First rotation, fellow interns?

[BlondeDocteur]

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Just for fun, since the board is ungodly slow.

I'm starting on a combined surg onc and vascular service at the university hospital. Double the pleasure, double the pain...

 

[thedrjojo]

we don't have our official schedule yet (should be getting it at departmental orientation tomorrow 😱) after 3 fun filled days of GME orientation, but the prelim schedule is start on VA 👍 then month 2 get the chairmans service

 

[kitsunepixie]

3 mos of AM neuroanatomy/PM outpt neurology & free weekends/no call (sans 1 weekend for neurosurg bootcamp and another for a dept bonding campout)

1 mo VA gen surg

2 mo trauma/sicu

3 mo VA neurosurg

3 mo busy level 1 trauma hospital neurosurg

I'm looking forward to it!

 

[MisterShake]

Starting off on night float here. Ugh. I wouldn't be so nervous if I'd actually seen a patient in the last, oh, five months or so. Oh well, surely it'll just be a bunch of calls for tylenol and pillow fluffing at 3am, right?

Headed to surg onc in August, then to acute care surgery the month after that. We have a pretty broad spectrum of rotations our first year: trauma, pedi, plastics, 2 months of general surgery, MIS, in addition to the aforementioned. I imagine it'll be at least somewhat interesting after I get my wits about me (if I ever do).

 

[MattD]

Trauma

Wheeeee!

 

[HIJay]

i have VACATION as my first block, which totally blows, then in august i officially starts with ICU

 

[45408]

Starts off on a combined service for July, then SICU in August. I'm definitely concerned about the SICU since I've never had an ICU rotation.

Orientation kicks off with ACLS tomorrow, woot. Just finished the pre-test.

 

[PharmaTope]

Starts off on a combined service for July, then SICU in August. I'm definitely concerned about the SICU since I've never had an ICU rotation.

Orientation kicks off with ACLS tomorrow, woot. Just finished the pre-test.

not that bag, just get the protocols down. just gotta make sure you can manage patients and such

 

[Samoa]

Just for fun, since the board is ungodly slow.

I'm starting on a combined surg onc and vascular service at the university hospital. Double the pleasure, double the pain...

Excellent attendings and great teachers all around on that service. It's clinic-heavy, but you'll learn a lot. And despite all the clinic, you'll still get to operate some.

 

[kitsunepixie]

3 mos of AM neuroanatomy/PM outpt neurology & free weekends/no call (sans 1 weekend for neurosurg bootcamp and another for a dept bonding campout)

I spoke too soon; I am incorporated into the call schedule (first call = July 1st!), but it's q8.

 

[Parietal Lobe]

Excellent attendings and great teachers all around on that service. It's clinic-heavy, but you'll learn a lot. And despite all the clinic, you'll still get to operate some.

Just finished 1st year and want to learn. What does it mean to be clinic heavy? How much clinic is considered heavy in surgical fields?

 

[vhawk]

First month is general general surgery, then next 3 months are general general again, colorectal, and then the same thing I did block 1. So, 3 of first 4 months are bread and butter general, 1 month of colorectal. Pretty happy with that start tbh.

 

[LucidSplash]

We still haven't been given our schedules. 🙁 Our department orientation is on Wednesday. I'm guessing they'll let us know then. Hopefully at least, as they expect us to show up for work on Thursday! 😉

 

[Buzz Me]

Just finished 1st year and want to learn. What does it mean to be clinic heavy? How much clinic is considered heavy in surgical fields?

A full day a week is pretty standard. More than 1 1/2 days a week would be a lot, IMHO, since that would leave 3 days (max) in the OR.

 

[thedrjojo]

finally got call schedule... first call is July 6th (5 interns on the call schedule, somehow managed to have one go twice before I even get my first call... end the month with call 3 of final 7...)

Still not entirely sure when to go in/where to go in to... hope the chief gets back to me before the morning of july 1st... I hate how disorganized it has been thus far, and starting to go crazy just sitting around waiting to begin with no direction....

did just get a new android phone (LG Ally) which has epocrates for free...

 

[SLUser11]

First month is general general surgery, then next 3 months are general general again, colorectal, and then the same thing I did block 1. So, 3 of first 4 months are bread and butter general, 1 month of colorectal. Pretty happy with that start tbh.

Nice start.

Still not entirely sure when to go in/where to go in to... hope the chief gets back to me before the morning of july 1st... I hate how disorganized it has been thus far, and starting to go crazy just sitting around waiting to begin with no direction....

did just get a new android phone (LG Ally) which has epocrates for free...

It can be sort of scary at first, and the learning curve is very steep, but if you can put your head down and make it through the first couple months, your comfort level will go way up. That's why none of us recommend handbooks or cheat sheets....1-2 months into your intern year, most of that stuff is worthless.


Also, just a quick reminder to all the new interns that it's important to make a good first impression. These impressions of you can stick for a long time.....so be excessively early, work excessively hard, etc. Don't ask for any special favors right away, don't complain about the hours, don't dish any work out onto the call team or night float. If you show up late a couple times at first, then be early or on time for years.....if you show up late again, they'll say "(blank) is always late!"

Also remember to re-develop your thick skin. It's tough returning to the bottom of the totem pole, but you can't let the bastards keep you down.

Good luck, and we all look forward to your intern stories that are sure to follow....

 

[VincentAdultman]

Starts off on a combined service for July, then SICU in August. I'm definitely concerned about the SICU since I've never had an ICU rotation.

Orientation kicks off with ACLS tomorrow, woot. Just finished the pre-test.

Just do what the ICU nurses (who are vastly superior both clinically and aesthetically to floor nurses) tell you to do, read Marino's book a lot and you should be good.

 

[45408]

and here we go...

 

[thedrjojo]

Nice start.



It can be sort of scary at first, and the learning curve is very steep, but if you can put your head down and make it through the first couple months, your comfort level will go way up. That's why none of us recommend handbooks or cheat sheets....1-2 months into your intern year, most of that stuff is worthless.


Also, just a quick reminder to all the new interns that it's important to make a good first impression. These impressions of you can stick for a long time.....so be excessively early, work excessively hard, etc. Don't ask for any special favors right away, don't complain about the hours, don't dish any work out onto the call team or night float. If you show up late a couple times at first, then be early or on time for years.....if you show up late again, they'll say "(blank) is always late!"

Also remember to re-develop your thick skin. It's tough returning to the bottom of the totem pole, but you can't let the bastards keep you down.

Good luck, and we all look forward to your intern stories that are sure to follow....

I have the added benefit of staying at my home program and already having a good rep from that, so hoping not to blow it on day 1... a little calmer today since the chief sent out an email about reporting and team information, and I got out of the house today to do stuff (all hospital related, but still got me out of the house/from behind the computer). T minus 13 hours (12 1/2 really... suppose to show up at 6pm for team rounds, probably get there around 5:30 to play around on the VA computer system/get some of the jitters out)

 

[LucidSplash]

Finally got my schedule Monday. Resident-run General for July. Not on call until July 7th though.

Off-site community for August, Trauma September & October.

 

[DrBorisCA]

Lovely beginning to my surgical career: Cardiac Surgery ICU, on call my first night (q3 thereafter, yay!) taking care of a pt pretty much trying to bleed out and another cardioverted 3-4 times in a few hours.

Did I say yay?👍 Loving it so far though!

 

[SouthernSurgeon]

Lovely beginning to my surgical career: Cardiac Surgery ICU, on call my first night (q3 thereafter, yay!) taking care of a pt pretty much trying to bleed out and another cardioverted 3-4 times in a few hours.

Did I say yay?👍 Loving it so far though!

I'm in the ICU as well (straight surgical though...our cardiac surg patients go to a combined cardiology/cards-surg unit).

Managing transplant patients scares the crap out of me...it seems like half our unit right now is on CRRT!

Loving it too though. I have a great senior helping me out.

 

[BlondeDocteur]

Well I have had the most benign introduction to surgery internship possible. I'm actually disappointed I haven't been asked to crash intubate anyone or decompress tension pneumothoraces or any of the other scenarios we all run through. 🙂

AND have logged a grand total of three cases as Surgeon Junior... 747 to go!

 

[kitsunepixie]

Very busy night on call covering three separate hospitals at once, but I had a senior resident with me who was awesome so it was fun. (I'll be taking call on my own w a chief on homecall in a few mos) Altogether, I fielded no less than 50 pages, 30 of which were from the pediatric hospital alone, although we had only 2 admits (both at the level 1 trauma hospital). I talked to a few frantic parents (mostly about shunts ), had a manipulative narcotic drug-seeker hounding me, and assisted ICP monitor placement in a fellow w self-inflicted GSW to the face. Hopefully I'll get to do it next since we were in a bit of a rush.

Got to go home right after rounds as both my class and clinic were cancelled until Tuesday, and as it's not my turn to round this weekend--3.5 day weekend! 😍 Not a bad start!

 

[45408]

Got to go home right after rounds as both my class and clinic were cancelled until Tuesday, and as it's not my turn to round this weekend--3.5 day weekend! 😍 Not a bad start!

I'm post call now, and I've got tomorrow and Monday off (the hospital makes July 5th a holiday so people get a day off), but then I'm on for 3 weeks straight....too bad I couldn't have swapped some of these days off.

First night on call was fairly benign. I'm sure I'll have much worse, but it was nice not to get hammered before I even figured out the way into the OR locker room.

 

[HouseHead]

First service is primarily plastics and head & neck. Post call today after my second call. Both calls got crazy, and I'm not even on a busy service (I have 5 months of the crazy busy busy service this year- yikes). Feeling like a total idiot because I am just sooooo sloooooooow compared to everyone my senior, but I know that will come to pass as I learn the system and figure out how to triage a better. All the residents are very nice and helpful, and generally understanding of the interns' stupid mistakes. Been in the OR every day- small plastics cases, but I've done about 90% of the case each time.
Jojo, have fun! I miss it there very much, even if I chose here. It's an awesome program.

 

[darjeeling14]

SICU at a level I trauma center. Awesome and crazy at the same time - since, I was on call the first day and there are no seniors on ICU call.

 

[PharmaTope]

I'm in the ICU as well (straight surgical though...our cardiac surg patients go to a combined cardiology/cards-surg unit).

Managing transplant patients scares the crap out of me...it seems like half our unit right now is on CRRT!

Loving it too though. I have a great senior helping me out.

just avoid Kayexalate in transplant patients

 

[thedrjojo]

So far, its been a VA experience. Our team is actually too big IMHO, as there are 5 interns, 2 PGY2, 1 PGY3, and 1 PGY4. Today we had 8 floor patients and 2 SICU patients... we did do it so only the post call intern and midlevel rounded on the patients (woo, fun for me) so my fellow interns got to come in at 7pm for M&M, and will be that way most of the time... but its hard to keep track of whats to be done, who has done what, who is going to do what with so many people. At least I haven't had to do much time in the clinic. First day, we meet up, paper round on all the patients, about to floor round then because I went in a few days early and got computer access (and was the only intern to have done so) I was the only person able to pre-op a patient and so got 2 cases (skin tag and inguinal hernia) right from the get go (nice deer in the headlights moment, hadn't even seen a hernia since last August). Since then I have not seen the OR... Also managed my first and likely only 3 day weekend for the rest of my residency life (va closed on monday, 5 interns, 4 nights call, one person was doubled up friday and monday, so 2 of us had 3 day weekends). Va has been nice.

 

[SLUser11]

So far, its been a VA experience. Our team is actually too big IMHO, as there are 5 interns, 2 PGY2, 1 PGY3, and 1 PGY4. Today we had 8 floor patients and 2 SICU patients....

That sounds like a big waste of manpower. I'm also not sure how educational that rotation would be.

The only time that size of a team is acceptable is when it's an internal medicine team, and then it's only for comic relief as you watch everyone file in and out of tiny rooms like the hospital's version of a clown car.

 

[deleted50541]

The only time that size of a team is acceptable is when it's an internal medicine team, and then it's only for comic relief as you watch everyone file in and out of tiny rooms like the hospital's version of a clown car.

Thanks for that laugh. I do get brief pangs of nostalgia for those less hectic times when I was a lowly med student in tow behind the train line of the medicine team.

Now I'm the exhausted surgical intern who charges through their quaint quorum in the middle of the hall to put out whatever fire my patients are fanning.

 

[thedrjojo]

i agree it is a waste of man power. The group preceding us had 3 interns, 3 midlevels, and a chief... thats what this rotation usually has... which sucks since its q3, but it is what it is.

Another rotation that the team can be this large (or larger, as it typically is): trauma. They roll with a pgy5, pgy4, up to 2 pgy3's (if the rotator is there), up to 2 pgy2's, and then upwards of 5 interns (depending on rotators as well), plus like 6 med students, a few pa's, and the attending, and maybe even a fellow or two. Its unsightly.

Education has been decent on the rotation thus far... the chief has been pretty good about that, and there are plenty of conferences and plenty of clinics to learn in (multiple each day)... just OR cases have been scarce... like I said, 3 cases in 10 days thus far (technically 7 since I've been off 3 days, plus a few ER I&D's) and next week looks to be about the same...

 

[45408]

i agree it is a waste of man power. The group preceding us had 3 interns, 3 midlevels, and a chief... thats what this rotation usually has... which sucks since its q3, but it is what it is.

Another rotation that the team can be this large (or larger, as it typically is): trauma. They roll with a pgy5, pgy4, up to 2 pgy3's (if the rotator is there), up to 2 pgy2's, and then upwards of 5 interns (depending on rotators as well), plus like 6 med students, a few pa's, and the attending, and maybe even a fellow or two. Its unsightly.

Education has been decent on the rotation thus far... the chief has been pretty good about that, and there are plenty of conferences and plenty of clinics to learn in (multiple each day)... just OR cases have been scarce... like I said, 3 cases in 10 days thus far (technically 7 since I've been off 3 days, plus a few ER I&D's) and next week looks to be about the same...

the trauma team at my school was the same way, because they have to provide their own in-house call. No one covers trauma patients or goes to traumas except the people on trauma, and there's always 2 residents on every night. Two residents x ~Q4 = 8 each month, roughly.

The general surgery services were a lot smaller, because the one person on call covered the other cross-cover and specialty-specific ER consults. Trauma took all the gen surg consults (SBO, appy, chole, etc).

 

[-Goose-]

126 hrs my first week.

 

[45408]

126 hrs my first week.

but what did you log?

 

[Winged Scapula]

126 hrs my first week.

Old skool...😎

 

[-Goose-]

but what did you log?

79.

 

[nonbilious]

what are people doing for organization.... I feel like I am constantly behind, with a firm grasp permanently just beyond my reach. note cards, check boxes, etc....i get my work done but i seem to loose stuff in the day to day.

so far so good for me.
hours are averaging out.... had a bigger week at about 110, but balanced it with a lighter week... about +20 hours right now on the month

Also,

What makes one a 'good' intern? I can't at this point see what my goals or markers of success should be.

 

[45408]

79.

Q2 all week long?

I'm at 92 for a 7-day stretch, and the middle of my month is going to be over hours, but the golden weekend and last Saturday of the month should average me out within reason.

 

[thedrjojo]

53 hrs week 1(3 days off) 86 hrs week 2. Week 3 will be around 65-70 cause golden weekend and week 4 might be closer to 100 cause 3 calls in 6 days(sun-wed-fri).

Trauma provides its own coverage overnight and there are typically 3 residents inhouse over night, q3 so the team is like 9-10 strong...

 

[45408]

fffffuuuuuu, if one more person asks me how old I am today, I'm going to have to choke a Wayne Brady.

 

[deleted50541]

fffffuuuuuu, if one more person asks me how old I am today, I'm going to have to choke a Wayne Brady.

I hear "you look like you're about 10 years old" at least 3 times a day.

🙄

 

[deleted50541]

Btw, anyone else find that a frequent topic of discussion amongst your fellow residents is how out of whack your own bowel function is? It's definitely the main point of conversation every morning on my service.

 

[45408]

I hear "you look like you're about 10 years old" at least 3 times a day.

🙄

"Oh, you're just a kid!"

No, I have a kid. You're old, and you cope with that by telling yourself that I'm just a kid.

 

[smq123]

"Oh, you're just a kid!"

No, I have a kid. You're old, and you cope with that by telling yourself that I'm just a kid.

I get that a lot, too. My personal "favorite" was when I was an MS3, and having a patient ask me if I was going to go to my prom and if I enjoyed being a candy-striper.

At least you're not getting, "Nurse? Go get me another can of ginger ale!" whenever you go in to check someone's JP. We have a particularly geriatric patient population, and a lot of them are completely stunned by the idea of having a female doctor.

 

[Dr.LeoSpaceman]

Btw, anyone else find that a frequent topic of discussion amongst your fellow residents is how out of whack your own bowel function is? It's definitely the main point of conversation every morning on my service.

Hard to avoid when it's the first thing you ask every patient.

As someone who has had GI issues on and off, I've made a point of filling my free time with consuming Fiber One products.

 

[LucidSplash]

At least you're not getting, "Nurse? Go get me another can of ginger ale!" whenever you go in to check someone's JP. We have a particularly geriatric patient population, and a lot of them are completely stunned by the idea of having a female doctor.

One of my co-interns was on call the other night and was paged by a nurse because of our patients was threatening to leave AMA because he "hadn't seen a doctor since being admitted." My co-intern thought to HERself "WTF I have seen him at least 2-3 times today." She went up to see him to see what the problem was.

The obvious punchline is that, despite introducing her self as "Dr. X" the little 90-something year-old guy thought she wasn't a doctor because of her gender.

 

[45408]

I stopped in the OR to peek in on an interesting case my chief was doing when an attending paged him.

The OR nurse answered and then said "Yes, there's someone else with him....a med student? -to me- Who are you? A resident?? -to attending- he looks like a kid!"

This coming from a 27-year old nurse. Sigh.

 

[smq123]

I stopped in the OR to peek in on an interesting case my chief was doing when an attending paged him.

The OR nurse answered and then said "Yes, there's someone else with him....a med student? -to me- Who are you? A resident?? -to attending- he looks like a kid!"

This coming from a 27-year old nurse. Sigh.

How can she tell how old you look, when 3/4s of your face is covered by a mask and a scrub cap? 😕

 

[45408]

I have youthful eyes.