Does intern year really mean anything

[fw5tape6kq]

I'm trying to set up my match list for TY years and basically have it between MSKCC - which is a somewhat more involved, labor-intensive and rigorous TY - vs. a very relaxed community hospital TY in my home state. I'd love to have people weigh in on what they think the TY year means in regards to Rad Onc- if anything - and, in that vein, if there's anything that I stand to gain by going the more punishing route and spending the year in NYC. Are there are research opportunities or connections to be made in the TY that would make a more rigorous program worthwhile? Or should I just go with the one with the easiest life, most electives, lower cost of living, etc?

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[Chartreuse Wombat]

Intern year is difficult enough, why make it harder? I chose the easier route nearly three decades ago and I have yet to meet anyone who said "I should have taken a more rigorous internship year". With duty hours things may have changed but back in the day intern year was a year to survive, learn a few things with an eye towards oncology and be happy when it is over.

 

[medgator]

If doing pp and you have no desire to stay in the NYC area, I don't see the point of the mskcc year

 

[fw5tape6kq]

If doing pp and you have no desire to stay in the NYC area, I don't see the point of the mskcc year

Hope to do academics, but even so, not sure if doing intern year at MSKCC really gives me much of a leg up in that area?

 

[Neuronix]

Hope to do academics, but even so, not sure if doing intern year at MSKCC really gives me much of a leg up in that area?

Doesn't mean anything and won't do anything for your career.

 

[OTN]

I did a medicine intern year at a prestigious, hardcore academic medical center. It's had no real bearing on my career, and in hindsight I should have gone with something easier. At the time, though, I was so focused on getting into radonc I didn't want to spend much energy on the intern year question.

 

[evilbooyaa]

No significant value, IMO.

Anecdotally, if you're doing a TY year that focuses more on cancer specialties (primarily surgical, including exposure to things like ENT, thoracic, surg-onc, maybe urology and ortho-onc, as well as some med-onc) I could see it being marginally useful. Not massively so and definitely not worth overtly justifying a year of pain, but I would consider signing up for a TY that was more cancer focused and not standard inpatient medicine (PNA, CP, PE, ESRD, etc. etc.)

 

[BobbyHeenan]

I will be a bit of a contrarian here on my opinion.

1. I do not think where you did your intern year has any bearing on your marketability or prestige.
2. The utility/advantage gained from doing an intensive medicine year will all depend on your overall practice once you're out. If you are in a stand alone outpatient center without inpatient consults and treating well to do patients with good PCP/med onc care then being an amateur internist isn't really needed.
3. I practice in a hospital based practice and a TON of my patients have minimal if any primary care; or they're staying in town for their radiation while their semi-retired PCP is out of town and only sees patients twice per week. I am asked to weigh heavily on inpatient management (ie interacting daily with the medicine team) and because of poverty or whatever reason I have a lot of patients with no PCP. In an obese patient with no PCP who then is tasked with starting insulin when their blood sugars are out of control because of the steroids for their brain met? When they're dehydrated from their cancer therapies with BP dropping who decides which anti hypertensive to come off of first? A lot of this stuff you can learn in your training if you have a brisk clinical program...but I still lean on my prelim internal medicine year where I also had a once a week PCP clinic. It was a pain in the as* at the time, but sometimes I'm happy to have that experience in my back pocket. I'm very much of the opinion to "stay in your lane" when managing patients...but sometimes you just have to do what you can do to keep them out of hte ER or do as best you can when they have no other doctors or no resources.

With all that said, I think I'd take the cush TY year. The silver lining if you do land a rigorous TY is #3. Agree with above though that for electives in prelim or TY things like palliative care (really good at pain and symptom mgmt in my experience), urology, surg onc, or gyn onc can be helpful. Things to avoid: ICU - you don't need to know how to run a vent.

 

[seper]

I agree. 8 years later, I still rely of on my intern training to pick out patients who need to be sent to ER, how to diagnose a UTI, to treat COPD exacerbation, what to do about high blood pressure reading... etc. Pretty useful year professionally.

 

[Mandelin Rain]

I agree. 8 years later, I still rely of on my intern training to pick out patients who need to be sent to ER, how to diagnose a UTI, to treat COPD exacerbation, what to do about high blood pressure reading... etc. Pretty useful year professionally.

Yup, agree with this. It's really your one chance/year to learn general internal medicine. And you will need at least some basic knowledge of medicine as any kind of doctor.

I don't think that a rigorous or highly focused year at a tertiary academic center is likely to give you the broadest mix of general IM problems that you'll routinely face in the clinic. I think a community TY program is probably the way to go. Not just for the more chill vibe, but for the spectrum of pathology you'll see/manage. You want to be seeing hypertension, chest pain, GI bleed, and COPD rather than liver transplant or motorcycle vs semi truck type patients.

 

[kristofer]

I'll echo this. I did a "real" intern year in medicine and found that it made me a much better doctor. Although it was at a major academic institution, the majority of the patients were bread and butter admissions (diabetic complications, bleeds, CHF, COPD, withdrawals, ID, etc. not trama/transplant, which typically wouldn't be on a med service anyway), but just an indigent patient population. A month on inpatient onc was also helpful. Third and fourth year at my med school were terrible, and I was very clinically deficient when I graduated. Intern year fixed that. It's also a slight red flag to say you want to do a cushy TY, and the reality is there are very few of these anyway. Most often a TY just buys you an extra elective month and one less wards month. Why not focus on medicine and become more proficient at it? Especially if you are going to have to move a long way away just to do a TY.

 

[Krukenberg]

I would agree with all who value a rigorous intern year. I did my intern year at a major medical center and oncology center and wouldn't trade it for a cush TY. I was easily able to trade away my specialty inpatient rotations for the inpatient oncology service, and got a ton of experience taking care of oncology patients hospitalized for either direct sequelae of their cancer or cancer treatment. I would say at any given time 50-75% of my patients either (a) had an inpatient indication for radiation treatment, or (b) were hospitalized due to an acute radiation toxicity, or (c) had gotten radiation in the past and were either free of late toxicity or had clinically relevant late toxicities. Obviously all three are super relevant to my career as a rad onc. I saw lots of spinal cord compression, painful bone mets, hemoptysis, GI obstruction, etc that ultimately got inpatient radiation. I saw what cancer patients actually die of, which makes me appreciate the importance of local control for select disease sites. Additionally I got to see toxicities of chemotherapy, learn about general oncology, get tons of experience with general palliative care, and become a more complete doctor through IM training. I think seeing onc and radiation patients from this perspective will give you a big advantage if you care about being a complete clinical oncologist and not just a radiation oncologist. Certainly possible to become one through the right training program but I suspect a minority of programs could replace the experiences I had with my intern year.

 

[Reaganite]

Chose a cush ty and would do it again all day, every day over a tough prelim med year. Did 1 month of IM during that year and hated every second of it. Have never felt my management of patients has ever been compromised. My referring docs dont want me managing their patients blood sugars, blood pressure, etc.

 

[scarbrtj]

I did a surgical intern year. Spending time in the OR doing prostatectomies or LARs or lobectomies or Whipples was actually very beneficial. Of course this was in the old days when the whole of rad onc itself was a bit more fluid. If you're a rad onc that goes to the OR a lot like for HDR catheters or implants, it would be very helpful I think. It was good to see how the neurosurgeons approach craniotomies and see the 3D guidance tech for that. Great to see ENTs doing neck dissections. Assist in a mediastinoscopy. Of course, getting up at 430AM to make it to the hospital for rounds and being on call every third night for some of the rotations was a pain. But in retrospect, it was a good year. I'm a big fan of practicality. Taking care of patients in a rheumatology or diabetes or cardiology clinic is maybe not the best use of your time for intern year, but who knows.

 

[BobbyHeenan]

I did a surgical intern year. Spending time in the OR doing prostatectomies or LARs or lobectomies or Whipples was actually very beneficial. Of course this was in the old days when the whole of rad onc itself was a bit more fluid. If you're a rad onc that goes to the OR a lot like for HDR catheters or implants, it would be very helpful I think. It was good to see how the neurosurgeons approach craniotomies and see the 3D guidance tech for that. Great to see ENTs doing neck dissections. Assist in a mediastinoscopy. Of course, getting up at 430AM to make it to the hospital for rounds and being on call every third night for some of the rotations was a pain. But in retrospect, it was a good year. I'm a big fan of practicality. Taking care of patients in a rheumatology or diabetes or cardiology clinic is maybe not the best use of your time for intern year, but who knows.

It may have been self selecting, but I found that my co residents that did a surgical year were much better at procedures than I was (prostate/gyn brachy). Whereas, I felt like I had more of a handle on the medicine side of things.

 

[evilbooyaa]

It may have been self selecting, but I found that my co residents that did a surgical year were much better at procedures than I was (prostate/gyn brachy). Whereas, I felt like I had more of a handle on the medicine side of things.

I can second this. Having some comfort with OR/scrubbing prior to Rad Onc doesn't hurt in the short term with procedural stuff. Probably doesn't make a huge difference in the long-term, but may affect what people are interested (or disinterested) in during their residency years.

 

[medgator]

I can second this. Having some comfort with OR/scrubbing prior to Rad Onc doesn't hurt in the short term with procedural stuff. Probably doesn't make a huge difference in the long-term, but may affect what people are interested (or disinterested) in during their residency years.

Let's be honest....how much OR time do surgical interns get, esp prelim vs categorical.

I may be cynical but that's the story I've heard

 

[Neuronix]

Let's be honest....how much OR time do surgical interns get, esp prelim vs categorical.

I may be cynical but that's the story I've heard

Where I went to med school the surgery interns never saw the inside of the OR except to transport a patient out of it or into it.

The medicine interns never went to lecture and tried to ignore/avoid rounds as much as possible. They were there to write notes, place orders, make phone calls, do social work, etc. There was no learning involved. I was despised as a sub-I because I actually paid attention on rounds and asked a lot of questions to the attending. The goal of rounds was to get out of them as quickly as possible. And no these weren't your hours long medicine rounds. They were usually about 20 minutes once a day, though with some attendings it wasn't even that.

When I was done med school, I found a cush TY with plenty of electives. I took them all in oncology and oncology-related disciplines. I did a research elective at my residency program and got two early residency first author papers. I went to every lecture offered (usually two per day). I felt like I learned way more than I could have getting my butt kicked on the floor with inpatients when I would never see inpatients again as an outpatient radiation oncologist.

I guess we all have different experiences in these regards. It's not like anyone has ever cared or commented where I did my internship. I feel plenty competent as a radiation oncologist.

 

[scarbrtj]

Let's be honest....how much OR time do surgical interns get, esp prelim vs categorical.

I may be cynical but that's the story I've heard

Well, no time, now. But in the Wild West in 1998, we were in the OR quite a bit and doing quite a lot. At the VA the chief residents were essentially attendings and the non-chiefs all the way down to the intern were chief-ish or chief-lite, situationally. Those were the days, when men were men, blah blah blah.

 

[medgator]

Well, no time, now. But in the Wild West in 1998, we were in the OR quite a bit and doing quite a lot. At the VA the chief residents were essentially attendings and the non-chiefs all the way down to the intern were chief-ish or chief-lite, situationally. Those were the days, when men were men, blah blah blah.

120+ hour work weeks, walking uphill in blizzards both ways to the hospital etc

 

[Chartreuse Wombat]

Let's be honest....how much OR time do surgical interns get, esp prelim vs categorical.

I may be cynical but that's the story I've heard

Hurray cynicism!
To the point-
In 1989-90 I did a TY internship that included 5 elective months of surgical subspecialties (urology, gyn oncol, head and neck, general oncology and thoracic). I can tell you that I spent more time in the OR than the poor general surgery interns who were sentenced to the floors or the ER. I was scrubbed in as first assistant on prostatectomy, laryngectomy, thyroidectomy, radical hysterectomy, etc. The experience was invaluable (I actually learned more gyn brachytherapy as an intern spending a month with a surgeon who did fellowship at Anderson with Fletcher). Oh and the internship included a free membership at golf club (not too fancy) but a great place to take out some aggression and relax at the same time.
From an academic perspective where you do your internship is meaningless, but you will gain valuable clinical experience if you choose wisely (sorry).

 

[evilbooyaa]

Let's be honest....how much OR time do surgical interns get, esp prelim vs categorical.

I may be cynical but that's the story I've heard

Not a lot but I (was forced to) scrubbed in about 5-10 cases a month as a first assist. Not the awesome breadth of oncologic experiences that Chartreuse and Scarbrtj seemed to have had, but enough to know how to scrub and not break sterile field, position patient, some manual dexterity, etc.
I doubt that any of that will be a long-term benefit to me, but it did get me some praise when I started residency.

Again - not advocating for that for incoming residents - but to try to pick something where you're going to learn, especially about cancer patients, to me, is never not useful. If I could go back and do a TY where I rotated on a bunch of surgical services for half the year that were all onc focused (like laryngectomies and neck dissections, not rhinoplasty or any of the non-oncologic stuff ENT does) that'd be pretty useful IMO. We have to cover post-surgical stuff so often, it's useful to have seen what a PJ looks like in the patient in a Whipple.

 

[scarbrtj]

When fiducial marker placement for prostate IGRT became a doable/usable thing thanks to technology, in 2004 I started doing in-office marker placement. My former attending back where I trained said "You're a brave man." I knew what bowel preps were like and what to Rx, antibiotics to prophylax with, and I just inserted a probe in a guys rectum and transrectally placed prostate markers no prob, sans fear, and had never done it before. Thanks intern year. Thousands of patients later, I'm still brave.