How to have a solid intern year

[sg24mc]

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What are the most essential qualities and skills for a successful OMFS intern? What makes a good intern vs a bad one, and what advice do you guys have for someone just starting out?

 

[dratc]

Work hard, don’t complain, be honest, help out your co interns (if you have them). You’ll have lots of opportunities to do the opposite of those things. That makes a bad intern.

 

[OMSDoc]

I have posted this here several times, and it still applies about the intern year:

I was fortunate to have a great chief. He shepherded me through that year. This is leadership, and you will need to do the same thing when you are chief.

There were numerous things he taught me that still stick with me:

1. If you are not 15 minutes early to an assigned meeting time with your chief or the attending, you are late. I think they call this Vince Lombardi time.
2. Have a good attitude all the time. Residents are as happy as they make up their minds to be. The answer to the question, "How are you doing?" was always, "Super!" If he gave me a task, he would say: "Oral surgery baby scout...never sick, never tired." He knew when to jump in when I was overwhelmed, though.
3. Never complain above the chief. Do not go over his head to an attending or administration if you have a problem. Never.
4. Residents should stick together. Inspire to make your co-residents look good.
5. Treat the assistants and support staff (clerical, nursing, etc.) very well.
6. Patients tend to be anxious when they see you, so you need to listen to them, and voice back to them what their complaints are.
7. Always think about patients in a systematic way, in the same order, starting with their chief complaint, history of present illness, review of systems, past medical history, family history, allergies, current medications etc. For example, don't jump ahead and get an x-ray before you know what medicines they take, what allergies they have, what surgeries they have had, etc.
8. Having said that, it is okay to have a shortened version of this depending on the presenting problem.
9. Verbally take a shortened history with the patient at the very beginning. Don't just rely on the form that the patient filled out. This goes a long way to establishing a positive rapport with the patient; they will have confidence that you know what you are doing and will trust you. Not only that, but you will sometimes glean things that they forgot to write down.
10. You need to do this workup to establish a diagnosis.
11. Never treat a patient without a diagnosis.
12. Never give or prescribe a medicine that you are unfamiliar with (half-lives, contraindications, interactions, etc.).
13. Most mistakes in medicine are mistakes of omission...you forget to do something. Create checklists.
14. If you are in a position to order blood products, know the indications and contraindications of each (i.e., whole blood, FFP, etc.).
15. Every night do not go to bed without reading at least one page of a journal, book, etc. Otherwise, you won't read.
16. Don't believe everything you read. Remember the authors had an incentive for writing.
17. Make a list of things that each attending prefers. For example, Attending A likes to give his patients certain antibiotics and analgesics after surgery, whereas Attending B prefers something different.
18. Don't hesitate to get advice from the chief.

 

[FosterWallace]

Most mistakes in medicine are mistakes of omission...you forget to do something. Create checklists.

I hear this advice to make checklists a lot. Can you give an example of what you mean? Like a daily to do list or what?

 

[dratc]

I hear this advice to make checklists a lot. Can you give an example of what you mean? Like a daily to do list or what?

Check lists will save you and drastically improve your efficiency. Here are some examples I had when I very first started. I made little check boxes and would tick them off as I went.

New consult:
- call consult page back
- add patient to service list
- see patient
- do procedure
- update ED
- update handoff
- do note
- request follow up

Orthognathic pre op
- consent
- h&p
- pre op orders
- speak with anesthesia re hypotensive anesthesia (if lefort)
- order txa (if lefort)
- acquire stuff to suture tube and do head wrap
- position patient in reverse T

Your checklists will be different based on the expectations in your program. But these are just some examples. Overtime things will become so second nature you can adjust the checklists. But I’m still thinking through checklists today and always will.