Anyone have any tips for intern year?

[lvspro]

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Dear wise one
So I'm on the road towards intern year, and I'll admit that I'm a little nervous. Hell, seeing as to how this is in private between us, I'll confide that I'm $hitting myself. It doesn't help that I finished my last rotation 1/2 way through February, which adds up to a 4.5 month hiatus from any patient responsibilities before I start.
Anyhow, oh wise one, I'd be blessed if you could drop little hints about things like books, and the like, that would be helpful during this time of stress.
Pictures of naked women, and fine whiskies are also appreciated, so please feel free to send any correspondence to the postmarked address.
Sincerely
lvspro

p.s. I realize other threads like this have been started, but I felt the title on this one was less ambiguous.

 

[pushthesux]

If it makes you feel any better...I, too, am feeling a little nervous. And...I, too, have not seen a patient since January.

I'd love to spend some time reading something, but I can't decide what might be good. Let me know if you figure something out. Thanks for starting this thread too. I was thinking of doing the same. Surely someone has some monumental advice.

 

[mikeshana]

I would just take it easy for the next few months, because starting july1, your life will COMPLETELY change. I also thought reading something prior to internship would help, but it does not. On call you will be dealing with things like BP, no urine output, pain, etc. The best thing to do would be to follow another intern around and see how the handle these specific problems. 1 month into internship and you will feel comfortable handling these specefic issues as most of these issues jus require a little common sense. If you have any issues there should be a senior resident u could call (and NEVER be afraid to call them even at 3am---I probably will feel different about this in 4 months)) So in the meantime enjoy the little time you have left

mike

 

[MSfour]

I completely agree with the previous reply. Internship is all about the grind. Efficiency, self-reliance and stamina are as important as what you know. Don't bother studying, you'll learn as you go like we all do, and you'll make it through like we all do. Last year, I finished med school before the match and travelled the entire Spring. Like you, I was a little nervous that I'd be "rusty", but it didn't really matter. If you're doing a medicine internship like me, all you'll need to know are the basics. 95% of your patients will be COPD exacerbation, r/o MI, generalized weakness (which, in a GOMER, equals UTI/dehydration), CVA, etc. Don't spend even a second reading about any of those obscure diseases you studied for on Step I/II because you'll never see them in real life. Just relax now, because the hardest part about internship is just going in every day and surviving all the endless call nights and excruciatingly painful rounds (if you're going into anesthesia you must, by definition, hate rounding). Good luck + go drink some beers and chill out while you still can. 😉

 

[militarymd]

Many have travelled this road before....you'll fare just like them.

 

[VentdependenT]

pocket pharmacopia
maxwells
current clinical stratagies: medicine (no brainer order set guide, your best friend at 3 am on your 5th admit)
tarascon pocket critical care
pocket medicine

these be little books that'll save your a$$ and wont weigh you down
Up To Date has the rest.
Get through The ICU book and baby miller and yer set.

Like MMD said, we've all been there and made it. You will too.

 

[Sugar72]

I'm going to watch the entire first season of Grey's Anatomy...it's just like real life right?

 

[Stillinscrubs]

Gomers, lmao.....I haven't read that book in years.

Thanks for the book list Vent. I have most already, but might get the others.......

 

[lvspro]

Thanks everyone, and especially the ever-informative Vent.


Now, back to paying homage to the magic refrigerator.

 

[joncmarkley]

If you are a computer savy person i recomend getting a pocket pc and getting some of skycapes software like 5mcc and NDH06 excellent programs. NDH06 will tell you how to use a drug, when, when not to, what to dilute it in (and of course what not to dilute it in) and the rate to give it. It is like having an attending in your pocket 24/7

good luck, you will do well. it is a very rewarding year

 

[ThinkFast007]

If you are a computer savy person i recomend getting a pocket pc and getting some of skycapes software like 5mcc and NDH06 excellent programs. NDH06 will tell you how to use a drug, when, when not to, what to dilute it in (and of course what not to dilute it in) and the rate to give it. It is like having an attending in your pocket 24/7

good luck, you will do well. it is a very rewarding year

what does NDH06 stand for?

 

[joncmarkley]

NDH06 - nurse drug handbook by scyscape. makes epocrates look like a joke. It is the most detailed program out there. once you get into anesthesia i recomend anesthesia drugs by skyscape as well

 

[joncmarkley]

by the way greys anatomy is nothing like real life but scrubs season one is just like being at work (this season sucks)! much more real than ER or greys

 

[Sugar72]

by the way greys anatomy is nothing like real life but scrubs season one is just like being at work (this season sucks)! much more real than ER or greys

mmm i frequently step to one side and soliloqui-ize....so I think you are right...I will prepare by watching scrubs.

 

[Mman]

NDH06 will tell you how to use a drug, when, when not to, what to dilute it in (and of course what not to dilute it in) and the rate to give it. It is like having an attending in your pocket 24/7

I can count on 1 hand the number of times I have had to decide what we were going to dilute a certain drug in and that's because the patient had major electrolyte issues. I've also never once been asked what rate to give a medicine at, other than perhaps an amio bolus. The only things I have ever had to do are indications and contraindications and interactions with other meds/medical problems.

 

[joncmarkley]

dear Mman

You may have inherent knowledge of how fast to give drugs but the rest of us needed to learn it. For example coming out of med school I did not know ampicillin has a risk of seizure if pushed faster than 100 mg per minute. Nor did I know vanco's minimum amount of fluid to be given in is 250 cc nor did I know aminoglycocides have increased ototoxicity if given to fast ( to name a few). As far as what fluid to dilute things in I didn't know out of medical school which drugs are recommended to be given in d5w vs. what can be given in more physiologic solution like NS and LR.

my point is nd06 helped put my mind at ease hen I was writing for a drug like iv potassium or magnesium for the first time at 3 am on july 2nd with no supervision

later

 

[Koil Gugliemi]

Not to sound like too much of an idiot...but you really don't need a super-definitive pharm. ref. book and 5 other books in your white coat making you look like a walking library, and you don't really need an extensive collection of computer programs. Epocrates is free and good for looking up usual doses of things (your admits will never remember or will be wrong). For any drug that you're not sure about, pick up the phone and call your hospital's pharmacist and ask 'em, while double checking on one of the many pharm. reference things on the computer. They're there 24/7, and have usually dispensed the drug hundreds of times and will know what the deal is. I often did it right from the ED while writing the H+P. No need to look it up only to have them page you an hour later with their specific protocol...

For differentials of common presentations, and specific management stuff, look it up on up-to-date while writing the H+P, while simultaneously calling the attending to tell 'em what you think before writing the orders (if possible). Their pretty much gonna tell you what they want and you might as well know what they're gonna want before you move on to the next admit.

Efficiency is the key, more so even than knowledge. See the patient, sit at a computer and look up old history (previous D/C summaries are like H+P cheat sheets) and page the attending as you start writing. If you're lucky, they'll call back as your getting to the plan and by time you finish the orders the patient will be completely tucked in and you can move on to the next one on the list. By the end of the first month you'll start to get fast, and fast is good.

 

[VentdependenT]

Not to sound like too much of an idiot...but you really don't need a super-definitive pharm. ref. book and 5 other books in your white coat making you look like a walking library, and you don't really need an extensive collection of computer programs. Epocrates is free and good for looking up usual doses of things (your admits will never remember or will be wrong). For any drug that you're not sure about, pick up the phone and call your hospital's pharmacist and ask 'em, while double checking on one of the many pharm. reference things on the computer. They're there 24/7, and have usually dispensed the drug hundreds of times and will know what the deal is. I often did it right from the ED while writing the H+P. No need to look it up only to have them page you an hour later with their specific protocol...

For differentials of common presentations, and specific management stuff, look it up on up-to-date while writing the H+P, while simultaneously calling the attending to tell 'em what you think before writing the orders (if possible). Their pretty much gonna tell you what they want and you might as well know what they're gonna want before you move on to the next admit.

Efficiency is the key, more so even than knowledge. See the patient, sit at a computer and look up old history (previous D/C summaries are like H+P cheat sheets) and page the attending as you start writing. If you're lucky, they'll call back as your getting to the plan and by time you finish the orders the patient will be completely tucked in and you can move on to the next one on the list. By the end of the first month you'll start to get fast, and fast is good.

so is writing PRN orders man.

Goal is always to move the body off your service. So push to get your scans performed and read. Get down there to radiology for the prelim read and move the body. Bottom line, befriend a radiology resident. Get cuddly with your consultants too.

 

[Mman]

dear Mman

You may have inherent knowledge of how fast to give drugs but the rest of us needed to learn it. For example coming out of med school I did not know ampicillin has a risk of seizure if pushed faster than 100 mg per minute. Nor did I know vanco's minimum amount of fluid to be given in is 250 cc nor did I know aminoglycocides have increased ototoxicity if given to fast ( to name a few). As far as what fluid to dilute things in I didn't know out of medical school which drugs are recommended to be given in d5w vs. what can be given in more physiologic solution like NS and LR.

my point is nd06 helped put my mind at ease hen I was writing for a drug like iv potassium or magnesium for the first time at 3 am on july 2nd with no supervision

later

I guess your hospital is a little different than the one I work at. I'm not allowed to dictate how fast the potassium or magnesium runs in, or any other drug unless it's a code. Vanc, gent, whatever. All the physician is allowed to do is specify the dose and interval between doses.

 

[supahfresh]

surgery pearls

1. Don't trust anyone
2. Eat when you can
3. Sleep when you can
4. Don't complain

 

[Frank Rizzo]

drink heavily

 

[iron]

I will also put in a vote for Current Clinical Strategies. The one I liked as an intern had admit orders for a variety of common conditions in I.M.. For example, "Community Acquired Pneumonia" "upper GI Bleed". They gave me a framerwork to start with. Only thing I didn't like was they didn't have Allergies:______ . So I would routinely get paged in the middle of the night by the pharmacy asking if the patient had allergies. Argh!
The anesthesia one was also very handy as resident.

 

[Carm]

You need to be a note taking machine. What I mean is to constantly be updating your "to do" list during the day. Most of hte time the overall plan will be laid out by staff or the chief, and you primary goal is to make the plan happen. If this sounds like secretarial work.....it is. The better you are as an intern at making the plans happen, and taking care of trivial matters the more value you have to your team. As a student you get credit for being a pimp answering machine, as an intern you get credit for being a work horse.

 

[lvspro]

So
It seems that the general consensus is that I should:
1. Drink plenty of alcoholic beverages.
2. Do as little as possible until I start.

I've already had my week of liver abuse, and quite frankly, I don't think I wanna see alcohol for at least a couple of months (the alcoholic "moment of clarity" may be talking right now). I've got 2 vacations to warm islands lined up, and I'm gonna make it out to see some family members that live, like, 60 miles away... otherwise, I'll be quite the unproductive sloth for about a month. When my grad cert comes in, I'm registering for step 3, and am gonna get it out of the way before intern year, and yes that is possible b/c I have a friend that just did it🙂

Anyhow, any other tips are appreciated, and I like the feedback I'm getting.


btw, Carm, good advice. I worked an IP FP rotation, and our IM interns were in clinic in the afternoons, so I was the pimp-answering machine, and the ultra-efficient intern in the afternoon. It was nice, b/c I volunteered to do everything, and the senior would just go through and sign all the orders/dc's/admits/ and notes. She had the benefit of being able to get out of scut, and I benefitted b/c it kinda taught me to be efficient. I realize a month is not gonna do much to prepare me, but I think it may have helped.

 

[TheSandMan]

Discovered "The Washington Manual Internship Guide" half way through intern year, and its great. Under 200 pages and gives you a quick breakdown on what to do in different situations. If you really want to read something before intern year, this is the only book I'd read.
Even if you read nothing at all, you'll still be in good shape b/c A.) everyone is starting on the same page as you and any reading they've done is not going to make all that much of a difference, and B.) you learn so much intern year that pretty much any upper year in any field will be a good resource to bounce your thoughts off of and almost all are more than willing to teach (lets face it man, chances are if your in medicine, you love to teach and help others out).

Some excellent pocket reference books have already been mentioned and up-to date is key.

Biggest key point to remember, its true what everyone says- intern year beats being a med student anyday (atleast after u make it through the first few days). And, like you've heard many times by now I'm sure, do all the traveling and stuff you want to do now b/c this is the last time u will have this much time on your hands. Seriously guys/gals, you've earned it, so enjoy