Feeling nervous about becoming an intern?

[psych72]

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Hey everyone,

I am finishing up 4th year going into ACMGE psychiatry program, I go to a DO school where we have a good majority of preceptor based rotations/private hospitals. I think our school does a good job for the most part. However, as a medical student, I have not had a lot of exposure to procedures (particularly because I was too scared to), and more importantly tot he whole discharge planning/dictating scheme of things.

I know this varies by resdiency, but since I have a little bit of time off, seeing though I can't take COMLEX level 3, until I graduate, I thought I'd practice a little, so that I don't look completely incompetent and have a hard time adjusting come intern year. I know you learn majority of things on the job, but I think my 4th year schedule has been too soft, and I honestly, can't remember the last time I wrote a note. It's primarily just been presenting.

I did a few sub-I's in Psychiatry, but my responsibilities as a medical student were limited.

Thanks

 

[22031 Alum]

I'd be more worried about you if you weren't nervous. I don't know much about the DO school to Allopathic residency transition, but I do know that the vast majority of programs consider interns empty vessels, ready to be filled with knowledge. Specifically, knowledge of the program's way of doing things. You might as well relax so you can start off refreshed and energetic, rather than teach yourself some bad habits in an attempt to get ahead. Besides, there isn't much discharge planning or dictation practice you can learn on your own.

 

[Wolf02]

Thank goodness! I didn't match last year but I matched this year and I'm super nervous. I'm trying to read as much as I can, but I feel like I've forgotten EVERYTHING! And am going to suck so bad.

 

[22031 Alum]

Thank goodness! I didn't match last year but I matched this year and I'm super nervous. I'm trying to read as much as I can, but I feel like I've forgotten EVERYTHING! And am going to suck so bad.

Reading is always a good idea.

 

[Gastrapathy]

Internship is about showing up on time and owning your own work. If you resolve to come in each day and work until you are done, you will cruise.

That said, first impressions matter. If you tell them "I'm a nervous DO student with a year off and I need help"...they will find you weak rather than self-aware. Fake it for a couple months and you'll be fine.

 

[Law2Doc]

Hey everyone,

I am finishing up 4th year going into ACMGE psychiatry program, I go to a DO school where we have a good majority of preceptor based rotations/private hospitals. I think our school does a good job for the most part. However, as a medical student, I have not had a lot of exposure to procedures (particularly because I was too scared to), and more importantly tot he whole discharge planning/dictating scheme of things.

I know this varies by resdiency, but since I have a little bit of time off, seeing though I can't take COMLEX level 3, until I graduate, I thought I'd practice a little, so that I don't look completely incompetent and have a hard time adjusting come intern year. I know you learn majority of things on the job, but I think my 4th year schedule has been too soft, and I honestly, can't remember the last time I wrote a note. It's primarily just been presenting.

I did a few sub-I's in Psychiatry, but my responsibilities as a medical student were limited.

Thanks

I ended up picking up an elective or two senior year that were procedure heavy exactly for the reasons you suggested. I doubt it impacted my knowledge base but did provide a comfort level.

 

[link2swim06]

I don't know of any psych residents who are performing any procedures besides ECT (and that is rare).

Even on your required medicine months, your fellow residents will gladly take your procedures if you don't want to do them. I guess it depends on what non-psych rotations you have to do...

 

[Mass Effect]

I don't know of any psych residents who are performing any procedures besides ECT (and that is rare).

Even on your required medicine months, your fellow residents will gladly take your procedures if you don't want to do them. I guess it depends on what non-psych rotations you have to do...

All programs require 4 months of IM and two months of neuro. Some programs add on a month of EM and a month of ICU where you likely have the opportunity to do procedures. Just depends on your program. But I agree that in those procedure-heavy fields, there will be other residents who will gladly do it.

 

[link2swim06]

All programs require 4 months of IM and two months of neuro. Some programs add on a month of EM and a month of ICU where you likely have the opportunity to do procedures. Just depends on your program. But I agree that in those procedure-heavy fields, there will be other residents who will gladly do it.

All programs? I thought I remember the program where I went to med school only requiring 1 month. I was friends with a couple of residents and it was their least favorite rotation of the year. And that was just floor medicine...almost no procedures unless you were to seek them out.

 

[ksharp33]

All programs? I thought I remember the program where I went to med school only requiring 1 month. I was friends with a couple of residents and it was their least favorite rotation of the year. And that was just floor medicine...almost no procedures unless you were to seek them out.

Yes, ALL ACGME-accredited psych programs require 4 months of medicine (some of the months can be substituted for EM/primary care/peds depending on the program) and 2 months of neuro.

 

[Mass Effect]

All programs? I thought I remember the program where I went to med school only requiring 1 month. I was friends with a couple of residents and it was their least favorite rotation of the year. And that was just floor medicine...almost no procedures unless you were to seek them out.

As @ksharp33 said, ALL ACGME psych programs require 4 months of medicine. Also, floor medicine does have procedures (central lines, LPs, etc).

 

[link2swim06]

As @ksharp33 said, ALL ACGME psych programs require 4 months of medicine. Also, floor medicine does have procedures (central lines, LPs, etc).

Interesting.

You might get a few LP (which would other people would be eager to take)...but I have never put a central line in on the floor. Not to mention there is really no reason a psych intern should be putting one in...but maybe different hospitals have different cultures.

 

[Raryn]

As @ksharp33 said, ALL ACGME psych programs require 4 months of medicine. Also, floor medicine does have procedures (central lines, LPs, etc).

As a medicine resident, I've worked with a number of psychiatry interns and can say that I've never made one do any procedures. Mind you, I've given them the option to, and even staffed one for a central line before because she wanted to do one and it was her patient... but if they aren't interested, I'd much rather staff one of my own medicine interns to learn how to do it. Or even just do it myself.

 

[Mass Effect]

Interesting.

You might get a few LP (which would other people would be eager to take)...but I have never put a central line in on the floor. Not to mention there is really no reason a psych intern should be putting one in...but maybe different hospitals have different cultures.

Unless the psych intern wants to do it. At my hospital, psych interns are treated like medicine interns (or prelim years) during their medicine months. No one is forced to do procedures, but if they want to, they can. And yeah, we do central lines on the floor.

As a medicine resident, I've worked with a number of psychiatry interns and can say that I've never made one do any procedures. Mind you, I've given them the option to, and even staffed one for a central line before because she wanted to do one and it was her patient... but if they aren't interested, I'd much rather staff one of my own medicine interns to learn how to do it. Or even just do it myself.

Right. As I said above, there will always be other residents who want to those things, but if you want to do them, you can. At least at my place you can.

 

[psych72]

Internship is about showing up on time and owning your own work. If you resolve to come in each day and work until you are done, you will cruise.

That said, first impressions matter. If you tell them "I'm a nervous DO student with a year off and I need help"...they will find you weak rather than self-aware. Fake it for a couple months and you'll be fine.

Luckily, I 'm good at that. I think my biggest struggle is the plan/management aspect of it, the transition of actually being alone and making clinical judgement (i.e. not to to bring' someone's pressure too low in hypertensive encephalopathy---should I give them hydralazine or labetalol??!!) I know someone people say google it, but I'm honestly so paranoid I'd probably take an hour to look at what study is best and won't get the order in on time haha

But I'm hoping that specific hospitals have specific protocols online that will be consistent with pharmacy availability too.

 

[McSap]

Luckily, I 'm good at that. I think my biggest struggle is the plan/management aspect of it, the transition of actually being alone and making clinical judgement (i.e. not to to bring' someone's pressure too low in hypertensive encephalopathy---should I give them hydralazine or labetalol??!!) I know someone people say google it, but I'm honestly so paranoid I'd probably take an hour to look at what study is best and won't get the order in on time haha

But I'm hoping that specific hospitals have specific protocols online that will be consistent with pharmacy availability too.

There really are very few medical emergencies that need absolute immediate action - and your ACLS training and ABCs will get you through these till help arrives. Everything else you will have a bit of time to ask and think about / look up a plan to run by your senior. The most important part is asking for help early.

 

[mvenus929]

The key is to ask for help when you need it, but make some attempt at figuring things out yourself. For instance, I had a patient who was admitted for pneumonia who suddenly had worsening facial edema, and it turns out had just been taken off a diuretic. I called e senior immediately after assessing her, and then talked out my plan when he arrived.... I had stopped the fluids for now, but wasn't sure whether to give Lasix now or not, given that I couldn't hear any pulmonary edema due to the pneumonia. We ended up calling in the attending and she threw everyone for a bit of a loop, but I attempted to think through things before calling my senior, and still called for help when I thought I needed it.

Don't be the intern who sees something odd and potentially dangerous and waits several hours to bring it up because you don't want to appear weak.

 

[link2swim06]

The key is to ask for help when you need it, but make some attempt at figuring things out yourself. For instance, I had a patient who was admitted for pneumonia who suddenly had worsening facial edema, and it turns out had just been taken off a diuretic. I called e senior immediately after assessing her, and then talked out my plan when he arrived.... I had stopped the fluids for now, but wasn't sure whether to give Lasix now or not, given that I couldn't hear any pulmonary edema due to the pneumonia. We ended up calling in the attending and she threw everyone for a bit of a loop, but I attempted to think through things before calling my senior, and still called for help when I thought I needed it.

Don't be the intern who sees something odd and potentially dangerous and waits several hours to bring it up because you don't want to appear weak.

Yep. Exactly. As the year progresses you will slowly gain more skills and competency. Also you learn your senior residents and attendings preferences and know who needs called for what.

I remember day one I had to call my sleeping senior to figure out correctly replace potassium. Last week (about 9 months later), I called 'just as a heads up' to my asleep ICU senior because I was about to have anesthesia intubate our pt and I was about ready to put an IJ in and start pressors. It's all about what both you and your senior are comfortable with you doing.