How to not be a bad surgical intern?

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SergeGainsbourg

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Most advice given generally concerns how to be a good intern. Good habits, values, goals etc. I pay attention to these of course - I want to be a good intern. But more specifically, what are some of the things that new interns do that tend to annoy upper levels and the team in general. Tell me some of the things that as an intern I should never do. And remember, it's in your favor to give some frank advice. For all you know I could be YOUR intern.
 
SergeGainsbourg said:
ell me some of the things that as an intern I should never do.

1) Lie
2) Lie
3) Include the phrase "because I'm the doctor" in a conversation with any nurse or ancillary staff member
4) Call about a patient issue without having first a) seen the patient b) opened the chart in your lap and c) logged in to any approppriate computer systems
5) Call before you've thought out what you have to say
6) Call about unimportant things. Not call about important things. (Note double bind)
7) [soapbox] Leave home without this book in your white coat. [/soapbox]
 
I am taking notes on how to be a good surgery prelim intern by watching Grey's Anatomy....that is really all I need to know right?
 
Pilot Doc said:
3) Include the phrase "because I'm the doctor" in a conversation with any nurse or ancillary staff member
Nurses can make your life wonderful or absolutely miserable. A little respect paid in their direction goes a LONG way.

I'll add a couple:
1. Let's say your upper level is getting pimped and doesn't know the answer. Your attending then turns to you. If for some reason you happen to know, pretend you don't. Making a good impression with the attending is not worth showing up your upper.
2. Never show up late...for anything. A resident here knew he was late for rounds one morning, so he crashed his car into a pole so he could say he got in an accident. No joke. I'm not sure if I should be impressed or feel sorry for him.
3. Don't bang nurses in the call room--for at least the first three months. Get a feel for the place first.
 
Pilot Doc said:
1) Lie
2) Lie
3) Include the phrase "because I'm the doctor" in a conversation with any nurse or ancillary staff member
4) Call about a patient issue without having first a) seen the patient b) opened the chart in your lap and c) logged in to any approppriate computer systems
5) Call before you've thought out what you have to say
6) Call about unimportant things. Not call about important things. (Note double bind)
7) [soapbox] Leave home without this book in your white coat. [/soapbox]

Pilot, what's the advantage of that particular book rather than all the others out there that are similar?
 
avgjoe said:
Pilot, what's the advantage of that particular book rather than all the others out there that are similar?

1) Small size - actually fits easily into a white coat
2) Practical, case-based organization. The chapters are all 2-3 pages long and have titles like "chest pain." There's also a section on pre-post op care of common operations - a whipple chapter, a colectomy chapter, etc.
3) Lots of organizational hints - how to prioritize your day, what to know before you call your chief.

Essentially - it's not a condensed textbook - it's a practical guide for the problems you deal with all day long.
 
Realize that intitally it will take you a lot longer to round than you think. (Especially if you're at a place different from your med school)

Early on, figure out how to organize your pt data and to do list so that you don't overlook anything (where you write these things on your list can be important...my first couple days I overlooked tasks because they were burried in with other stuff and I just didn't see it)

First take care of all the basics that got you through rotations...knowing about your pts, following up labs, etc. Make sure you take care of all scutwork. Know about all your patients. When on call, it's always better to go see the pt...especially at first. Over time you'll learn what can be handled by phone (and that some things never can be!)

When discharging pts, I believe that the discharge isn't done until the d/c summary is dictated. If you can't do it at the time you d/c the pt, put it on your to do list and do it before you go home that day (this will save you trips to medical records months later when you'll have to dictate from the chart and you won't remember the pt!). Occasionally one will slip through, but if you stay on top of them you'll save yourself some hassle. Put in the d/c summary stuff you'd want to know if you had to admit the pt a week later and didn't know anything about them. Also, fill out the d/c instructions and put the Rx on the chart a day or so before you expect the pt will go home. When you scrub same day cases, make sure you put Rx pad in your scrubs pocket so you don't have to go back to your white coat to get write the Rx.

Learn to involve your med students when you have them. You can teach them to do things like suture removal and jp removal, which can be a big help on a busy day. If you are at a place that still uses paper orders, you can teach them how to write some orders for their pts (check it before you sign it!) Be sure to teach them useful stuff, too. In the first days, they will appreicate feedback on their notes.

When signing out to cross covering interns, make sure that they know issues that may come up on any of your pts, what (if any) tentative plans are made should that issue happen, and who the backup person to call for your pts is. Be kind to your fellow interns and make sure that everybody has appropriate prn meds ordered (such as tylenol, anti-emetics, BM inducing suppositories, etc)

Do you remember how to tie knots? One of our interns last year forgot, and when pulling back a chest tube, I had to step in and help. It didn't upset me (I thought it was kind of funny) but some people might get upset, plus it's certainly very embarrassing. (would have been worse if an attending had been around!) While you're at it, make sure you can tie nice, proper, square knots.

And remember, thousands before you have muddled through and done just fine!
 
Don't show up later than any senior residents and don't allow any more senior resident to preround/write notes on more patients than you do as and intern. I've been on many busy services and don't mind helping with notes as the senior, by by no means should I be doing more or even half of the work than the intern - I already know how to manage floor patients well, this is your opportunity to learn, so get here early and do it.

When you have caught up on all your work, ask if any of the other interns need help. This will not only make friends, this will also hopefully encourage them to help you out when you are swamped. This is especially important in this go-home-early-post-call era - you have to help each other out or you will never get out on time. Also check with senior residents on teams whose intern is post-call in the afternoon and see if there is anything you can help with - I've already pulled more JP's and chest tubes than I care to count and if I hear you are napping in the call room when I as a senior resident am doing these tasks you could have helped me with, I will not be happy.

Communicate frequently with your senior residents about what's going on with the patients. This may mean coming into the OR to talk (at an appropriate time), or leaving a message for them to call you between cases. As the above poster said, have your story together (have seen and assessed the patient), when you are asking questions about how to manage an issue.
We shouldn't be hearing on afternoon rounds about some crisis that happened at 10am that you never appropriately assesed yourself and never told anyone about.

I'm much more likely to push to get a helpful intern into the OR than a lazy one, so use your common sense and just don't be lazy. Intern year isn't always fun, but this is the year you can start establishing yourself as a trustworthy member of the team, someone people can count on to get things done. And it's your opportunity to learn a lot, so ask questions, do what you're told, read when you can, and you will do fine.
 
Dont ever ask to go home and dont ever log in more than 80 hrs..o ya also dont ask for any weekends off
welcome to surgery :laugh:
 
Sugar72 said:
I am taking notes on how to be a good surgery prelim intern by watching Grey's Anatomy....that is really all I need to know right?

It's an essential start! Take detailed notes. Record episodes to study frequently and prepare for significant free time to watch and re-watch episodes. Also, idolize/worship strong, character-driven "doctors" around whom the show is focused. 😍
 
To be a good surgery resident:
1. You can't be stupid.
2. You can not be a liar.
3. You can not be lazy.

Be intelligent/well-read, honest, and work hard.

And I hate listening to whining...then again, I'm just a pee-on intern
 
Our seniors...especially the 3rd years, are very willing to help out with floor work. Our censi carry 40-70 patients w/many of them being very sick. We are very much into the team approach here. It fosters a close-knit residency program. BTW...how's life Smurfette? You here anything about the '06 class?
Smurfette said:
Senior residents writing notes and doing floorwork?!!! unheard of, at least at my program.
 
SteadyEddy said:
Our seniors...especially the 3rd years, are very willing to help out with floor work. Our censi carry 40-70 patients w/many of them being very sick. We are very much into the team approach here. It fosters a close-knit residency program. BTW...how's life Smurfette? You here anything about the '06 class?
ditto

when i become a senior resident it would not be beneath me to write notes or help out with floor work if im not in the OR.
 
I was kind of curious about an earlier post. If an upper-level student/doctor is unable to answer a question when asked by the attending and you are able to, you shouldn't answer?

Is there a way to provide the answer without looking like you are showing up your fellow colleagues?

I would think there is a way to show the attending that you are on top of your stuff without implying that your upper level colleagues are lazy bums 🙂
 
cdql said:
I was kind of curious about an earlier post. If an upper-level student/doctor is unable to answer a question when asked by the attending and you are able to, you shouldn't answer?

Is there a way to provide the answer without looking like you are showing up your fellow colleagues?

I would think there is a way to show the attending that you are on top of your stuff without implying that your upper level colleagues are lazy bums 🙂

Generally attendings pimp uphill (MS, intern, chief...) so the situation should come up infrequently enough that you can play dumb harmlessly.
 
(1) Know you way around the hospital well. Upper levels seem to lose their sense of direction the higher up they go. You have to lead them around the hospital because they never seem to know were our patients are... even with patient lists.

(2) Be nice to nurses, especially those working in the ICU setting. They can save your butt if they like you.

(3) Write everything down and keep up w/ your things to do list.


(4) Don't lie. The truth will come out eventually and it won't be pretty.

(5) Avoid fooling around in the callrooms. Nurses talk and gossip spreads fast across a hospital.
 
don't LIE
don't be LATE
don't be LAZY

the rest will fall into place.
 
You guys keep mentioning "don't lie"...what is there to lie about? About mistakes you made?


manofsteel said:
don't LIE
don't be LATE
don't be LAZY

the rest will fall into place.
 
jessie said:
You guys keep mentioning "don't lie"...what is there to lie about? About mistakes you made?

"pupils equal and reactive"...intern
"he doesn't have a left eye"...attending
 
jessie said:
You guys keep mentioning "don't lie"...what is there to lie about? About mistakes you made?

An intern at my med school (in the pre-80 hr days when you prerounded on every patient) became infamous for once beginning a presentation on a patient who had died the night before.
 
Sugar72 said:
"pupils equal and reactive"...intern
"he doesn't have a left eye"...attending

hahaha... :laugh:

I'd probably be rolling on the floor laughing if that ever happened

(and subsequently be kicked out for showing up a fellow colleague!)
 
Thanks to everyone who contributed to this thread. Internship time is almost upon us. Into the breech we go. Any last bits of advice would be much appreciated. 🙂
 
I should probably follow my own advice, but more time reading Sabiston's, less time on SDN would probably help. 🙂
 
I'm gonna bump this cause I don't wanna make my own thread.

I'm currently a 4th year med student looking to not soil myself next year once july rolls around. What are some good resources on how to learn basic troubleshooting on things that will pop up when you start patient care? Or good ways to handle common things that you will get paged on? I'm wondering if there is agood concise book that has stuff like "If patient hasn't peed, do XYZ , if patient has this, do that" etc. It would be nice to have a resource that talks about how to assess wounds, the different types of dressings and why they're used, etc. I feel like in my 4th year, the residents have all told me to just go to the OR and participate in cases and so I have some book knowledge, but I know I'm lacking in the practical/floor knowledge department.

Also, I am overwhelmed by how intelligent everyone is. I know its from experience and working hard. I feel like I barely have time to read 30min-1 hour a day on some of my busier rotations, and I know things will be busier when I start residency. Is me reading 30 min or so a night good enough? I have come across some totally incredible residents and I feel like I will never get to that point if I only read for half an hour a night on work days.

I know some of you might say its early for me to think about this stuff, but I wanna try and build good habits now so I don't get caught totally off guard once the real world starts.
 
Last edited:
I'm gonna bump this cause I don't wanna make my own thread.

I'm currently a 4th year med student looking to not soil myself next year once july rolls around. What are some good resources on how to learn basic troubleshooting on things that will pop up when you start patient care? Or good ways to handle common things that you will get paged on? I'm wondering if there is agood concise book that has stuff like "If patient hasn't peed, do XYZ , if patient has this, do that" etc. It would be nice to have a resource that talks about how to assess wounds, the different types of dressings and why they're used, etc. I feel like in my 4th year, the residents have all told me to just go to the OR and participate in cases and so I have some book knowledge, but I know I'm lacking in the practical/floor knowledge department.

Also, I am overwhelmed by how intelligent everyone is. I know its from experience and working hard. I feel like I barely have time to read 30min-1 hour a day on some of my busier rotations, and I know things will be busier when I start residency. Is me reading 30 min or so a night good enough? I have come across some totally incredible residents and I feel like I will never get to that point if I only read for half an hour a night on work days.

I know some of you might say its early for me to think about this stuff, but I wanna try and build good habits now so I don't get caught totally off guard once the real world starts.

Pay attention to what the interns do when you're on call with them. After 3rd/4th year should have a good idea of basic things.
Write down some common scenarios...
Chest pain...I'll do this
Fever...I'll do this
Urinary retention.... I'll do this
And most importantly "patient can't sleep...I'll tell the nurse to kiss my ass"
Anyway just have a basic work through for common things that you can put to memory. That will help ease your mind a lot. In reality the specialty specific stuff for the first couple of months, at least when I trained the junior residents just expected the intern to call and ask. They will be thrilled if you have at least obtained sufficient information PRIOR to calling them to allow them to direct care through you without having to tell you what sufficient information is and send you back to collect it.
Re: reading, read constantly. Read every day. People appear smart because medical students/residents are very good/talented in terms of framing and displaying things they know. They'll avoid questions entirely to give a 10 minute dissertation on another subject they know well to avoid revealing they don't know jack about the subject at hand. It becomes obvious over time and if you focus on clinical management and broad knowledge base and don't worry about the exact topic being discussed tomorrow you'll be better off.
 
Pay attention to what the interns do when you're on call with them. After 3rd/4th year should have a good idea of basic things.
Write down some common scenarios...
Chest pain...I'll do this
Fever...I'll do this
Urinary retention.... I'll do this
And most importantly "patient can't sleep...I'll tell the nurse to kiss my ass"
Anyway just have a basic work through for common things that you can put to memory. That will help ease your mind a lot. In reality the specialty specific stuff for the first couple of months, at least when I trained the junior residents just expected the intern to call and ask. They will be thrilled if you have at least obtained sufficient information PRIOR to calling them to allow them to direct care through you without having to tell you what sufficient information is and send you back to collect it.
Re: reading, read constantly. Read every day. People appear smart because medical students/residents are very good/talented in terms of framing and displaying things they know. They'll avoid questions entirely to give a 10 minute dissertation on another subject they know well to avoid revealing they don't know jack about the subject at hand. It becomes obvious over time and if you focus on clinical management and broad knowledge base and don't worry about the exact topic being discussed tomorrow you'll be better off.

As a follow up, it's a good idea to learn the reflexes as an intern, e.g. Chest pain gets an EKG, troponins and CXR - this will keep you afloat as a doctor for a while. But you have to keep reading. You need to know why you are doing what you are doing. As an intern, you mostly just put complaints into a box and that works as an intern - for fever, do X, for chest pain, do Y, etc. As you advance in medicine, you start learning why certain people don't fit into certain boxes - this is what makes you good at what you do. This is what seperate a you from the army of midlevels.
 
When you are calling a consult, take a minute to understand why. The last thing anyone you are calling wants to hear is "I'm just covering but my attending wants you to see this patient." Always try to ask the consultant a question. Bad consult: hi Dr Nephron, my attending told the other intern on rounds to call you because our patient has a high creatinine but he forgot so now I'm calling you at 4. This isn't my patient so, yeah, I don't know the baseline labs or what he had done. Good consult: (great, ****wad intern forgot to call about his patient so now its up to me. I can't fix the fact that its 4pm and Dr Nephron will be pissed but here it goes). Hi Dr Nephron, sorry for the late consult, it was a miscommunication on our team. We would like you to make sure we aren't missing anything on this patient who had a superduper vascular surgery. We expect these patients to have some AKI but this patients Cr went from crappy to supercrappy and hasn't turned around. We'd really appreciate your assessment of whether its time to use the big artificial kidney." That probably took about 90 sec of chart review before the call and yet, lots of interns don't bother.
 
When you are calling a consult, take a minute to understand why. The last thing anyone you are calling wants to hear is "I'm just covering but my attending wants you to see this patient." Always try to ask the consultant a question. Bad consult: hi Dr Nephron, my attending told the other intern on rounds to call you because our patient has a high creatinine but he forgot so now I'm calling you at 4. This isn't my patient so, yeah, I don't know the baseline labs or what he had done. Good consult: (great, ****wad intern forgot to call about his patient so now its up to me. I can't fix the fact that its 4pm and Dr Nephron will be pissed but here it goes). Hi Dr Nephron, sorry for the late consult, it was a miscommunication on our team. We would like you to make sure we aren't missing anything on this patient who had a superduper vascular surgery. We expect these patients to have some AKI but this patients Cr went from crappy to supercrappy and hasn't turned around. We'd really appreciate your assessment of whether its time to use the big artificial kidney." That probably took about 90 sec of chart review before the call and yet, lots of interns don't bother.

When you said "4" I assumed that you were talking about 4am. You consider 4pm late? Genuine question. Maybe its just practice environment, but that seems like a normal time to send out consults. Especially for post-op AKI or inpatient HD consults to nephrology... I just checked my texts, last week I sent 7 consults to 3 different nephrologists after 4pm. Granted, private practice and I'm texting them basically for dialysis orders, but unless it is after like 7pm I consider it semi-normal.
 
When you said "4" I assumed that you were talking about 4am. You consider 4pm late? Genuine question. Maybe its just practice environment, but that seems like a normal time to send out consults. Especially for post-op AKI or inpatient HD consults to nephrology... I just checked my texts, last week I sent 7 consults to 3 different nephrologists after 4pm. Granted, private practice and I'm texting them basically for dialysis orders, but unless it is after like 7pm I consider it semi-normal.
I'd venture that anything that occurs after normal rounding hours (I don't see medicine teams rounding after 5) and may require the Chief resident/attending to come back in is "late".

Exceptions of course are things that just occurred but in the case @Gastrapathy gave, this was a problem noted on am rounds so calling at 4 pm is definitely late, IMHO.
 
I guess I do. When decisions made on AM rounds aren't transmitted to the receiving service until the end of the day, that's one of those attn to detail things. I get late consults all the time and nearly all relate to the time that an issue presented or was recognized. That doesn't bother me.

Not all of us think like surgeons about the hour of the day. But yes, 4am would be late too.
 
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