want it STAT? They're different. Bronze Donor 2+ Year Member

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    Journal of Veterinary Internal Medicine - Consensus Statements - Wiley Online Library
    I didn't just sit down and read all of them, but if I saw a dog on the schedule with seizures, proteinuria, cushings, etc I made sure to review it.


    Sent from my iPhone using SDN mobile
     
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  14. cheathac

    cheathac Purdue c/o 2021!!! 2+ Year Member

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    Did any of you want to specialize before starting vet school? My interest in lab animal has increased dramatically, and I'm loving my new job in the field. I'm definitely going to keep an open mind, but there is just this feeling of satisfaction and joy being in the environment that I am in. It just feels "right." And I know I don't have a ton of experience in the area, but it's a different feeling than when I was at a vet clinic or watching large animal clinicians. It fuels my desire to want to study vet med. I just didn't know if wanting to specialize before starting was too premature.
     
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  15. Rwwilliams

    Rwwilliams 2+ Year Member

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    Awesome, thank you so much! I know I've made it through a few while studying in school, but it'll be nice to have them so readily available.

    I've wanted to specialize in surgery way before I started vet school. I wouldn't say that your desire is premature, but I would absolutely encourage an open mind. Not only is it possible for you to fall in love with something else, but I think maintaining an open mind makes it that much more pleasurable to study other disciplines as opposed into falling into the "well, I have radiologists/pathologists/food animal vets/etc for that."
     
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  16. SocialStigma

    SocialStigma OVC c/o 2015 7+ Year Member

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    I've thought about specializing in surgery since I was 16-17 and saw my first orthopedic procedure while shadowing a vet. In my 3rd year of undergrad I decided I wanted to be a surgeon. I still kept an open mind in vet school, though deep down I knew I was never going to be as passionate and excited about any other specialty. I'm entering my second year of my surgery residency now and I am still just as excited by the field as when I was 16. It's okay to know/decide early on what you want to specialize in, just like it's also okay to not figure it out until you graduate vet school.
     
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  17. kcoughli

    kcoughli Minnesota c/o 2017 2+ Year Member

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    Came into vet school knowing I wanted to do lab animal and will be starting my lab animal residency in July :) Best thing about knowing what you want to do is you can tailor your experiences to match and really show them that yes, you know what the field is about, and you are dedicated to it. For example I got a part time job working at a medical device company (essentially animal care staff), was on the leadership board of the Research Animal Medicine Club, spent a summer doing an ASLAP summer fellowship, and used all of my elective externships doing lab animal ones at various places. That being said I also did a part time gig at an emergency vet clinic and some shelter work just to check out my options. I think getting experience in the field and making connections really helped my application in the long run, but definitely explore your other interests as well.
     
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  18. jesskb

    jesskb KSU CVM c/o 2015 5+ Year Member

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    I picked Therio when I was 15. I made sure along the way there wasn't something I wanted to do more but now that I'm in residency I know I made the right choice. It never hurts to plan ahead as long as you don't get so set on the idea that you can't let it go if it's time to let it go.
     
  19. cheathac

    cheathac Purdue c/o 2021!!! 2+ Year Member

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    @jesskb What is meant by knowing it's time to let go? Like if you can't get a residency in that particular area? Thanks for all the replies everyone!
     
  20. Kpowell14

    Kpowell14 Mizzou c/o 2017 2+ Year Member

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    Sent you a PM! Thank You!!
     
  21. jesskb

    jesskb KSU CVM c/o 2015 5+ Year Member

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    Or if you find something else you like. Seems common about vet school in general. Some people get to the point where they only want to do it because they've planned on it forever even though it's not what they thought or they no longer like it. Be open to changing your mind is I guess what I'm saying.
     
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  22. NStarz

    NStarz Ohio State c/o 2016 7+ Year Member

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    I'll grab some off the tip of my memory and update later (coming off a long string of tough days and I'm SUPER tired). Some are some weird tidbits that I've picked up unique to where I've worked but may help you in some weird/unique situations along the way that others may not tell you...

    1. Kitten maintenance rates are higher than expected - 120 ml/kg/day up to 4-5 months. I've packed kittens with panleuk upwards of 260 ml/kg/day if they've needed it (if they can't handle it, something's usually wrong congenitally, usually. Technically, you can fluid overload a kitten, but it's realllly hard).

    2. Rib fractures RARELY occur in motor vehicle accidents. Especially rib fractures at different stages of healing...think non-accidental injury. If you are suspicious of NAI, come up with a reason to take CXR, you'd be surprised how often you'll find rib fx and you have reason, then, to report animal abuse.

    3. Don't try to solve all of an animal's problems on ER (still struggling with this one). If an animal comes in in CHF, it's really less of a concern to fix the pododermatitis (maybe at a follow up with the rDVM).

    4. Cats can get pyometras. Keep it on your differential list. (This may be a 'duh,' but I was burned my first few times with cat pyos because really, who is silly enough to have an intact female cat in their house?

    5. Don't be stingy on the fluids with UOs. Post-obstructive diuresis is a thing.

    6. I've gone faster to recommending PUs because of $$ (faster than the theoretical 3 strike rule). If an owner can only afford a one time UO then it will be euthanasia if they obstruct the second time, better to give the cat a chance with a UO --> PU then UO --> UO/euth.

    7. Don't judge owners (also struggle with this one, though to a much lesser degree). I have an internmate who not uncommonly tells owners: "we could have saved Fluffy if you brought him/her sooner." NOT COOL, and not the time/place. Sure, if they're bringing in a stable pyo, say "hey next time, spaying will prevent MGTs/pyos/overpopulation, but I am not of the opinion that an appropriate time to do this is when the animal comes in with a BCS 1/9, a sobbing owner, and a creat of 14.5.

    8. Learn from EVERYONE. Techs, specialists, assistants, staff doctors. Be humble. Everyone has something to teach you. There's one doctor here who writes horrific SOAPs. We all dread picking up her cases the next day because we don't understand her plan or what was discussed. She knows what she's doing and is incredibly intelligent. But I've learned that I don't want to write my SOAPs like her (ie, SWO - "UO - very sick, may die" is paraphrasing.

    9. In our experience, doxycycline IV causes a nasty cellulitis when it extravasates. We love it for our URI kitties, but will only give it PO, or diluted and given over 4 hours.

    10. If something's dead, you can't make it deader. Most things will either 1) die or 2) recover without our intervention. It's most important to MAKE A DECISION (learned this the hard way when I ran a code by myself at 1 am).

    11. There are certain drug dosages you need to know by heart. These include: valium and calcium gluconate. Others, you have time to look up (and will remember with repeated usages). Know what drug reverses what sedative.

    12. Know your shock doses. And get comfortable guesstimating an animal's weight in your head (and confirming with others - ha! Do you guys think this dog looks about 40 lbs? Yeah? Okay, give a bolus...)

    13. Stress is a big killer of cats. If a cat can't breathe - hands off. Throw it in oxygen +/- drugs. Agree with someone above that everything should be able to handle one dose of lasix. I like torb as my first go to.

    14. Don't be lazy. You're there to learn, and you're only there for a year - make the most of it.

    15. The stress of internship isn't that bad, it's all the personal stuff that creeps up during the year that makes it unbearable at times. Have good coping mechanisms in place. You'll need them.

    That's all for now. Hope some of this was helpful!!

    ~N
     
  23. that redhead

    that redhead 7+ Year Member

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    So I didn't do an internship, but as a general new vet-

    * Yes to the notebook - drug doses, basic diagnostic plan for commonly presenting things (GI, skin, etc) but can also jot down things to read up on as time goes on.
    * Things to review - clin path (including u/a), basic chest/abd rads
    * Have your VIN password memorized

    I wanted to specialize in lab animal before I was accepted. I did all the things geared toward lab animal med and had a solid residency application. Applied broadly, rejected everywhere. Working in SA GP now but actively trying to get back to lab animal med. Moral of the story: be prepared for set backs. Have a back up plan. Do NOT gear your entire vet education toward one niche. Hopefully it works out, but if it doesn't, what would your plan be? That sort of thing.
     
  24. cheathac

    cheathac Purdue c/o 2021!!! 2+ Year Member

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    Thanks!!! This is very helpful. Is there a reason as to why you didn't get into a residency? I'm hoping me being involved early will help but isn't certain by any means. I can't help but be energized when I work. Today, I saw the heart of a pig beating while in it's chest. Wires/thrombocatheters were being tested. I was in awe and loved it.
     
  25. that redhead

    that redhead 7+ Year Member

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    I was told by multiple places that a lot of already experienced applicants had applied that year. Another friend applying to LAM residencies was told the same. I had a ton of lab animal experience throughout my undergrad and into vet school, an ASLAP award, rotations in fourth year, good letters...just wasn't meant to work out at that time it seems. It is truly an amazing field :) Try to go to the AALAS conferences and network or even join the various associations if you're able to- most offer student discounts.

    I should add: the vast majority of older vets I know who are specialized (lab animal, path, etc) did some time in GP before moving on. It's okay to go that route!
     
    Last edited: May 24, 2017 at 4:51 PM
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