First intern rotation...

[DocWasabi]

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Now that the end of June is rapidly approaching, I'm starting to get a little nervous. Anyway, I just found out today I'm starting my internship on the liver transplant service. (plus the call is q2 from home...weird). I never got a chance to do any transplant rotations as a 3rd or 4th year student. Any advice/tips on what I should do or read so I only appear mildly incompetent? 😉 Thanks.

 

[blue2000]

As a intern who's supposed to start on pediatric surgery (a topic I know, um, zero about) I am hoping to obscure my ignorance about pediatric surgery with my overwhelming ignorance at how to be a surgery intern, and go with it. And I've read a very small part of the Sabiston peds surgery chapter, when my anxiety gets really revved up. After about thirty minutes of reading, I take a nap. I'll let you know how my "preparation" panned out. 😳

 

[UI2003]

Now that the end of June is rapidly approaching, I'm starting to get a little nervous. Anyway, I just found out today I'm starting my internship on the liver transplant service. (plus the call is q2 from home...weird). I never got a chance to do any transplant rotations as a 3rd or 4th year student. Any advice/tips on what I should do or read so I only appear mildly incompetent? 😉 Thanks.

I started on Transplant in July two years ago too. My advice would be:

1. Let all your OCD tendencies run free - transplant patients can be incredibly complex and your number 1 defense is your ability to know EVERYTHING (labs, meds, vitals, surgeries, their 3rd cousin's roomate's step daughter's cat's brand of kitty litter).

2. Read up on all the side effects of the transplant meds commonly used. Attendings hate it when residents can't recite basic immunology.

3. If you have a question - Ask. If you aren't sure - Ask. If you think you know - ASK!! No one expects you to have all the answers all the time. Also, this is your first month - don't be afraid to kick it upstream and ask your resident.

Most of all relax. Just by virtue of the fact that you're worried this early, you probably will work like a horse, learn a ton and experience some incredible things.

Enjoy!

 

[njbmd]

Hey Folks,
Pull out that Mont Reid Handbook and you should be just fine. You can also read the chapters in Lawrence and do OK. Transplant and Peds are great to start with and loads of interesting scut.

For Transplant: Know the drugs, mechanism of action and side effects.

For Peds: Know pediatric fluid balance and nutrition.

Have fun!
njbmd 😉

 

[supercut]

Pray, pray, pray that there is an active hepatology service where you are going. That will significantly reduce your pain on transplant. If not, you become the hepatology service and will have to manage all the super sick pts with liver disease awaiting transplant. Review all the liver diseases.
Also review tylenol OD. Frequently these pts are sent from Podunk Hosiptal when they present at the ED with transaminases > 3000. The doc panics and sends the pt to transplant center. Most will get better without transplant. Take a look at King's critera. Follow trends in transaminases, INR and T bili. And make sure to get your poison control folks involved for mucomyst (N-acetycystine) dosing.

Your call duties will include preping pts for transplant when a liver becomes available. The coordinator (usually a nurse) calls you to tell you they are bringing in Mr X for a liver. If you are ata program that uses "extended criteria" livers, be sure to ask if it is and if so, why (you'll have to include that information in the consent...there will likely be a special consent). There should be a packet with a standard order set for what to order for these pts.

While the service can be painfully busy, try to get to the OR and see a transplant...it's very cool surgery. Also try to get to a harvest.

And remember that while it's overwhelming to start on transplant, you'll get a painful service out of the way early.

Good luck

 

[Smurfette]

I'm an intern and still don't know what rotation I start on or vacation dates or anything. *sigh* Hope I didn't miss an email or something.

 

[lovemydrhubby]

Good Luck to the Interns! I'm hoping you all have a great first day, week, etc. Post when you can- I'd love to hear all about it 🙂

 

[DocWasabi]

Pray, pray, pray that there is an active hepatology service where you are going. That will significantly reduce your pain on transplant. If not, you become the hepatology service and will have to manage all the super sick pts with liver disease awaiting transplant. Review all the liver diseases.

UI2003, njbmd, and Supercut... Thanks for the tips! Time to sit down and start reading. Only three days of freedom left.

 

[Whisker Barrel Cortex]

I'm an intern and still don't know what rotation I start on or vacation dates or anything. *sigh* Hope I didn't miss an email or something.

Surgery interns don't get vacation! What kind of cush residency do you think you're starting here. 😀

 

[Blade28]

I start on July 1st...surg onc...have NO idea where I'm supposed to report, or when, or who I'm supposed to see. Hopefully they'll tell me by June 30th. 🙂

 

[neutropeniaboy]

Now that the end of June is rapidly approaching, I'm starting to get a little nervous. Anyway, I just found out today I'm starting my internship on the liver transplant service. (plus the call is q2 from home...weird). I never got a chance to do any transplant rotations as a 3rd or 4th year student. Any advice/tips on what I should do or read so I only appear mildly incompetent? 😉 Thanks.

A July PGY-1 taking home call on a transplant service? Wow. Tell me what program you're at so I can transfer....

 

[Smurfette]

Hmm...sorry, but i think home call on transplant may be theoretical only. I'd be shocked if you don't spend every call night at the hospital. not that I should talk---I will be having my own fair share.

 

[traumasurgeon]

Good luck interns. All of you be prepared for one of the worst two weeks of your life. Don't worry it gets better.

 

[quicksilver2000]

Good luck interns. All of you be prepared for one of the worst two weeks of your life. Don't worry it gets better.

I can't agree more. Take it from someone finishing his intern year. Those first two-three weeks were the worst time of my life. But it gets so much better after the first month.

You're coming off months of sleeping lots, staying out late and it takes your body time to adjust. Everybody eventually does though. That put together with the fact that everything takes twice as long at the beginning because you don't know how the hospital works. I thought that was a bigger problem than a lack of knowledge base. If you have good seniors your lack of knowledge won't hurt you because you're seniors will anticipate and tell you all the orders you need to right for the day. But as an intern you are the master coordinator. You are the point man/woman talking to so many different services (PT/OT, home care, social work, other services etc.) that when you don't know how to get a hold of all these people your day just never ends. As you progress, you're efficiency will get better and you'll know how to save time. Just survive that 1st month and you'll be fine.

 

[quicksilver2000]

Intern Year Motto:

Discharge Discharge And Discharge