Intern Jitters

[Pomacentridae]

Hello,

I am a 4th year medical student about to graduate soon and will be starting my intern year this July. I have been in low spirits which affected my learning(lack of motivation, low energy,etc.) in 3rd and 4th year so much so that I feel incompetent clinically. I am getting my depression currently addressed.

I don't have any red flags but I am very worried about performing poorly during intern year. I am going into a specialty that is not IM but obviously I will have to go through many medicine months as an intern. I haven't failed any exams but it also seems to me that the material tested on the Step 1 and even the Step 2 doesn't really gauge one's ability to do well in a practical sense on the wards(which is mostly about being efficient, writing notes, coordinating care,etc.). I don't feel that my note-writing and especially my presentation skills are up to par and I fear that some of the med students I'll be supervising might be better than me when I start in July. I am all over the place with presentations. It takes me a long time to pore through charts and organize myself and I usually have to look back at my writings to remember details about my patients. How do I get to the point where all the minor details stay in my head and I don't have to look at my notes to rattle them off? Does anyone know any resources I can use to improve my presentation skills(and note-writing too) before I start intern year?

---

Members don't see this ad.

 

[Lostin_space]

Hello,

I am a 4th year medical student about to graduate soon and will be starting my intern year this July. I have been in low spirits which affected my learning(lack of motivation, low energy,etc.) in 3rd and 4th year so much so that I feel incompetent clinically. I am getting my depression currently addressed.

I don't have any red flags but I am very worried about performing poorly during intern year. I am going into a specialty that is not IM but obviously I will have to go through many medicine months as an intern. I haven't failed any exams but it also seems to me that the material tested on the Step 1 and even the Step 2 doesn't really gauge one's ability to do well in a practical sense on the wards(which is mostly about being efficient, writing notes, coordinating care,etc.). I don't feel that my note-writing and especially my presentation skills are up to par and I fear that some of the med students I'll be supervising might be better than me when I start in July. I am all over the place with presentations. It takes me a long time to pore through charts and organize myself and I usually have to look back at my writings to remember details about my patients. How do I get to the point where all the minor details stay in my head and I don't have to look at my notes to rattle them off? Does anyone know any resources I can use to improve my presentation skills(and note-writing too) before I start intern year?

Just about every intern sucks initially. That's normal. Most interns catch up quickly, however, as there is an exponential increase in knowledge, efficiency, and what not during the first few months.

 

[J ROD]

Practice makes perfect. Just work on it.

 

[DrYoda]

As mentioned above typically most people don't feel very competent early in intern year (and I would argue that the majority of those that do feel competent probably should'nt).

 

[Pomacentridae]

Thanks for the responses. I feel less anxious but even still does anyone know good resources(either online or otherwise) for improving on your note-taking and presentation skills(especially the latter)?

 

[GimpGenius]

Experience?

Seriously, relax and enjoy the last free time we all have for a while.

 

[Pomacentridae]

Experience?

Seriously, relax and enjoy the last free time we all have for a while.

I'm just worried that my presentation skills are below a third year's lol. No one knows of any online resources that might be helpful in that regard?

 

[ThoracicGuy]

I'm just worried that my presentation skills are below a third year's lol. No one knows of any online resources that might be helpful in that regard?

This is the last time you'll have that will have basically no responsibilities. Enjoy it while you can.

 

[AMEHigh]

I'm just worried that my presentation skills are below a third year's lol. No one knows of any online resources that might be helpful in that regard?

I know every program is different, and I'm still an intern but the biggest thing it seems to me is to show up on time and to work hard and follow through on what residents and attendings tell you to do.

You should know your patients very well (med history, meds, vitals, labs and what consults recommend) and be able to write a note. (With emr it's pretty hard to mess up note format). In regards to presenting, every resident or attending might want it differently. Some want all the info and some just want the bare minimum. As long as you are prepared that's all that matters, so just follow the format of your note.

And yes sometimes the med students help me out (sometimes they've been on a service and I'm just starting out that month), so it's ok to use them for help. Plus they're often studying for boards so remember the nitty gritty of things that I've forgotten. I don't get nervous if I'm asked a question and I don't know the answer, I just look it up. There is a lot I don't know, no biggie.

Like I said, the biggest thing I hear residents complain about in regards to interns is those that are late or don't seem to be carrying their weight. I've never heard complaints about an intern because they didn't know how to properly treat xyz.

Residents always do the admission note, so I just follow the plan from there. If there is an acute change in patient status then I try to come up with a plan and ask them before I change anything, if I really don't know what to do then I just tell them what's going on and ask for advice. So far I've gotten great feedback, mostly I think because I'm always on time and don't let things fall through the cracks when they ask me to do something. I'm definitely not a genius!

 

[Cornbread]

Hey mate. Intern here. Starting ophthalmology in July. Finishing up a relatively rigorous transitional year (definitely not as cush as most) in a large academic hospital.

I had many of the same concerns you did. By now, I'm a confident intern. I actually grew to appreciate, and even enjoy the year. Some advice:

1. Number one key: hard work. Presentations not as polished? Syntax on your notes amateurish? Accidentally give your patient fluids and lasix (common intern mistake)? Work hard and none of this matters. With hard work, you will grow to be respected by interns, residents, attending, students. Show up early. Stay late if you have to. Have the social workers, case managers on "speed dial," constantly on the phone working dispo plans. Know your patient is headed towards an ID consult? Don't wait until its discussed on rounds. Have it called BEFORE rounds. Good chance your patient will be discharged tomorrow? Prepare the discharge meds, paperwork, the day before. Be the first to volunteer to take on new patients on call day. You get the idea.

2. Show up early. This is key to making #1 happen. You consistently create more time in your day. I consistently arrived at the hospital 2 hours before rounds. Trust me, you will always look sharper/be more prepared than those who show up 1 hour before.

Do these top two things and I PROMISE, the rest will fall into place. I wouldn't worry about your presentations. Only thing that will improve these is practice. Trust me, your value as an intern will be determined by #1 and #2. Not so much the presentation quality, at least, not at first. One thing that makes presentations easier, is that you are more directly involved with the patients (compared to a student). YOU ordered the labs. YOU ordered the meds. YOU called the consults. YOU are steering the ship. This direct ownership makes presenting what you did much easier (as apposed to presenting what someone else did like students have to).

This helps too: being an intern is FAR more meaningful than being a student. Directly managing their care, taking care of their needs, watching them get better because of a treatment plan YOU put into place. You are THE DOCTOR for the first time. And its AWESOME : )

Best of luck,

-Cornbread

 

[rokshana]

Hey mate. Intern here. Starting ophthalmology in July. Finishing up a relatively rigorous transitional year (definitely not as cush as most) in a large academic hospital.

I had many of the same concerns you did. By now, I'm a confident intern. I actually grew to appreciate, and even enjoy the year. Some advice:

1. Number one key: hard work. Presentations not as polished? Syntax on your notes amateurish? Accidentally give your patient fluids and lasix (common intern mistake)? Work hard and none of this matters. With hard work, you will grow to be respected by interns, residents, attending, students. Show up early. Stay late if you have to. Have the social workers, case managers on "speed dial," constantly on the phone working dispo plans. Know your patient is headed towards an ID consult? Don't wait until its discussed on rounds. Have it called BEFORE rounds. Good chance your patient will be discharged tomorrow? Prepare the discharge meds, paperwork, the day before. Be the first to volunteer to take on new patients on call day. You get the idea.

2. Show up early. This is key to making #1 happen. You consistently create more time in your day. I consistently arrived at the hospital 2 hours before rounds. Trust me, you will always look sharper/be more prepared than those who show up 1 hour before.

Do these top two things and I PROMISE, the rest will fall into place. I wouldn't worry about your presentations. Only thing that will improve these is practice. Trust me, your value as an intern will be determined by #1 and #2. Not so much the presentation quality, at least, not at first. One thing that makes presentations easier, is that you are more directly involved with the patients (compared to a student). YOU ordered the labs. YOU ordered the meds. YOU called the consults. YOU are steering the ship. This direct ownership makes presenting what you did much easier (as apposed to presenting what someone else did like students have to).

This helps too: being an intern is FAR more meaningful than being a student. Directly managing their care, taking care of their needs, watching them get better because of a treatment plan YOU put into place. You are THE DOCTOR for the first time. And its AWESOME : )

Best of luck,

-Cornbread

^ nicely said.