Be on time.
Be on time.
Be on time.
When you have your patients, have them. Know them. You're not expected to know everything, but always, always, always, always have a plan. Anyone can do an H&P. It's the last part of SOAP, though - the Plan. Be concise - I need to know positives, and pertinent negatives. I should know in the first 10 seconds why the patient is there. Don't do the IM thing of the entire history and then "with ankle pain after stumbling". It's more of "54 y/o male with ankle pain after stumbling. Able to ambulate. Insulin dependent diabetic. Poorly compliant. Neurovascular intact. Xray is indicated due to the Ottawa ankle rule. I also have concern for a Charcot joint." If it's a diabetic, find out the fingerstick and have that when you tell the resident or attending.
Always be doing something. You'll often find IM residents just sitting there, but don't be like them. You want to be EM. If your patient is waiting for something, see if that is a good time to get another patient. You, as a student, shouldn't have so many sick patients that you are bogged down. You shouldn't have more than 3 patients total at any one time, because you don't have the basics down. And, as a student, if you get wrapped up in a complex patient, you probably will get shunted to the side, because, if they're that sick, they need more than a student; however, be at the person in charge's elbow. Have a pair of gloves with you all the time. If you have the gloves, you put them on, and you're right in there with your hands in the ****. If you don't, or have to go fumbling, you'll be, again, shunted off to the side. If you're "playing it cool" and laying low, you won't get your hands on any lacs, and definitely no one will be letting you touch the laryngoscope.
Act like you want to be there, and BE THERE, in mind and person, and don't think anything is beneath you. In academic hospitals, often, nurses have quite a chip on their shoulders, and will either ignore you, or actively try to submarine you. This also includes some 24 year old with an associate's degree treating you like you're a child, despite your having almost 400% more education and being older. Let that roll off you like water off a duck's back.
Put your ego away. You will be wrong, but don't make it an issue. Residents run the gamut - a few will be teaching superstars, a few will look like that, but will undercut you, a few will be as interesting as warm spit, and a few will actively hate you, just for being a student, because they hate their lives. I had all these as colleagues in residency. Ask up front, each shift, to whomever will be the person to whom you report, if you should ask them if it's all right to take another patient, or do they want you to show initiative and take it yourself. In this manner, some attendings (like I would) might throw you a "good" case, instead of a lemon that's next on the pile. If I think you're a dope, or you're abusing the intern (even if you ARE smarter than them, don't show it), I'll make you regret that behavior, and it will be all above board and kosher.
You'll probably have a project or test. Don't leave it until the end. Parcel it out bit by bit. Some people are stars in the department and screw the test. Others have nearly zero clinical skill, but their written stuff is aces. Do both.
