Intern year is pointless

[RestoreSight]

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For all the ophthalmologists out there, intern year is pointless.

My attending the other day was handing out presentations for the interns to give on rounds. She asked each of the transitional year residents what they were going into. The interns going into radiology were asked to present how to read a chest x-ray, the future-anesthesiologists about airway management, then she asked me what I'm going into. I said, "ophthalmology," and she said:

"...Ophtho? well... I guess you don't have to give a presentation then, you can go home."

Intern year is pointless if you're going into ophthalmology

Please comment on experiences during internship for those ophthalmologists who completed it (residents, attendings) or those who just started it ...(The Useless 'Terns!)

 

[JMK2005]

For all the ophthalmologists out there, intern year is pointless.

My attending the other day was handing out presentations for the interns to give on rounds. She asked each of the transitional year residents what they were going into. The interns going into radiology were asked to present how to read a chest x-ray, the future-anesthesiologists about airway management, then she asked me what I'm going into. I said, "ophthalmology," and she said:

"...Ophtho? well... I guess you don't have to give a presentation then, you can go home."

Intern year is pointless if you're going into ophthalmology

Please comment on experiences during internship for those ophthalmologists who completed it (residents, attendings) or those who just started it ...(The Useless 'Terns!)

As an intern, you do mostly hospital medicine where ophthalmic knowledge is less appreciated. An outpatient internist would appreciate a brief overview of red eye, taking a good ophthalmic history (flashes, floaters, etc).

On the flip side, I felt my internship was useful and should still be required for ophthalmology residency.

 

[Dusn]

I think the transitional year schedule with some peds, surgery, and adult medicine, and ample time for electives (like neuro, neuro-radiology, and rheumatology) is probably the best choice. I did an all adult medicine prelim year and when I was in the peds hospital I felt pretty lacking in terms of my understanding of their underlying genetic and systemic diseases and how to dose the systemic meds that we were placing them on. It made me appreciate the familiarity I had on the adult side of things.

Give your attending a presentation on pituitary apoplexy, giant cell arteritis, a cavernous sinus thrombosis, etc.. there's plenty of ophtho relevant things that medicine needs to know.

 

[Visionary]

Your attending obviously knows nothing about the eye and how eye pathology can correlate to systemic pathology. This should have been a teaching opportunity for you. Internship, while painful, is very useful, IMO.

 

[orbitsurgMD]

That is disappointing to hear. That attending lacks imagination or sufficient experience in examining eyes to understand that internists are actually supposed to know something about eyes. He really should know better. Do none of his patients have diabetes, hypertension, hyperthyroidism, autoimmune diseases?

I think many ophthalmologists would be better served with a more surgically-intensive internship year, with rotations on general plastic surgery.

 

[xanthomondo]

Intern year is pointless if you're going into ophthalmology

I disagree. Already I've had to consult ophtho a bunch of times (patient with fungemia among other reasons) and I think it's useful to be on the other side of the fence for a year before going into ophtho.

 

[4ophtho]

Intern year is learning how to think like a doctor, learning good clinical judgement, and developing a good foundation in medicine. It is naive to think you can practice good eye care without first understanding how to treat systemic diseases that affect the eye. This is what makes us doctors and not optometrists. Work hard and learn as much as you can - you've only been doing this for 2 weeks.

 

[namams]

This is what makes us doctors and not optometrists.

Oh god. 🙄

 

[Shnurek]

Oh god. 🙄

lol here we go again

 

[RestoreSight]

Intern year is learning how to think like a doctor, learning good clinical judgement, and developing a good foundation in medicine. It is naive to think you can practice good eye care without first understanding how to treat systemic diseases that affect the eye. This is what makes us doctors and not optometrists. Work hard and learn as much as you can - you've only been doing this for 2 weeks.

6 weeks, but that's beside the point.

Intern year is not about treating systemic diseases that affect the eye at all. It has nothing to do with the eye, that's my point. We spent 4 years learning to think like a doctor in medical school. Now I am a doctor and my days are spent adding fluid one day and diuresing the same fluid off the next day. If the goal is to understand systemic diseases that affect the eye the intern year should be integrated into ophthalmology training, say 3 months each year of wards, instead of an entire year upfront that is essentially an anomaly when compared to an entire career.

You make good generic points, but the bottom line is intern year as structured is inefficient and cumbersome and not designed well. 😴

 

[RestoreSight]

I disagree. Already I've had to consult ophtho a bunch of times (patient with fungemia among other reasons) and I think it's useful to be on the other side of the fence for a year before going into ophtho.

Come on. You consulted ophtho a "bunch of times?" I went to a major teaching hospital with a huge ophtho department for medical school and in 2 years on the wards we consulted ophtho a total of like 3 times. Once for an orbital mass that turned out to be a glaucoma filtering device, lol. The other two were neuro related.

 

[RestoreSight]

On the flip side, I felt my internship was useful and should still be required for ophthalmology residency.

I think a lot of the posts are forgetting the day-to-day life of an intern and just how mindless it really is. Your day is basically a combination of long rounds and a bunch of computerized orders. You do not see fascinating cases on a daily basis that challenge your intellect. What you see is CHF, chest pain rule out, CKD, COPD... EVERY DAY. Orders are in sets and entirely computerized. You follow the same routine for 95% of the patients that present with common conditions. What you do is add and take away fluids on patients, replete mg and phos, pain meds and write endless notes, admission orders, transfer orders, accept orders... the list goes on. I don't find this educational or useful in any way for ophthalmology residency. Feel free to disagree, but try to be an intern again for a day on nightfloat and you might see things differently. 👍

 

[Dusn]

For more practical reasons, depending on which residency program you go to you may have inpatients on your own service. Our medicine department pushed back hard against admitting patients that weren't "medicine." As a result we'd have several patient on our service at any given time -- post-ops that didn't do well after extubation, oculoplastics (orbit) patients needing post-op monitoring, ruptured globes, etc. Some of them were 90 year old parkinsons patients with corneal ulcers (admitted because they couldn't get eye drops in their eye) and these guys always had a bunch of other medical problems.

 

[WhatNEyeTem]

I agree. One of the important skills you learn during internship year is how to admit patients, manage them on the floors, etc. You also learn how to deal with a LOT OF STRESS, multi-tasking, and managing very sick patients.

Managing sick eyes requires alot of the same skill set.

 

[TheLesPaul]

I think a lot of the posts are forgetting the day-to-day life of an intern and just how mindless it really is. Your day is basically a combination of long rounds and a bunch of computerized orders. You do not see fascinating cases on a daily basis that challenge your intellect. What you see is CHF, chest pain rule out, CKD, COPD... EVERY DAY. Orders are in sets and entirely computerized. You follow the same routine for 95% of the patients that present with common conditions. What you do is add and take away fluids on patients, replete mg and phos, pain meds and write endless notes, admission orders, transfer orders, accept orders... the list goes on. I don't find this educational or useful in any way for ophthalmology residency. Feel free to disagree, but try to be an intern again for a day on nightfloat and you might see things differently. 👍

Perhaps it is the program you're attending. I'm doing a prelim IM year as well, and while I've only been at it for 2 weeks, I've been learning (and re-learning) so much medicine. Even when it's "just CHF", it's not "just CHF". Why is the patient having the symptoms he is? How can I assess this? What makes him sick versus not sick? Do I have a methodical plan to evaluate his problem and a way to go back and choose a different path if I'm wrong?

These are skills that all doctors should have; all the knowledge we learned in med school does nothing until we learn to apply it, and we only learn to apply it by doing and making mistakes in a controlled setting. That setting is called internship. It is, also, what separates us from other health care providers. We do ourselves a great disservice if we ignore the rest of the body, and then claim that we are better than NPs and optometrists because of our superior training.

 

[xanthomondo]

Come on. You consulted ophtho a "bunch of times?" I went to a major teaching hospital with a huge ophtho department for medical school and in 2 years on the wards we consulted ophtho a total of like 3 times. Once for an orbital mass that turned out to be a glaucoma filtering device, lol. The other two were neuro related.

in a total of three weeks thats how many times ive had ophtho on the phone

i guess the service i was on dealt a lot with septic patients

if fungus ever shows up = auto ophtho consult

 

[JMK2005]

I think a lot of the posts are forgetting the day-to-day life of an intern and just how mindless it really is. Your day is basically a combination of long rounds and a bunch of computerized orders. You do not see fascinating cases on a daily basis that challenge your intellect. What you see is CHF, chest pain rule out, CKD, COPD... EVERY DAY. Orders are in sets and entirely computerized. You follow the same routine for 95% of the patients that present with common conditions. What you do is add and take away fluids on patients, replete mg and phos, pain meds and write endless notes, admission orders, transfer orders, accept orders... the list goes on. I don't find this educational or useful in any way for ophthalmology residency. Feel free to disagree, but try to be an intern again for a day on nightfloat and you might see things differently. 👍

There are learning opportunities all along the way. you can think the same about general ophth training.

why do I need to learn retinoscopy?
don't need to worry about the retina since i'm only interested in cataract surgery. etc...

Keep a good attitude and an open mind and you'll get more out of internship.

 

[e4e]

I don't know if it is completely useless or not, probably most of it is. But one thing I'm sure of, internship sucks like nothing else (talking of prelims).

 

[Dr. USMLE]

I think a lot of the posts are forgetting the day-to-day life of an intern and just how mindless it really is. Your day is basically a combination of long rounds and a bunch of computerized orders. You do not see fascinating cases on a daily basis that challenge your intellect. What you see is CHF, chest pain rule out, CKD, COPD... EVERY DAY. Orders are in sets and entirely computerized. You follow the same routine for 95% of the patients that present with common conditions. What you do is add and take away fluids on patients, replete mg and phos, pain meds and write endless notes, admission orders, transfer orders, accept orders... the list goes on. I don't find this educational or useful in any way for ophthalmology residency. Feel free to disagree, but try to be an intern again for a day on nightfloat and you might see things differently. 👍

I agree completely. I like the term "clinical clerkship"...even though it's usually to describe med student rotations, terns really are just clinical clerks/secretaries. Whenever any sort of higher order reasoning is needed beyond what you've described above, the specialists are consulted. It's great to have a positive outlook and make the most of the year, but that doesn't change the mundane, mindless nature of the work. This is confirmed by all of the senior specialists I've met who strongly encourage TYs over PYs.

 

[TheLesPaul]

I agree completely. I like the term "clinical clerkship"...even though it's usually to describe med student rotations, terns really are just clinical clerks/secretaries. Whenever any sort of higher order reasoning is needed beyond what you've described above, the specialists are consulted. It's great to have a positive outlook and make the most of the year, but that doesn't change the mundane, mindless nature of the work. This is confirmed by all of the senior specialists I've met who strongly encourage TYs over PYs.

Again, this is *completely* program-dependent. I know of a few programs (and am at one) where interns are expected to reason through and formulate the plan on their own. In fact, after a few months, we are expected to take call overnight on our own, with our seniors available for backup by phone.

 

[Visionary]

Again, this is *completely* program-dependent. I know of a few programs (and am at one) where interns are expected to reason through and formulate the plan on their own. In fact, after a few months, we are expected to take call overnight on our own, with our seniors available for backup by phone.

Agreed. My program, for instance, had us interns taking overnight cardiology call with the fellow only available by phone (fax for EKGs). Mine was a prelim, not transitional.

Sent from my HTC Incredible using SDN Mobile

 

[paboi101]

Having just finished my first month as an IM prelim at a crazy-busy inner city hospital, about to start night float, I can say that while much of what I'm doing has only tangential benefit to my future as an ophthalmologist, I would never say that this is pointless. Full disclosure, I did chose this over a t-year or even a cush IM year, so I'm obviously biased. Not only am I learning how to keep a cool head "in the trenches" but I'm also learning how to be a doctor...take responsibility...and grow up. I already have a lifetime of war stories. This has made me all the more excited to continue on...

There's a ton of scut, there's a ton of pointless BS, but there are a lot of great lessons. I've also watched as a Ophtho attending in my hospital was absolutely horrible (completely unjustified) in her interaction with a co-intern. What a great role model in how not to act when I'm the one dropping in for a consult.

So, will I change my tune in a few more blocks? maybe. But for now, its just kind of cool to be part of something real for a change.

 

[MstaKing10]

For all the ophthalmologists out there, intern year is pointless.

My attending the other day was handing out presentations for the interns to give on rounds. She asked each of the transitional year residents what they were going into. The interns going into radiology were asked to present how to read a chest x-ray, the future-anesthesiologists about airway management, then she asked me what I'm going into. I said, "ophthalmology," and she said:

"...Ophtho? well... I guess you don't have to give a presentation then, you can go home."

Intern year is pointless if you're going into ophthalmology

Please comment on experiences during internship for those ophthalmologists who completed it (residents, attendings) or those who just started it ...(The Useless 'Terns!)

Your attending is an idiot

 

[WhatNEyeTem]

Having just finished my first month as an IM prelim at a crazy-busy inner city hospital, about to start night float, I can say that while much of what I'm doing has only tangential benefit to my future as an ophthalmologist, I would never say that this is pointless. Full disclosure, I did chose this over a t-year or even a cush IM year, so I'm obviously biased. Not only am I learning how to keep a cool head "in the trenches" but I'm also learning how to be a doctor...take responsibility...and grow up. I already have a lifetime of war stories. This has made me all the more excited to continue on...

There's a ton of scut, there's a ton of pointless BS, but there are a lot of great lessons. I've also watched as a Ophtho attending in my hospital was absolutely horrible (completely unjustified) in her interaction with a co-intern. What a great role model in how not to act when I'm the one dropping in for a consult.

So, will I change my tune in a few more blocks? maybe. But for now, its just kind of cool to be part of something real for a change.

I think you hit the nail on the head. One of the biggest benefits of doing internship is learning how to handle EXTREMELY stressful situations and make on-the-fly decisions. I remember having to take care of >40 patients on surgical call...for a 30 hour shift. It was hell on earth for those 3 months (I did a TY), but I can honestly say that nothing came close to phasing me in comparison during Ophtho residency.

I think Transitional Years are the best. You get your core inpatient rotations (e.g 3 months of Medicine, 3 months of Surgery), but can also choose a variety of electives. The diversity really helps in your communication with the folks that will be eventually referring Pts to you (and you referring Pts to them). I would choose electives in Derm and Rheum if at all possible.