Intern year....oh the dreaded intern year!!

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AceH

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I just started intern year at a pretty reputable program in the west. I must say, it was quite a shock. I've had 5 shifts and I am almost always drowning, forgetting stuff, giving crappy presentations with crappy assessment/plans. Being pulled in 20 different directions and I just feel utterly incompetent/dumb/fake. I am learning everyday, trying to improve/learn one to two things every shift. I'm reading about the cases I was weak on every day, but boy, I just can't help but think sometimes that I may not be cut out for this. Self doubt, bad joo joo. I want to improve as much as possible first month.....what do I need to do? any advice is appreciated. I push myself as much as possible. Tell me this gets better!
 
Get constructive feedback from your attendings as they are observing your workflow, thought patterns, and presentations. Intern year is difficult for most people and you'll undoubtedly suck for the first 6 months but this is the time to push yourself, learn, and grow. This is to be expected. You won't be and should not expect to be comfortable throughout residency because if you are then you're not learning or doing enough. Relax and enjoy your time.
 
AceH said:
I just started intern year at a pretty reputable program in the west. I must say, it was quite a shock. I've had 5 shifts and I am almost always drowning, forgetting stuff, giving crappy presentations with crappy assessment/plans. Being pulled in 20 different directions and I just feel utterly incompetent/dumb/fake. I am learning everyday, trying to improve/learn one to two things every shift. I'm reading about the cases I was weak on every day, but boy, I just can't help but think sometimes that I may not be cut out for this. Self doubt, bad joo joo. I want to improve as much as possible first month.....what do I need to do? any advice is appreciated. I push myself as much as possible. Tell me this gets better!
Click to expand...

This feeling is both normal and expected. I am sure most of your classmates feel the same. You could be describing how I felt the first few months of intern year.

It gets better. Not right away, and maybe not for a while. But keep at it, you seem to have the right attitude. Keep reflecting on what you can do better with each shift, and ask for feedback from everyone, including nurses. There is a saying that as an intern you won't feel smart until next July when you see the next batch of interns effing everything up. Only then will you really appreciate how far you've come.
 
AceH said:
I just started intern year at a pretty reputable program in the west. I must say, it was quite a shock. I've had 5 shifts and I am almost always drowning, forgetting stuff, giving crappy presentations with crappy assessment/plans. Being pulled in 20 different directions and I just feel utterly incompetent/dumb/fake. I am learning everyday, trying to improve/learn one to two things every shift. I'm reading about the cases I was weak on every day, but boy, I just can't help but think sometimes that I may not be cut out for this. Self doubt, bad joo joo. I want to improve as much as possible first month.....what do I need to do? any advice is appreciated. I push myself as much as possible. Tell me this gets better!
Click to expand...

Completely and utterly normal. Keep doing what you're doing. You're going to feel dumb for most of intern year. That's because you have no idea what you're doing yet. Emphasis on yet. You're fine. Everyone else is / was in the same boat when they were in your shoes.
 
thanks for all the responses. I wanted really work on developing a good system to see patients so I don't miss/forget stuff. Any recommendations for that? I've been doing quick chart reviews (vitals, pmh), then see patient, put in orders (most times senior puts in orders before I even can), then chart H&P, then check for pending results for dispo...put re-assessment somewhere in there..then repeat. I've been writing a to do list on every patient in every patient (this takes up some time).
 
Dude I'm with you. Had my first shift today. Literally my first patient was a baby found in cardiac arrest. Had to figure out how to call ME/how to write a note for a dead patient (never learned that in med school), handle the family, etc. Forgot to ask tetanus status on a kid with a lac. Thought "document 10 ROS" meant 10 individual items, not 10 systems. Had a trauma transfer by myself that was getting sleepy and going apneic after getting 8mg of morphine at the outside and had no clue what the issue was (any ideas? lol). I'm sure all my notes blew and that I messed up somebodies treatment along the way as well. All in one shift! Good to know other people are in the same boat. This is a whole nother ball game as a resident than as a med student! Hoping I pick up on things quickly.. Good luck to all my fellow interns!

Edit: I now also see why EM people are somewhat aggressive with interventions... There is so much going on that you don't have time to sit and monitor people forever. Just intubate them and then you can see the next patient and manage them from a distance.
 
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Intern year is tough.
It is normal to doubt yourself everyday.

There is no one system that works for everyone.

Find 1 attending and 1 senior resident who can help mentor you.

Force yourself to read something everyday.
Especially read about the common chief complaints. That is a good starting point.

Anyone who doesn't feel lost likely has no insight.

Just trust the system and try to keep learning.
 
New attending here.

Normal. Lots of people feel like that. You learn a crazy amount as a resident. I've gotten a small taste of the continued, different, learning curve that comes with being an attending.

All part of the game. Enjoy your time as others said. It'll be done and over with before you know it.
 
HLxDrummer said:
Dude I'm with you. Had my first shift today. Literally my first patient was a baby found in cardiac arrest. Had to figure out how to call ME/how to write a note for a dead patient (never learned that in med school), handle the family, etc. Forgot to ask tetanus status on a kid with a lac. Thought "document 10 ROS" meant 10 individual items, not 10 systems. Had a trauma transfer by myself that was getting sleepy and going apneic after getting 8mg of morphine at the outside and had no clue what the issue was (any ideas? lol). I'm sure all my notes blew and that I messed up somebodies treatment along the way as well. All in one shift! Good to know other people are in the same boat. This is a whole nother ball game as a resident than as a med student! Hoping I pick up on things quickly.. Good luck to all my fellow interns!

Edit: I now also see why EM people are somewhat aggressive with interventions... There is so much going on that you don't have time to sit and monitor people forever. Just intubate them and then you can see the next patient and manage them from a distance.
Click to expand...

Unless your patient was opioid naive with end stage renal failure, 8mg of morphine is not going to cause respiratory depression and certainly not apnea.
Remember that 10mg of morphine only equals 1.5mg of dilaudid. I've given upwards of 20mg of morphine to patients with severe traumatic injuries.

In any case if you're worried you can always hook them up to ETCO2 monitoring.
 
alpinism said:
Unless your patient was opioid naive with end stage renal failure, 8mg of morphine is not going to cause respiratory depression and certainly not apnea.
Remember that 10mg of morphine only equals 1.5mg of dilaudid. I've given upwards of 20mg of morphine to patients with severe traumatic injuries.

In any case if you're worried you can always hook them up to ETCO2 monitoring.
Click to expand...

Ya that is what I was thinking... just couldn't think of what else was going on. GCS 14, a little confused so I didn't think there was some severe brain injury or something. Oh well, he ended up breathing normally eventually lol
 
The White Coat Investor said:
Hmmmmm... you suck at our job in your first week? Weird. The rest of us became perfect at it in like 3 shifts. I'm not sure what your problem is. It's a totally easy job.
Click to expand...

Thats exactly what I mean! I feel like I should be attending level day 1. How do I accomplish this? 3 years seems too long, I was thinking 2 days at max.
 
AceH said:
I just started intern year at a pretty reputable program in the west. I must say, it was quite a shock. I've had 5 shifts and I am almost always drowning, forgetting stuff, giving crappy presentations with crappy assessment/plans. Being pulled in 20 different directions and I just feel utterly incompetent/dumb/fake. I am learning everyday, trying to improve/learn one to two things every shift. I'm reading about the cases I was weak on every day, but boy, I just can't help but think sometimes that I may not be cut out for this. Self doubt, bad joo joo. I want to improve as much as possible first month.....what do I need to do? any advice is appreciated. I push myself as much as possible. Tell me this gets better!
Click to expand...

Every word in this post is...


One hundred...

Percent....



...normal.

It gets better. I'm not just bullsh¡tting to make you feel better. Just put one foot in front of the other. Just get through the day. Today. Tomorrow: repeat. That's all you need to do. Don't delete this post. In fact, set your iphone with a link to remind yourself to re-read it in 2 3/4 yr to remind yourself how far you've come.

It gets better.
 
Then relive it on attending day no 1.


Sent from my iPad using Tapatalk
 
PGY4 here. Totally normal intern feelings. If you didn't feel this way, I'd be severely worried that you have the dreaded and dangerous confidence / ability mismatch. As a junior resident you get gold stars in my book for the following: honesty, coachability, timely completion of patient centered tasks (i.e. orders, consults, seeing new patients). Sometimes the documentation has to wait until later.
 
GonnaBeADoc2222 said:
PGY4 here. Totally normal intern feelings. If you didn't feel this way, I'd be severely worried that you have the dreaded and dangerous confidence / ability mismatch. As a junior resident you get gold stars in my book for the following: honesty, coachability, timely completion of patient centered tasks (i.e. orders, consults, seeing new patients). Sometimes the documentation has to wait until later.
Click to expand...
Thanks for the advice. New intern here, and I feel like there are so many times during my shifts when I've got a hundred things to do and I don't know where to start. Focusing on getting the patient-centered tasks completed first actually has made my last few shifts seem to flow more efficiently (even if it is at the expense of sticking around and charting for an extra half hour).
 
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