I’m worried I’m going to get inadequate training.

[Latteandaprayer]

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I’m about to start intern year tomorrow at a program I was very upset about matching it. The more I learn about it, the more I worry.

For example, there isn’t a primary Neuro team. Only consults (except stroke). If there is a primary patient, APPs will cover them and the residents still act as consultants essentially. I’m worried about not having that primary experience.

Hours are also okay. Tend to end around 4:30-5p, and APPs cover a lot of the nights. Because APPs are so heavily involved I really worry about my ability to take ownership and feel like I’ve gotten a well-rounded education.
Tomorrow I start on Cardiology which is consult-only and APPs cover the nights. Which means I won’t get that overnight experience taking care of complex patients.

I know I sound crazy for wanting to do more when you’re are already long. I’m just worried.

 

[Captain_Falcon]

Few things.
#1 you cannot do anything about it since this is where you matched, so best just go to about the experience as best you can and treat each consult as if you were handling them on a primary service
#2 you are way overthinking things, nobody cares if you don't cover nights on a Cardiology consult service your intern year. The only thing you will need to learn from Cards is how it relates to strokes and perhaps the basics of dysautonomia in certain neurodegenerative diseases
#3 primary service would be ideal from a learning perspective, HOWEVER most jobs after training are consultants only. The positives you will experience are no discharges, so just appreciate that aspect and go with the flow.

 

[Lifeblood_20]

Grass is always greener on the other side — I’m at a program with a primary neuro service, ICU/CCU overnight shifts and a Neuro ICU month in PGY-1 and my schedule is overwhelming. 😬

It’s always good to focus on the positives.

 

[Dr. Basketball]

I am currently at a program where we have an inpatient and consult service for the general and stroke teams. I dislike being primary and dealing with getting them out of the hospital if they are uninsured and having to have the "peer to peers" when insurance companies find dumb reasons not to approve them for rehab to save money for that quarter and push off accepting them to the next quarter. I became a specialist for a reason 🙂 Trust me, I love being on the consult team and then being able to sign off when we're finished with our work up and then the hospitalist can deal with all the other stuff. Just saying.

Best of luck.

 

[CnsCrit]

I'm a neurointensivist so I enjoy the challenge of caring for the whole patient. Still, you'll escape lots of headaches as consult only and will have a somewhat easier experience. Not all bad.

Do your best to invest as much as you can into your intern year, learn medicine and in the rest of your training try to understand how neurology relates to systemic disease. Try to take ownership of the medical issues as much as you can. If you are interested you will still learn. I rotated with a neurologist as a medical student who refused to start any anti-hypertensives without consulting medicine. Don't be that neurologist.

After intern year (outside the ICU) a lot will get deferred to medical consultants even if you have a primary service, so you may not miss quite as much as you think.

Try and befriend the APPs, the experienced ones can be very good. They learn mostly from experience rather than book knowledge and that can be a valuable resource in its own right. If you can learn to work with them and not antagonize or act as their superior it will go a long way.

 

[Dr. Basketball]

I'm a neurointensivist so I enjoy the challenge of caring for the whole patient. Still, you'll escape lots of headaches as consult only and will have a somewhat easier experience. Not all bad.

Fair enough. But I will say that getting a patient out of the ICU is a lot different than getting them out of the hospital.

I rotated with a neurologist as a medical student who refused to start any anti-hypertensives without consulting medicine. Don't be that neurologist.

Agreed!