Intern starting on NICU

oldbearprofessor

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    I am an incoming intern starting in the NICU. Any advice on what I can do to prepare? I'm afraid that I will be completely out of my depth.

    Dang - what a lucky intern (really....the NICU is the bestest place in the hospital).

    Okay, now to answer the question....there's not much to prepare except to make sure you have a working calculator and easy access to a good resource (UpToDate or a pocket neo guide). Just remember that neonatology is a team sport and the nurses, RTs, dietitians and the rest know what you don't know and will tell it to you if you listen and respect their advice. Meanwhile, be careful to find out the "rules" about examining babies, ordering labs and making vent changes. Believe me, the senior residents, fellows and attendings are well aware that new interns don't know NICU. We won't expect much and you'll have a quick learning curve.

    Best of luck and enjoy hanging out with the littlest people.

    My first NICU rotation was 38 years ago and I'm still at it and still enjoy being there. I also enjoy rounding with interns in July and August and will do so again this year.
     
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    Perrotfish

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    1. Attending Physician
      I am an incoming intern starting in the NICU. Any advice on what I can do to prepare? I'm afraid that I will be completely out of my depth.
      I am strong believer in buying an reading Polin and Yoder's workbook in practical neonatalogy: Link HERE. Basically its a casefiles style book for the NICU. Its a dense read and will take a full week to get through but if you finish and understand it you will be way ahead of your peers. Other than that pay attention in NRP and show up rested and ready to learn.
       
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      MEN2C

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        Be nice. Be willing to learn. It's OK if you hate it - many people do. Try to get as comfortabl as possible with NRP and delivery room experience. Examine (during care times!) as many babies as you can and learn the basics (RDS, hypoglycemia, meconium, murmurs, etc). It'll be fine.
         

        BigRedBeta

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          It really will be fine.

          Ask for help - early and often! Your other interns, the nurses, your senior, the RTs, the Nutritionists, and your attendings.

          Being efficient will make this and every rotation easier. The exact order will vary a little bit based on how your teams round, but in general after rounds - put in orders, call consults, work on discharges, and then worry about the rest of your notes.

          Your notes do not need to be perfect. In any ICU, the plan at 830am may have absolutely zero relevance at 845am.

          Practice being able to summarize every patient in 2 sentences. For your intern year, write it down on every patient, every day until it's natural. That summary is useful on rounds and when talking to consultants as it conveys the highlights and gets people on the same page with you.

          Especially with COVID, call every parent every day. You'd want the same if it was your kid. And with all the craziness going on, depending on your hospitals visitor policies, it's probably the highlight of their day to hear an update from you.
           
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          BabyDoc86

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            I am strong believer in buying an reading Polin and Yoder's workbook in practical neonatalogy: Link HERE. Basically its a casefiles style book for the NICU. Its a dense read and will take a full week to get through but if you finish and understand it you will be way ahead of your peers. Other than that pay attention in NRP and show up rested and ready to learn.
            I second this, it's a great book and I learned a lot from it during my med school rotation, intern rotation, etc.

            Ask for help, but push yourself. The tiny ones scare just about everyone the first time they're in charge. Golden hour babies scare everyone the first time. There's lots to learn that is useful even if you don't love NICU itself.
             
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            dmjfourth

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              Big fan of NEJM rotation guide too for neonatology. I started in the NICU after dreading It and crossing my fingers while they were handing out our schedules. Find a good senior resident, NP, or fellow and stay close. Ask lots of permission to start. Always check in with your nurse before examining. I think the learning curve is steep; there’s lots of unique physiology and acronyms to learn, but after you get that down it gets a lot more fun.
               

              Arodgeisfire

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                Big fan of NEJM rotation guide too for neonatology. I started in the NICU after dreading It and crossing my fingers while they were handing out our schedules. Find a good senior resident, NP, or fellow and stay close. Ask lots of permission to start. Always check in with your nurse before examining. I think the learning curve is steep; there’s lots of unique physiology and acronyms to learn, but after you get that down it gets a lot more fun.
                Couldn’t disagree more with the bolded. A resident should be learning medicine from physicians, not a midlevel.
                 

                PTPoeny

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                  Couldn’t disagree more with the bolded. A resident should be learning medicine from physicians, not a midlevel.
                  There is a lot to learn other than medicine as a new intern. At the start of reach rotation intern year most interns are figuring out where the bathroom is, which order sets to favorite in the EMR, which note templates to use, which attendings want "x" in the presentation, when to examine the babies, what time are standard morning labs in this unit, where to look to most efficiently get information out of the EMR and all sorts of other "not medicine". There are a million and one things everyone in any unit can teach a brand new intern and the interns should be learning from everyone and not just MDs. Many interns need to get comfortable with much of this basic stuff before they can start really retaining the medical learning. I think you are overreacting to a useful suggestion.
                   
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                  Calcio92

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                    Dang - what a lucky intern (really....the NICU is the bestest place in the hospital).

                    Okay, now to answer the question....there's not much to prepare except to make sure you have a working calculator and easy access to a good resource (UpToDate or a pocket neo guide). Just remember that neonatology is a team sport and the nurses, RTs, dietitians and the rest know what you don't know and will tell it to you if you listen and respect their advice. Meanwhile, be careful to find out the "rules" about examining babies, ordering labs and making vent changes. Believe me, the senior residents, fellows and attendings are well aware that new interns don't know NICU. We won't expect much and you'll have a quick learning curve.

                    Best of luck and enjoy hanging out with the littlest people.

                    My first NICU rotation was 38 years ago and I'm still at it and still enjoy being there. I also enjoy rounding with interns in July and August and will do so again this year.
                    Thanks for this, it really has helped settle my nerves! :)
                     

                    Calcio92

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                      I am strong believer in buying an reading Polin and Yoder's workbook in practical neonatalogy: Link HERE. Basically its a casefiles style book for the NICU. Its a dense read and will take a full week to get through but if you finish and understand it you will be way ahead of your peers. Other than that pay attention in NRP and show up rested and ready to learn.
                      Cheers, I will pick this up this week. Thanks.
                       
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