How to Survive --General Surgery Intern

[wakawakawaka]

Hi all, by now most have survived the first week of general surgery residency.....Now I want to ask a general experience question from all of you!
Can anybody start a list of the responsibilities of an intern....i am joing prelim surgery in 1 week (i know i know i'm starting late)

But i'm shakin in my boots right now, because i feel like I forgot everything from med school....I know we have to order consults (who actually makes the decision that a patient needs a consult from whichever dept?) also do we order basic tests on our own (xrays cbc's).....I just want to have an idea of what decisions do we make...vs. when we just follow orders!

Also where can I get a sample admit/discharge/soap notes....any good resources on the internet? Good luck all......

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[Smurfette]

Your senior and/or chief resident will tell you what you need to do, who to call, etc. Usually they will tell you what things you should automatically do without asking (i.e. give Mg if it's below 2, give K if below 3.6, etc. They'll probably tell you doses at first until you just know them.)

Every program is different in how they do the different types of notes. They will show you their way when you start.

 

[Blade28]

Just echoing some of what Smurfette already wrote, but your senior residents and chief will help you out the first couple days. We also have to replete lytes as necessary (if K < 3.5, Mg < 2.0, phos < 4.0), check dressings, make sure pain, nausea and bowel function is OK, handle admits and discharges, etc. Of course, you're also supposed to go to the OR whenever you get the chance. And teach the med students!

 

[njbmd]

Hi all, by now most have survived the first week of general surgery residency.....Now I want to ask a general experience question from all of you!
Can anybody start a list of the responsibilities of an intern....i am joing prelim surgery in 1 week (i know i know i'm starting late)

But i'm shakin in my boots right now, because i feel like I forgot everything from med school....I know we have to order consults (who actually makes the decision that a patient needs a consult from whichever dept?) also do we order basic tests on our own (xrays cbc's).....I just want to have an idea of what decisions do we make...vs. when we just follow orders!

Also where can I get a sample admit/discharge/soap notes....any good resources on the internet? Good luck all......

Hey there,
Purchase the little pocketbook, General Surgery Intern Survial Guide by Chamberlain (a GW grad!! and one of my former students). This small red book will keep you thinking about how to do the day to day management of your patients from admission orders to operative dictations of intern-level cases. While your learning curve is steep in the first few weeks, you are going to be old veterans pretty soon. Relax and enjoy!

njbmd 🙂

 

[GenSurg]

The most important thing to learn as an intern is efficiency. This will help throughout this year and throughout your entire residency.

It's important to keep the list of patients up to date with medications, esp antibiotics, and which drains or lines are present, if any.

I would preround and write all notes by the time the chief resident or junior resident would show up to do walking rounds. The notes really aren't all that important and can be fairly generic as far as activity level and bowel care and pain control.

During walking rounds, the chief resident could give recommendations as far as GT managment or making diet changes. Also they decide when consults are needed and who can be discharged.

After this, a team breakfast is always important.

After breakfast, I would prioritize my to do list. I made notes on the census list so I would not forget anything. Discharges where usually near the top of the list, then calling consults if they can wait until mid-morning. I would also do floor work that needed to be done, such as dressing changes and writing orders for diets, transitioning to oral pain medicine and bowel care.

I set a time I would want to run labs, usually late morning when all labs are back. Important to also check on cultures. Replace all labs and write orders at the same time. This will help keep the HUC happy.

Afternoons were spent checking on consults, PT/OT recs, nutrition recs for TPN initiation, and checking echos or DVT scans. Evening walk rounds would cover the daily events and what was ruled out/in with each test.

It is easy to get bogged down early, it often seems that as many patients as you can discharge, there are always more waiting to take their place. Have a good attitude and you'll get through it. Look forward to next year when you'll be operating more and doing less discharge summaries.

Good luck, and keep a positive attitude and you might actually enjoy this year.

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[fourthyear]

Ask, ask, ask.
No one will fault you for asking for clarification on what you are supposed to do - especially in the first few weeks/months. You arent' really supposed to be making any big decisions on your own in the beginning - once you get more experience and see and do more you'll get comfortable with handling things, but at first you'll be told every little thing you're supposed to be doing - once you ask how much K to give for a K of 3, write it down, you'll have it available for next time - this is the idea of residency training, you learn from those above you and from experience.

all you need to do at first is keep good notes of a "to do" list every day, get it done, know your patients better than anyone else on the team b/c you'll be the contact person seeing them most throughout the day (since everyone else will be more likely to be in the OR than you, scutboy/girl) - do this, and you'll be a good intern. It's more about getting the to do list done and alerting those above you of any changes in patient status than having any real medical/surgical knowlege at first.

 

[blue2000]

If you have a question that needs to be answered, and everyone who can answer it is in the OR, walk down to the ORs rather than calling. Calling, and speaking through a scrub nurse, is a complete pain in the butt. Plus, it reminds the attendings that there is an intern on the service; you might get to stay and watch something cool for five minutes, and it's a lot easier to add on the "stupid" questions you've been saving up for later. Plus, sometimes it's just nice to remember the end point of intern year.