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So I'm about to enter my P4 year in a few short months and am already scared to death about being a 1st year intern. Actually it's not really that I'm scared to death, but from all the horror stories you hear it's enough to make your knees shake. For those residents and attending out there, how was your experience as a PGY-1? Are all the horror stories really true?
btw, for those out there that are having the same trepidation about being plunged into the "real world" here is a fantastic post I found on an MD forum...
btw, for those out there that are having the same trepidation about being plunged into the "real world" here is a fantastic post I found on an MD forum...
Quote:
Originally Posted by BurnOnMyYeeeow
Everyone stresses to death about starting internship. Those who don't get shocked rudely. Your first month you are going to lean heavily on your senior residents. To them it will seem like you can barely roll over, let alone crawl or walk.
It's July, they should know and expect it. My dad has a saying: Frogs forget what it's like to be tadpoles.
If you have time, read Charles Bosk's 'Forgive and Remember.' It's his sociology PhD thesis: he studied surgery teams at the University of Chicago (disguised in the book) like he was studying a primitive tribe. He focuses on punishment, team building, ethics, errors. Much of it remains true to this day. It's a very thin book.
He describes:
Technical errors - Forgivable if recognized early and rectified.
Judgement errors - Same
Ethical/moral errors - Not forgivable. Making a technical error, such letting go of the wire during a central line, have it disappear into the patient, then not telling anyone out of fear and leaving it in the patient, then having the team discover it two days later on CXR, is conversion of a technical error to an ethical error, is bad. That resident is now working in a flower shop, not because they messed up with the wire, but because of how they handled that situation.
One of the doctors in it, rumored to be Dr. George Block, is quoted as saying: I want from a resident these three things: Availability, affability, and ability, in that order.
Things I remember (I just graduated last June):
Reputations snowball. People categorize interns into 'strong' and 'weak.'
Strong: You'll never go wrong if you go to see the patient.
Strong: Write everything down. You will probably round and be given 3-5 thing to do on every patient. Write it down. You will not remember. Nobody does. Come up with a system, a patient list with check boxes every day, something, anything. If your chief sees you writing down all the tasks every AM, and you forget something, it'll easier to be forgiven than if he or she never sees you write anything down.
Strong: Learn early how to prioritize. A patient being kept waiting till 4PM for discharge orders when you decided on AM rounds to d/c, while the patient not going home today got his staples out and steri-strips on in the AM, not good. If you're having trouble, check with the chief. I used to tell my 'terns, if you get three things done before 10AM, they should be...and I want to know this CT result by 1PM... soon, I didn't have to, they just knew.
Strong: Action, reaction. If you do something, follow up on it. Don't bolus a liter for oliguria then 8 hours later find out the urine out put didn't pickup and now the patient is anuric. Don't write orders for 2 units on the patient with cardiac issues and four hours later get called for hypoxia and wet crackles. Don't be asked on afternoon rounds, so what did that CT show? And say uh... and find out radiology bumped you to the end of the line and it may not even get done today now.
Strong: Don't procrastinate. You don't want to get pulled off service because you have 100 discharge summaries waiting for you in medical records.
Weak: Your body and emotions are your own worst enemy. Your desire to eat lunch, rack for a few more minutes, letting your hatred of a particular nurse cloud your judgement when they call you with 'this guy doesn't look right' is where you will get burned, not from lack of intelligence or even lack of knowledge.
Weak: Continual conflicts with support staff. Getting stressed and yelling at the nurses doesn't help. It just makes the rest of the rotation harder and your attendings will hear about it. In many cases, the attendings have known that nurse for much longer than they have known you.
Strong: There is a difference between efficiency and cutting corners. One will get you time to go to the operating room and get you home at a reasonable hour. The other may get you home in the middle of the day, without a job.
Strong: The enthusiastic and cheerful resident tends to have an easier time than the sullen, complaining shirker who the nurses always see is calling from the call room: you do not want to graduate and at your Chief Roast win the 'Napa Valley Whine' award.
Strong: Your chief will only look as good as you let him or her look.
Strong: corollary: never blame anyone else, accept responsibility and also put forward a plan for how to fix the mistake.
Weak: Constant excuses and explanations for why something didn't get done.
Strong: Your only allies are your fellow interns. Don't screw them over. Build a team and syngergy can result. Every once in awhile a program seems to get someone who thinks they can get out a little earlier, make their own life a little easier at the expense of their co-residents. You work together too closely and for too long for people not to figure out pretty fast that someone smells, and not long after, who the stinker is. Life for that person tends to get considerably harder after that.
We used to fight over sign out before the days of 80 hours, and when we had Q2-3 call.
Sign out to me!
No! I'll be done with everything in another hour.
Just gimme your list! I'm here all night anyway!
No, you've got enough to do and I'm almost done!
Turns out our chairman was around the corner, med student stumbled into the chairman and was like, the boss is right around the corner listening to you guys. A week later, we were out having drinks at a local hotel lounge, someone said they thought they saw the chairman. Later, we were mystified when we were told our tab was already covered. (8 residents and s/o's, it was a big tab). When we asked who?... they showed us the receipt.
People appreciate what you do. They just don't tell you 99% of the time. It's the last bit of the old school left, IMO.
I had a code called on a patient who was accidentally given too much IV beta blocker. Ran there, gave her atropine, got her to unit, no lasting adverse events. Attending slapped me on the back and I feel good. Later that day, he yell at me about something and asks if I've done anything at all to advance the care of his patients that day!!??! So I mention that earlier incident. He says, 'That was five minutes ago. What have you done lately!?' then he laughed and chilled out.
So my final advice to you is: Let it roll off, like water off a duck's back.
A person who climbed the highest peaks on each continent did Everest last, and said the last stretch of Everest was the hardest to keep going up. You are on that last stretch. Don't give up now, be confident but not arrogant, work hard and care, and you'll be fine.
I'd definitely recommend it as a "fun" (get away from the schoolbooks) read.
