Intern year help

[thejanitorfromscrubs]

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Hi,
Im starting intern year in July. The most common advice I have gotten from others so far has been to NOT study too much, and many people have also advised to just review common topics.
So what exactly are the most important 10-20 topics that I should familiarize myself with? Please help me make a short list.

 

[GoSpursGo]

Just review whatever your patients have. That will be plenty.

 

[mvenus929]

The 'top 10' things you should know is going to vary hugely by specialty.

But if you're starting on an inpatient service, you should get sign-out on your patients before you start. Read up on what they have the night before and just keep looking up something on every patient you see. You'll get there.

 

[DOFOSHO]

there is nothing you can read to prepare yourself for intern year.

 

[Perrotfish]

10

Hi,
Im starting intern year in July. The most common advice I have gotten from others so far has been to NOT study too much, and many people have also advised to just review common topics.
So what exactly are the most important 10-20 topics that I should familiarize myself with? Please help me make a short list.

So a quick review of your posts shows that you're doing a transitional year. I agree that it won't help stress TOO much. You have been preparing for Intern year for 4 years. There is nothing that you will study that will move the needle that much. That being said, if you're determined to do something:

1) First and foremost, be ready to go on day 1. There is a saying among PDs that the problem intern is the one who is late to orientation. Don't be the intern still moving crap into his apartment on July 1. Specifically on day one you will want
1a) Housing no more than 15 minutes drive (ideally less than 10) from your primary work site
1b) A sleeping area that you can make completely dark in the middle of the day
1c) Every OTC cough/cold medication you could possibly need for dragging yourself into work while moderately sick. Cough drops, Tylenol, motrin, phenylephrine, gas drops, melatonin, and probiotics are a minimum. If you can get an albuterol inhaler for possible future bronchitis its not a bad investment, ditto several bottles of Pedialyte.
1d) Take at least a 4 day weekend where you do absolutely nothing before you start orientation.

2) If you're done with that, buy and read all three books in the bouncebacks! series. These are books written for the ER, about cases that initially looked benign and then bounced back and presented as something serious. Its a good review of pathology and medico-legal issues, its fun-ish and won't exhaust you too much, but most importantly every case is a review of the most important lesson an intern can learn, which is to assume that every patient is deathly ill until proven otherwise. Most Intern disaster stories start with an exhausted intern rolling his eyes at something the patient/nurse said.

3) Read some books about Intern year itself. Intern by Jauhar and Intern blues are my two favorites. Reading through threads on common intern errors on SDN is also kind of fun. Try to work out what the common points of failure are.

4) If you insist on trying to shore up your medical knowledge, try to focus down on one area that is easy to practice outside of a patient care environment and that you know you will be quizzed on. Learn to read EKGs (better than you already can). Start with Dubin. Then ready through 12 lead, the art of interpretation and start working through the cases on wavemaven. Or go through the learning radiology website and move onto radiology courses/books. If you must do something, that's probably going to the be the highest yield thing to do. ​

What I don't recommend is to try to do just a tiny bit more of qbanks/general studying. No Harrisons. No UWorld. Without patients to read on your retention is going to be low, with only a month to work on this your improvement will be minimal, and you will lose more than you gain by exhausting yourelf.

 

[nlax30]

Not sure how much yield it will be right now to try and and review a list of specific topics/diagnoses. What field are you going into?

I think the biggest hurdle people have during intern year is more related to navigating a new hospital system, EMR, people, dealing with subjective evaluation and just in general managing their time with much different expectations and responsibilities than we had as medical students.

Here are some other random thoughts....

Reviewing and reading up on whatever you particular patients have is a must and certainly easy way to decide what to review each day.

Go into this somewhat humble, rested, and ready to learn a new "system" and way of doing things, especially if it's not your home program. Remember, this is now a job for which you are getting paid and there's an element of working with and getting along with others here that I think some people stumble with. This then results in threads here about how they're on suspension or dismissed from residency.

You want to be the intern that is easy to get along with.

Develop some sort of organizational system to keep track of patients/labs/tasks, whether that's a printed patient list with checkboxes, clipboard, app, etc....

Take criticism well and don't take things too personally.

If in doubt call a senior, if you think you know what's going on, call. Regarding any real medical decisions, we don't expect you to know the answer but we do expect you to call us and at least have an idea of what you’d like to do.

 

[atomi]

Prelim or categorical? If prelim, your only objective is to survive. Your natural tendency will be to act and fear like the categoricals. In reality there are no exams other than step 1, and all you have to do to pass is show up, and nothing you do other than passing matters to your advanced program. This helps keep it in perspective when you are in the verge of quitting because you got chewed out for a bad presentation on rounds or screwing up an order set or something.

 

[DocVapor]

You should do as much hands-on studying of your preferred romantic gender as possible. Nothing else will help.

 

[TennisShoeChic]

Hi,
Im starting intern year in July. The most common advice I have gotten from others so far has been to NOT study too much, and many people have also advised to just review common topics.
So what exactly are the most important 10-20 topics that I should familiarize myself with? Please help me make a short list.

My time to shine! 😀 😀 😀
As someone who struggled intern year, here are things I wish I had studied more prior to July 1.

As a disclaimer, I anticipate many people will feel these are skills they mastered as an M3 or M4. That is wonderful! But for myself, these are areas I wish I had been more familiar with.

1. Antibiotics. Oh the dreaded antibiotics. Now don’t go crazy- you don’t need to memorize the mg/kg to give for every disease. But you should immediately be able to regurgitate what antibiotics you would give for pneumonia, cellulitis, UTI, strep throat, otitis media, sepsis, etc.

2. Responding to Late night calls from stable patients: Make a list of go-to meds you will use if you get a call the a patient has high BP, low BP, high potassium, low potassium, cough, can’t sleep, itching, nausea, diarrhea, constipation, etc. it is incredibly frustrating when you are running on little sleep to try to remember what anti-nausea med you should write for after the zofran “failed”. Having these little meds fresh in your mind that you will be called for again and again and again is very helpful.

3. Pain management. Deserves its own special category. Everybody has a hierarchy of how they like to prescribe meds for mild, moderate, and severe pain, and you will definitely pick that up quickly on wards. But refamiliarizing yourself on the difference between Toradol and Tramadol and the Opioid equivalents (like the equivalent oxycodone for a dose of dilaudid) will make your life simpler.

4. Anticoagulation. Familiarize yourself with the dosing (here’s where you want to look up mg/kg) for “prophylactic” anticoagulation to prevent DVTs and when you want “therapeutic” dosing. Also Familiarize yourself with when you stop anticoagulation before surgery, like a gallbladder removal.

5. Get a Step 3 CS book and start skimming it. That is the most bare-bones/boiled down to the basics order-set collection I encountered. the more familiar you are with what orders you would place for CHF exacerbation, stroke/TIA, abdominal pain, migraine, etc, the easier it will be on the wards.

6. Reassure yourself that even if you do none of these things, you will learn all this stuff as others have said as you hit the ground running in July. Also, no one expects interns to know anything for the first few months. your seniors and attendings will be there to help you. 🙂 🙂 🙂

 

[Dejavu]

I remember my first internship night. I was on call of course.

My senior said, jokingly I find out, “Don’t bother me tonight.”

Next morning, after admitting 5 patients, he sees me about 30 minutes before attending rounds and says, “Wow, quiet night, huh.” I told him about all the admissions, he says, “Crap. Why didn’t you call me? I have to see all of them before rounds. Holy Crap.”

I said, “You told me not to.”

Do Not do the above.

 

[geripalgal]

I remember my first internship night. I was on call of course.

My senior said, jokingly I find out, “Don’t bother me tonight.”

Next morning, after admitting 5 patients, he sees me about 30 minutes before attending rounds and says, “Wow, quiet night, huh.” I told him about all the admissions, he says, “Crap. Why didn’t you call me? I have to see all of them before rounds. Holy Crap.”

I said, “You told me not to.”

Do Not do the above.

Do not do the above, especially on your First internship night!!!

 

[GoSpursGo]

I remember my first internship night. I was on call of course.

My senior said, jokingly I find out, “Don’t bother me tonight.”

Next morning, after admitting 5 patients, he sees me about 30 minutes before attending rounds and says, “Wow, quiet night, huh.” I told him about all the admissions, he says, “Crap. Why didn’t you call me? I have to see all of them before rounds. Holy Crap.”

I said, “You told me not to.”

Do Not do the above.

To be fair, I find it absurd that your senior didn't check in with you at some point in the middle of the night just to see how things were going. But yes, please do not do this!

 

[Smurfette]

I remember my first internship night. I was on call of course.

My senior said, jokingly I find out, “Don’t bother me tonight.”

Next morning, after admitting 5 patients, he sees me about 30 minutes before attending rounds and says, “Wow, quiet night, huh.” I told him about all the admissions, he says, “Crap. Why didn’t you call me? I have to see all of them before rounds. Holy Crap.”

I said, “You told me not to.”

Do Not do the above.

Sounds like your senior learned a lesson as well.

 

[lulu09]

Really the best advice like what people have said above and what you were told in medical school is just read up on the conditions your patients have. There are always resources equivalent to Uptodate in every specialty, and if you want to get fancier go to Pubmed and search for reviews in reputable journals. If you do this with even 1/2 of your patients, you would have learned an immense amount even after your first month of internship.

But really, don't do any prep now, "get your affairs in order" (your housing, car, major shopping...etc.), and enjoy this last month (if you can take off a week or a long weekend and just go somewhere and revel in the warm weather). The hardest part of each day in intern year (or really all of training) is showing up. Once you dragged yourself out of bed and you've gotten yourself into the hospital, congratulations, you'll be able to take it from there. Be nice to everyone. Learn their names. Ask questions. Use common sense. You'll be fine.

ps. Be on time!! I have never gotten in trouble for being 10 minutes early, but have had a lot of unexpected surprises (random networking with the speaker before the talk which turned into a research opportunity, best dibs on assignments/scheduling) by showing up early. If your residency consistently has a lot of meetings and morning reports...etc. run by PDs/APDs, they'll notice if you show up on time, and that's not a bad thing 🙂

 

[cillycilly]

Hey guys quick question.. I’m about to start my internship year as a prelimb in medicine in one program and then I transfer to another for my pGY2 year in another program for Anesthesia. ( it’s in another state). Issue is I just got my schedule and I’m working till June 30th on the floor but I start orientation for pgy2 like June 22. I think my prelimb program should be aware of this. I can’t use vacation for last two weeks cuz I’m prego and need the 4 weeks earlier in the year... is this something i should be concerned about and fight to change or are the last 2 weeks just going to be relaxed since the programs obviously know their prelimbs will be need extra time to move and orientation. Or am I really screwed and should get my schedule changed as soon as possible ?

 

[nlax30]

Ideally would take vacation/PTO time for that last week and usually what people at my place have done. In your case it could be an issue if you are unable to save up some vacation time to do that.

Regardless I would talk to your PGY-1 program as soon as you can to see about coming up with a solution....whether it’s movig around vacation time or switching which rotation you are on that last month.

 

[rokshana]

Hey guys quick question.. I’m about to start my internship year as a prelimb in medicine in one program and then I transfer to another for my pGY2 year in another program for Anesthesia. ( it’s in another state). Issue is I just got my schedule and I’m working till June 30th on the floor but I start orientation for pgy2 like June 22. I think my prelimb program should be aware of this. I can’t use vacation for last two weeks cuz I’m prego and need the 4 weeks earlier in the year... is this something i should be concerned about and fight to change or are the last 2 weeks just going to be relaxed since the programs obviously know their prelimbs will be need extra time to move and orientation. Or am I really screwed and should get my schedule changed as soon as possible ?

you need to let your Chief and PD for your prelim know ASAP (usually the Chief residents make the schedule). It may be possible to use your sick live to pay for time off after your pregnancy or you make have to take a shorter (or unpaid leave) after giving birth...maybe they can put you on an elective like research or one that doesn't require a lot of time to it. Remember FMLA guarantees you the time off, but ACGME requires a certain number of weeks for the training to count...take more than a month off and you will have to make up the time to get credit for the year.

The other is to ask the Anesthesia program if you have to be present for orientation and if somethings can be taken care of before or after your start date...many time orientation things aren't mandatory and thing like physical and vaccines and EMR training can be done at other times.

 

[deleted875186]

Simply know off the top of your head what to do for serious calls overnight on the floor. Everything else, you have time to look it up and/or talk to others.

For example, work up acute chest pain. Treat and work up SOB or hypoxia. Treatments for rapid Afib. You get the idea. Have an idea of what’s most important to do and what’s important not to miss. After a few night shifts you get this stuff down pretty quickly.

 

[GoSpursGo]

Hey guys quick question.. I’m about to start my internship year as a prelimb in medicine in one program and then I transfer to another for my pGY2 year in another program for Anesthesia. ( it’s in another state). Issue is I just got my schedule and I’m working till June 30th on the floor but I start orientation for pgy2 like June 22. I think my prelimb program should be aware of this. I can’t use vacation for last two weeks cuz I’m prego and need the 4 weeks earlier in the year... is this something i should be concerned about and fight to change or are the last 2 weeks just going to be relaxed since the programs obviously know their prelimbs will be need extra time to move and orientation. Or am I really screwed and should get my schedule changed as soon as possible ?

Speak with both programs immediately. If the schedule says you're working on the floor until 6/30, that's what it literally means. As mentioned above, the 4 weeks off thing isn't a program specific number, it's an ACGME thing and you can't get credit for the year if you take more than 4 weeks off.

This sucks and isn't fair, but I think realistically the options will be 1) your prelim program puts you on research that last month, or some other rotation that you don't need to be physically present for; 2) your anesthesia program lets you show up late for orientation; 3) you take less than 4 weeks of maternity leave (or they give you 2-3 weeks and follow it with a light rotation where you don't need to be physically present, as in number 1 but just a slightly different order).

You'll be fine, this must have happened at some point in the past (for example, the anesthesia program must have some experience with people who can't show up on 6/22, or who actually are on maternity leave during orientation). But talk to your programs now so they can figure this out.

 

[NotAProgDirector]

Hey guys quick question.. I’m about to start my internship year as a prelimb in medicine in one program and then I transfer to another for my pGY2 year in another program for Anesthesia. ( it’s in another state). Issue is I just got my schedule and I’m working till June 30th on the floor but I start orientation for pgy2 like June 22. I think my prelimb program should be aware of this. I can’t use vacation for last two weeks cuz I’m prego and need the 4 weeks earlier in the year... is this something i should be concerned about and fight to change or are the last 2 weeks just going to be relaxed since the programs obviously know their prelimbs will be need extra time to move and orientation. Or am I really screwed and should get my schedule changed as soon as possible ?

When discussing this with your program, you definitely need to have a different attitude / talk about it differently. It's not your prelim program's problem that your orientation for your PGY=2 starts 6/22. They have hired you through 6/30. And, to receive full credit for the year, you need to work through your last work date. If you want to leave earlier than that, you need to arrange to have vacation. I understand that you're pregnant and hence think that you need to use your vacation elsewhere, but this is your problem to address, not the prelim's. There's no "fight" here, and don't expect anything to be "relaxed".

Also, your PGY-2 may have a later orientation for those in this type of scenario.

 

[Raryn]

Hey guys quick question.. I’m about to start my internship year as a prelimb in medicine in one program and then I transfer to another for my pGY2 year in another program for Anesthesia. ( it’s in another state). Issue is I just got my schedule and I’m working till June 30th on the floor but I start orientation for pgy2 like June 22. I think my prelimb program should be aware of this. I can’t use vacation for last two weeks cuz I’m prego and need the 4 weeks earlier in the year... is this something i should be concerned about and fight to change or are the last 2 weeks just going to be relaxed since the programs obviously know their prelimbs will be need extra time to move and orientation. Or am I really screwed and should get my schedule changed as soon as possible ?

Yeah, you need to get this addressed ASAP. Unless your pgy2 program will allow you to start late, you will need to have shifts traded with a cointern so that you aren't on inpatient the last week or two of the year. You will also likely need to take vacation those weeks. The problem is that to get credit for the year if you have too much time off, so you may end up needing to cut your maternity leave short. It's a ****ty situation to be in because the medical establishment, who should very well know the importance of maternity leave, really isn't built to take it into accojnt. They can give you longer time off if they put you one some BS research or self study elective for a few weeks, but they are under no obligation to do so.

I had the same thing where I had to use my last week and a half of vacation in residency to make it to fellowship orientation. It sucked.

Up to you if you want to try to address it with your prelim or advanced program first.

My personal feeling is that advanced programs and fellowships should just universally start August 1 and give people a clear window to move/orient/whatever, but then you run into other problems (a month without pay, possible lapses in insurance coverage unless you pay for COBRA, etc). And no one is asking me.

 

[mvenus929]

My personal feeling is that advanced programs and fellowships should just universally start August 1 and give people a clear window to move/orient/whatever, but then you run into other problems (a month without pay, possible lapses in insurance coverage unless you pay for COBRA, etc). And no one is asking me.

Most peds fellowships are moving to a start date around July 7th. My orientation is July 6th, but I know several people also starting fellowship this year who are starting July 9th. Most of them took the last week of residency as vacation anyway, but we were working on adjusting the block schedule so that all third years could take the last 1.5 weeks of residency as 'research' time to move and whatnot for fellowship or jobs, or just boards studying...