dell2004

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Alright, so match is in 5 days. Will then need to find a place to live and then, well, giddy-up! Intern year is on! What's the best way to prep (if there is one) for intern year? What was your study schedule like intern year? Any feedback would be very helpful. Thanks.
 

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dell2004 said:
Alright, so match is in 5 days. Will then need to find a place to live and then, well, giddy-up! Intern year is on! What's the best way to prep (if there is one) for intern year? What was your study schedule like intern year? Any feedback would be very helpful. Thanks.
(1) ask an intern how he/she organzes him/herself each day.
(2) learn how to take care of basic calls--tachycardia, fever, etc.
(3) consider doing an icu rotation if you haven't already done so... this will help you think by system, and make you more efficient.
(4) go on a few vacations. see friends and family. gamble. drink. carouse. sleep in.
 

Denial

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Get the corporial body used to 4 hours of sleep . Infact sleep in pieces.Learn to stay focused when poop hits the fan.
learn your knots! master the rudimentary suture skills.
Learn to NOT have a life and NOT whine about it chronically as your seniors have ingested every thing you will be chewing now.
Sow extra pockets in your labcoat which serve as food reservoir. If you are in a program which has ONcalls as opposed to the Nightfloats then you need to brace yourself up for Zero sleep oncall and then making your rountine rounds in the morning without batting the eyelid.
If you are in a night float system them thank what ever cosmic power you believe in ! and Enjoy!
 

surgchick

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Have you guys ever heard of the book, "The surgical intern pocket survival guide"? If so, was it a good book to have?
 

klubguts

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surgchick said:
Have you guys ever heard of the book, "The surgical intern pocket survival guide"? If so, was it a good book to have?
i bought that book last week (it's really cheap, so figured i couldn't loose much)...it seems like a good book (by a guy named Chamberlain) and was suggested to me by some of the interns at my home place..congrats on matching and good luck everyone.
 

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Appropriate preparation for the intern year:

1. Buy Xbox
2. Buy Halo 2
3. Buy significant quantities of alcohol. Fat Tire beer, Bombay gin, and some form of margarita mix are essential.
4. Mix steps 1-3 daily.
5. Go to the beach. Drink Corona.
6. Go to Europe. Drink fancy wine.
7. Read trashy novels.
8. Go to Spring Training. Sit with the scouts and listen as they take notes.
9. Go to Opening Day. Drink overpriced beer, eat hotdogs.
10. Show up when you're supposed to be there. Don't do anything else.

That's pretty much what I did to prepare for my intern year. My best friend did a month in the Cardiac ICU, a month of medicine sub-I, and an extra surgical sub-I. I called him from Vail while I was on the gondola, Jupiter while I watched the Cardinals, St. Louis on Cards opening day, some small town just west of Nice, and from several shady bars. He read Marino's ICU book, Mont Reid, Sabiston, and a couple of surgical journals. I read a biography of Sandy Koufax, a couple of Agatha Christie mysteries, and Rolling Stone.

We were both idiots for the first couple of weeks of internship. He knew the ACLS protocol better than I did, but I didn't run a code until October (so it didn't matter). He remembered common med dosages better than I did. I just used ePocrates for the first couple of weeks.

Medical school is your preparation for intern year. Enjoy your last few months in peace, because once it starts you'll never have that much free time again.

Good luck in July. Have fun until then.
 

neutropeniaboy

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Finally! Someone with good advice.

Internship is brainless and is almost solely an exercise in endurance. If you have good organizational skills, can write fast, and can jot down a list of things to do, you'll be a superstar.

maxheadroom said:
Appropriate preparation for the intern year:

1. Buy Xbox
2. Buy Halo 2
3. Buy significant quantities of alcohol. Fat Tire beer, Bombay gin, and some form of margarita mix are essential.
4. Mix steps 1-3 daily.
5. Go to the beach. Drink Corona.
6. Go to Europe. Drink fancy wine.
7. Read trashy novels.
8. Go to Spring Training. Sit with the scouts and listen as they take notes.
9. Go to Opening Day. Drink overpriced beer, eat hotdogs.
10. Show up when you're supposed to be there. Don't do anything else.

That's pretty much what I did to prepare for my intern year. My best friend did a month in the Cardiac ICU, a month of medicine sub-I, and an extra surgical sub-I. I called him from Vail while I was on the gondola, Jupiter while I watched the Cardinals, St. Louis on Cards opening day, some small town just west of Nice, and from several shady bars. He read Marino's ICU book, Mont Reid, Sabiston, and a couple of surgical journals. I read a biography of Sandy Koufax, a couple of Agatha Christie mysteries, and Rolling Stone.

We were both idiots for the first couple of weeks of internship. He knew the ACLS protocol better than I did, but I didn't run a code until October (so it didn't matter). He remembered common med dosages better than I did. I just used ePocrates for the first couple of weeks.

Medical school is your preparation for intern year. Enjoy your last few months in peace, because once it starts you'll never have that much free time again.

Good luck in July. Have fun until then.
 

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Read harrisons...its a quick read and will really help you for that absite. Oh, wait a minute, disregard prior statement. I was trying to say you should pick up on the opposite sex as much as possible in between your scut.
 

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This a related question. I'm going into fourth year soon. Looking back what kind of classes taken or skills developed would have helped with intern year. I realize that nothing is really gonna prepare me and I do plan on enjoying fourth year, but really, what do you recommend? Thanks.
 

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phoenixsupra said:
This a related question. I'm going into fourth year soon. Looking back what kind of classes taken or skills developed would have helped with intern year. I realize that nothing is really gonna prepare me and I do plan on enjoying fourth year, but really, what do you recommend? Thanks.
Learn how to write outpatient subscriptions. If your Chief gives you a signed, blank script, PLEASE fill it out correctly. Invariably, the Chief is called at home at some good awful hour by the pharmacy when Mr. X is trying to fill his Percocet script without a dispense number on it.

Learn your IV fluids, what works best when and how to calculate maintenance amounts.

When you sign out to cross cover, do a good job. Most of the mistakes these days take place not because of tired residents, but because of the necessity of cross coverage who don't know the patients. Give them as much info as possible; don't sign out early unless you have an agreement to do the same for that intern. Don't ask them to do things which you could have done hours ago, or are pending - just stay another 20 minutes to check on the lab results, etc.

Do as many procedures as you can - central lines, chest tubes, etc.

Learn how to read an xray - if you're at a hospital without in-house radiology residents or attendings, YOU will be the one calling your attending with the read.

Learn what stuff the nurses like to give for "patient comfort" - ie, what to give for hiccups, "heartburn" (once you've decided it really isn't crushing central chest pain), sore throat, diarrhea, constipation, MSK pain, etc.

Learn how to handle outside calls from patients - you don't actually have to do this, but &*&^% I can't tell you the number of times I've had a resident tell me " some patient" called. If you haven't learned proper phone message taking, please do. WRITE DOWN the following: patient's name, birthdate or SSN (or whatever you can use to find the patient on the computer if there are 10,000 John Smiths on record), who their attending is (they may not know), what they had done or are planning on having done, when their next clinic appointment is (if its something that can wait until clinic), where they live, a CALL BACK NUMBER and why they're calling. It will save you lots of headaches if you can take a complete message and deal with it appropriately (ie, can this person be called back in the am after you've spoken with the attending or does it require immediate action?).

Learn how to take calls from consultants - either your own or from other hospitals. You may not get these calls, but the same above applies. Why are they calling (do they want to transfer a patient), who are they calling about, what's the patient's malfunction and where can they be reached? Its unlikely as an intern you'll get too many of these or be able to accept transfer patients, but you shoudl have the information in case you do, or need to call someone else with the information. Rather than just give the caller the person he/she needs to talk to, its better if you take the information and call that person yourself, IMHO.

Learn what you need/must have in your call bag - a toothbrush and paste or at least those Brush-Ups, a sweater or sweatshirt, clean socks and underwear, an extra pair of scrubs if you keep them at home, snacks if your cafeteria isn't open 24/7 (or to save $$), an alarm clock that will wake you if your room doesn't have them, a bedside lamp if your room doesn't have them (its a real pain to get out of bed to read your pager in the dark), etc.

Call your spouse or SO when on call and as often as possible during down-time. It will make your life less painful when you are home.
 

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Hi there,
Things that really helped me through internship:

Those "French Fry" lights from the SICU for that cold drafty sleep room. I could plug them in and bask under their warm red glow. Extra warm socks helped too. The hospital got frigid summer and winter.

Hot chocolate! Coffee just made me jittery and didn't really keep me alert. I dropped most drinks with carbonation and caffeine. UVa had the most wonder soda fountains on every floor but I stuck to hot chocolate and water. Crystal Light is nice to have too.

Extra toothbrushes everywhere. There is nothing worse that post call mouth. Even if you can't muster a shower, the teeth have to be brushed. Clean underwear and socks are a must too. A shower is a great way to greet the morning or after a long case in the OR. You really build up a sweat and a shower is heaven.

If you respect the nurses, they will help you at every turn. I would not have made it through internship without the support of the nurses. You will quickly learn which nurses are experienced and which nurses are still on the same learning curve as you. I really didn't find any nurses that just wanted to bug me for no good reason. If they bothered to call me, I got up and saw the patient. I listened to what they had to say and I often sought their advice on patient comfort issues. I made it a habit of making bed check rounds an hour after the late shift came on and took care of any little nagging problems. I could get more sleep that way.

Scrub every case that you can get your hands on. Operating is the reason that you do all of that scutwork. Operate with your chief and do what he or she does. Learn good techniques and ways to save movements. Your chief can get you polished up very quickly. Practice everything until it become second nature and no hand movement is wasted.

I used the "Surgical Interns Survivial Guide" by Chamberlain when I was an intern. There is lots of wisdom in that little book and it can keep you out of trouble. Keep it and a Palm Pilot/Pocket Pharmacopea in your pocket. A calculator is a good thing to have also if you do not carry a Palm device.

If you think you should call the chief, call the chief. If a patient is sinking, load the boat! Call early and never apologize for calling. Sometimes the chief can tell you one little thing that gets you out of trouble. Call early and have good information. The worse thing as a chief is to come in and find that there was something that could have easily been handled over the phone if you had been informed.

Keep your chief and senior resident informed all of the time. You are the point person on the floor and you are the one to be sure that the care plan of the day gets carried out. Write down everything and check off when things are done. Report to your seniors often during the day. Check your patients often. Don't hide the the call room, get out on the floor and keep up with what is going on. Most of the time, you can head off trouble by just being present. If you are scrubbing, have the nurses keep a "scut sheet" (a list of things that they need but do not have to call you every five minutes for). Check the scut sheet often during the day and cross off what you have done.

The second-year residents are your best source of how to get and keep organized. They are there to help you look good. Utilize their knowledge and they will help you get up to speed. Learn every kind of procedure that you can. Put in chest tubes, do central lines, put in arterial lines, put in temporary hemodialysis catheters and keep doing the procedures with a second-year "riding shot-gun" until you are checked off to do these procedures independently.

Remember that the clock keeps ticking no matter what. No matter how much you hate a rotation, it will eventually come to an end. Learn everything that you can and do not whine and complain. Go home at the end of your shift and give a good signout. Do not sign out discharge dictations or anything that you can do ahead of time. Sign out only those things that you cannot do because of time constraints. The night float person is not there to clean up after you but there to cover your patients until you get back in the morning. Don't sign out "follow-ups" on labs and radiographs that were done hours before your shift ended.

Do not work more than 80 hours. When you get close, make sure that your chief knows that you are close. The RRC takes hours violations very seriously so don't work more than 80 hours. Go to the ACGME website and read the regulations concerning hours. Do not violate them for any reason.

Have fun and don't whine. All of us went through internship and some of us went through internship under the pre-80 hour work week. Find a solution to every problem and get it taken care of. Respect your fellow interns and hang together.

njbmd :)
 

whipple

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njbmd said:
Hi there,
Things that really helped me through internship:

Those "French Fry" lights from the SICU for that cold drafty sleep room. I could plug them in and bask under their warm red glow. Extra warm socks helped too. The hospital got frigid summer and winter.

Hot chocolate! Coffee just made me jittery and didn't really keep me alert. I dropped most drinks with carbonation and caffeine. UVa had the most wonder soda fountains on every floor but I stuck to hot chocolate and water. Crystal Light is nice to have too.

Extra toothbrushes everywhere. There is nothing worse that post call mouth. Even if you can't muster a shower, the teeth have to be brushed. Clean underwear and socks are a must too. A shower is a great way to greet the morning or after a long case in the OR. You really build up a sweat and a shower is heaven.

If you respect the nurses, they will help you at every turn. I would not have made it through internship without the support of the nurses. You will quickly learn which nurses are experienced and which nurses are still on the same learning curve as you. I really didn't find any nurses that just wanted to bug me for no good reason. If they bothered to call me, I got up and saw the patient. I listened to what they had to say and I often sought their advice on patient comfort issues. I made it a habit of making bed check rounds an hour after the late shift came on and took care of any little nagging problems. I could get more sleep that way.

Scrub every case that you can get your hands on. Operating is the reason that you do all of that scutwork. Operate with your chief and do what he or she does. Learn good techniques and ways to save movements. Your chief can get you polished up very quickly. Practice everything until it become second nature and no hand movement is wasted.

I used the "Surgical Interns Survivial Guide" by Chamberlain when I was an intern. There is lots of wisdom in that little book and it can keep you out of trouble. Keep it and a Palm Pilot/Pocket Pharmacopea in your pocket. A calculator is a good thing to have also if you do not carry a Palm device.

If you think you should call the chief, call the chief. If a patient is sinking, load the boat! Call early and never apologize for calling. Sometimes the chief can tell you one little thing that gets you out of trouble. Call early and have good information. The worse thing as a chief is to come in and find that there was something that could have easily been handled over the phone if you had been informed.

Keep your chief and senior resident informed all of the time. You are the point person on the floor and you are the one to be sure that the care plan of the day gets carried out. Write down everything and check off when things are done. Report to your seniors often during the day. Check your patients often. Don't hide the the call room, get out on the floor and keep up with what is going on. Most of the time, you can head off trouble by just being present. If you are scrubbing, have the nurses keep a "scut sheet" (a list of things that they need but do not have to call you every five minutes for). Check the scut sheet often during the day and cross off what you have done.

The second-year residents are your best source of how to get and keep organized. They are there to help you look good. Utilize their knowledge and they will help you get up to speed. Learn every kind of procedure that you can. Put in chest tubes, do central lines, put in arterial lines, put in temporary hemodialysis catheters and keep doing the procedures with a second-year "riding shot-gun" until you are checked off to do these procedures independently.

Remember that the clock keeps ticking no matter what. No matter how much you hate a rotation, it will eventually come to an end. Learn everything that you can and do not whine and complain. Go home at the end of your shift and give a good signout. Do not sign out discharge dictations or anything that you can do ahead of time. Sign out only those things that you cannot do because of time constraints. The night float person is not there to clean up after you but there to cover your patients until you get back in the morning. Don't sign out "follow-ups" on labs and radiographs that were done hours before your shift ended.

Do not work more than 80 hours. When you get close, make sure that your chief knows that you are close. The RRC takes hours violations very seriously so don't work more than 80 hours. Go to the ACGME website and read the regulations concerning hours. Do not violate them for any reason.

Have fun and don't whine. All of us went through internship and some of us went through internship under the pre-80 hour work week. Find a solution to every problem and get it taken care of. Respect your fellow interns and hang together.

njbmd :)
Thank you very much for your time and advice.
Whipple
 

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Cheers guys, very useful… I’ve already forgotten most of what I’ve just read, but thanx anyways :D
 

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Great posts, everyone.

My question: What, exactly, does a GS intern do, daily? Are we talking about retractor holding and camera driving 24/7, or will you actually get to hold the bovie every know and then?

I know that "intern = scut monkey". I guess I'd like a clearer definition of "surgical scut."

Thanks.

--Funkless
 

njbmd

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Hi there,
Your camera driving days are over unless you are scrubbed with the chief and an attending. Usually a medical student will be driving the camera while you assist the attending and if you are lucky (as I was with Bruce Schimer), you will be doing the case under his or her direction.

What I did as an intern:
1. Made sure that all of the floor patient's medical plans were ordered and carried out even if it meant that I had to push the patient to radiology.
2. Admitted (history and physical and orders) everyone to my service and discharged (dictated) everyone.
3. Supervised medical students who were helpful in writing notes and assisting with procedures.
4.Followed up on every piece of labwork, radiological study on every patient on my service.
5. Made sure that everyone had a coherent note every day.
6. Made sure that I scubbed every case that I could get my hands on even if it wasn't on my service. I ended the year with well over 300 cases with most of them surgeon junior.
7. Worked up patients in clinic on my clinic days.
8. Did every procedure that I could get my hands on: chest tubes, central lines, arterial lines, Dobhoffs, hemidialysis catheters, Swan lines and removals of tunneled catheters.
9. Did anything laparoscopic that I could find.
10. Read and studied every day for ABSITE.

There is less scut and more on the job training as a GS intern. With the 80-hour work week limitation, you have to be aggressive about getting your work done efficiently so that you can get into the OR and get some good cases. It is a really blast!

nbjmd :)
 

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Sounds like nbjmd operated a lot more than I did as an intern! I held camera quite often; as a matter of fact, in the old days when I was an intern (pre 80 hr or 30 hr shift restrictions), it was said to be a priviledge to be a post-call intern on the Peds Service holding the liver retractor for a Lap Nissen Fundoplication rather than being out on the floor doing work. Some priviledge. Sitting on a stool in a dark room being yelled at if I slipped my grip a little or heaven forbid fall asleep, when my colleagues who weren't post-call got their work done quickly and might even be able to nap to at least rest. :laugh:

At any rate, good advice above.

Scut work is traditionally defined as work that is not clinically useful. Things like wheeling patients to radiology; fetching films for conferences, etc. Hopefully you won't have to do much of that.

Remember: an order is just a suggestion. Its not necessarily taken off, done or reported back to you in any sort of timely fashion. I learned the hard way that the Chief doesn't want to hear that you don't know what time the CT Scan will be done or what the results were when an NGT was placed in one of your patients. Check and make sure orders are taken off the chart; get the nurse to do it for you if its urgent or your ward clerk a little on the slow side. Call radiology yourself with a request; oftentimes, especially if the residents know you, things will get done quicker. Ask the techs when the tests will be done; check on results asap.

If you do any intervention - send labs, place an NGT, etc. KNOW the results. Otherwise, why bother. For afternoon rounds, try and have all test results back and an update on the patient's progress.

Don't stack up discharge summaries. Do them everyday. You might get a mean Chief like me who will make you stay late on your last night on rotation to finish all those discharges you've been carrying around. My reasoning is that if you don't do them, I have to.

Have some sort of organization system. You probably figured one out as a student. It doesn't matter if you use a PDA or a piece of paper to track patient data. I have a system of checkboxes - they are crossed off as each task is done.

Keep the patient list updated whenever you can. Especially important if you cross cover at night. PLEASE put new admissions on the other service's list. Its really distressing to find a new patient on am rounds you didn't know about because they weren't on the list.

Teaching medical students should be your responsibility. They are there to learn; not to do your work. Therefore, try and give them some teaching if they are pre-rounding with you, or show them how to tie knots, etc. Obviously they will be doing the same with the more senior residents and in the OR, and your time is precious, but don't treat them like your slaves. If they don't know how to remove a JP or staples, show them but don't keep them from the OR or lectures to do it for the 100th time. I hate it when I see interns scutting medical students. At the same time, I hate it when I see medical students kissing my ass and treating the interns like crap. I notice it. We all do.

Help your fellow intern. If you are cross-covering and doing nothing, consider seeing if the other service wants to sign out an extra half-hour or so early. Its really no big deal to you and the good will it generates will earn you a lot of love and respect from your fellow residents. Don't shaft another intern on your service; decide amongst yourselves who will be in the OR and who is doing floor work, and divide the work evenly. Be adults about it; I cannot be bothered to settle disputes about this kind of thing...but sometimes I have to.

Try and be in radiology when your studies are being read. You can learn a lot going over the films with the attendings and residents.

EVEN IF YOU AREN'T GOING TO BE ABLE TO STAY OR SCRUB IN. As one of my attendings said, "I want to see every intern's face every day they're here". Get them to know you and act interested. Come to the OR to talk to me or the attending if you have a question; don't page into the OR with it unless the patient bedside cannot be left

Do as many procedures as you can. Don't be scared of hurting the patient. You will. I was scared and it took me longer to get comfortable with central lines and chest tubes than it did my more aggressive colleagues.

become comfortable with the attendings; you'll be working with them for 5+ years. Often interns fall into the student habit of being intimidated by the attendings. They're people...usually. :smuggrin:

Old saw: don't be a jerk to the nurses and other allied health professionals. If you are, they will page you at 300 am for a renewal on some Cepacol lozenges for the patient. You don't have to socialize outside of the hospital with them but always be respectful, even if you disagree with their patient management or if they are rude to you. Yelling gets you nowhere and you may be suprised when the faculty doesn't support you in this type of behavior.

So a GS intern should daily do as njbmd notes:

see patients and write notes on them
keep track of their daily progress and the results of any tests
get to the OR as often as possible
pre and post op patients
get consent for procedures (ask if you don't know the complications)
work on discharge plans and summaries
admit patients
on some services you might see ER or other consults
read daily...I didn't do this and made studying for the ABSITE harder. Carry a photocopied chapter in your pocket, so you can peruse it while on hold or during other down times.
try and get to know all other residents in house, especially the radiology, gastro fellows and anyone else you might have frequent contact with. Its so much easier to get help when you can call and say, "hey its Kim, I was wondering if you can help me with something." People love to help people, especially those they know


best of luck...
 
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dell2004

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Any opinions on this from the residents?
 

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dell2004 said:
Any opinions on this from the residents?

Don't use either. Our program recommends Greenfield and I have Cameron as well. If your program recommends one, or gives you a free book, use that one as they'll often gear their academics around it.

But frankly, the best book is the one you use. They all have basically the same material. Cameron is more clinic, Greenfield more basic science. If you can read ANY text this year, I will salute you. :laugh: