Intern Year: To Cush or Not to Cush

[googled]

---

Members don't see this ad.

Partially prompted by this Post: Needing some encouragement...

For CA-1s - CA-3s reading this forum, or PGY-1 for that matter, what's your take about doing an easy intern year vs a more rigorous one? Does it make a huge difference where you do internship and the hardship in PGY-1 to make you a better anes resident?

Say you're planning to match in a top tier program that offer only a few 4-yr positions and mostly 3-year spots, and have to plan to do an intern year else where.

So you're looking at either Transitional (2-3 months ward medicine, 1-2 months ICU, the rest "electives") or Prelim medicine (upto 5-6 months ward medicine, 1-2 ICU months, rest "electives"). And you're a self-motivated learner, not a party-er, and plan to read a lot in your free time to pass Step 3 and prepare for CA-1 year. So you can either pick the Transitional year and have more say in your schedule/time or Prelim medicine and tough it out.

I realize it's mostly personal and what you want to put into it and take out of it, but just wanted to see where those that have gone through it have to say. Do you have any regrets and what would you do different if you had to do it over again with 20/20 hindsight?

I've had PDs and attendings on interviews tell me that after the first 1-2 months of CA-1, everyone pretty much is on the same level no matter what/where you do internship (with some people standing out as having more medicine management experience, etc).

 

[MAC10]

Partially prompted by this Post: Needing some encouragement...

For CA-1s - CA-3s reading this forum, or PGY-1 for that matter, what's your take about doing an easy intern year vs a more rigorous one? Does it make a huge difference where you do internship and the hardship in PGY-1 to make you a better anes resident?

Say you're planning to match in a top tier program that offer only a few 4-yr positions and mostly 3-year spots, and have to plan to do an intern year else where.

So you're looking at either Transitional (2-3 months ward medicine, 1-2 months ICU, the rest "electives") or Prelim medicine (upto 5-6 months ward medicine, 1-2 ICU months, rest "electives"). And you're a self-motivated learner, not a party-er, and plan to read a lot in your free time to pass Step 3 and prepare for CA-1 year. So you can either pick the Transitional year and have more say in your schedule/time or Prelim medicine and tough it out.

I realize it's mostly personal and what you want to put into it and take out of it, but just wanted to see where those that have gone through it have to say. Do you have any regrets and what would you do different if you had to do it over again with 20/20 hindsight?

I've had PDs and attendings on interviews tell me that after the first 1-2 months of CA-1, everyone pretty much is on the same level no matter what/where you do internship (with some people standing out as having more medicine management experience, etc).

My take:
I am a PGY-I doing a pre-planned transtional year (no say in my schedule) with a pretty rough schedule and trust me if you have the opportunity to do a cush year then take it. I am usually no more than a scut monkey, note writer, admit h&p getter, holiday call taker for the service im on, most of my learning is self taught. I am trying to study for step III now while putting in 70-80 hrs per week, with 26-30 hr call q4. When i was in your shoes i was all gung-ho, i wanted a challenging intern year, but untill you are doing it you have no idea how exhausting it is to work 30hrs non-stop. It gets old real quick. I am also really dissapointed because with the exception of my ICU months (which are the best) im not learning much to do with anesthesia. If i could do it all over again i would take a cush intern year, study for step III, read up on anesthesia and look forward to being a CA-1. The extra bs and abuse is not needed.

 

[VentdependenT]

Take a transitional year if you can, slap in a unit month, pulm, cards, & rads. The easy months you can actually go out with friends, work out, date, and read! Its amazing how far a little reading goes.

In summation take a couple of rough months but off set them with easy ones. You may never have the opportunity to have such extended periods of chillititude for quite a while. It'll save your brain and sanity for the CA-1 year. Plus you'll be ahead of the game having had some time to read about your craft.

 

[UTSouthwestern]

I'd go for the prelim year because you WILL be in charge of your patients at some point in the year and your decision making skills and confidence will improve through trial by fire. That being said, most programs are working toward total categorical positions in anticipation of new ACGME requirements in 2007 or 2008.

 

[Lonestar]

Go with Cush. Our program has a transitional built in with 4 ICU months. I learned the most from my ICU months. Everything else except for anesthesia is BS. Try to find a program where the ICU months don't beat you down to the ground and you have an idal intern experience with some ICU months and the rest cush. My months so far: Medicine 3 months (3-4 overnight calls), MICU 2 months (Q6), SICU 1 month (Q4.5), CCU 1 month (Q 4---hardest month), Rads (enough said), Anesthesia (no weekends, no call), Pulm (enough said), ENT (my surgery month 😀 ), and ER (17 shifts). I am very happy with my intern year so far especially since I have some of the cush ones to look forward to. Hope this helps.

 

[Pilot Doc]

... plan to read a lot in your free time to pass Step 3 and prepare for CA-1 year.

I can't speak for CA-1 prep, but seriously DO NOT study for Step 3. Assuming you passed Steps 1 & 2 without much problem and have had no intervening neurologic injury, you'll pass Step 3.

Now on to my other soapbox - you left out a great option - surgery prelim. (I'm serious). Find a surgery prelim year at a well-staffed, 80 hour compliant program and I bet you'll enjoy your year far better than medicine. At my institution, the GS program is dead serious about complying with 80 hours and the interns take Q7-Q14 call except for 1 month Q3 in the unit. The medicine interns are Q4 most of the year and they flagrantly violate the work hour regs, routinely staying well over 30 hours post call.

 

[Jefe]

But if you do decide to do a transition year..then go into CA-1 year... and decide that Anesthesia is not what you thought it would be like and you don't want to continue with your Anesth residency and decide to go into IM; your transition year does not count toward your IM residency so you'd have to be an intern 2x. Right? This is what I heard that if you do do a transition year it may be like shooting yourself in the foot if you change residencies.

 

[NYCAnesthesia]

Go with Cush. Our program has a transitional built in with 4 ICU months. I learned the most from my ICU months. Everything else except for anesthesia is BS. Try to find a program where the ICU months don't beat you down to the ground and you have an idal intern experience with some ICU months and the rest cush. My months so far: Medicine 3 months (3-4 overnight calls), MICU 2 months (Q6), SICU 1 month (Q4.5), CCU 1 month (Q 4---hardest month), Rads (enough said), Anesthesia (no weekends, no call), Pulm (enough said), ENT (my surgery month 😀 ), and ER (17 shifts). I am very happy with my intern year so far especially since I have some of the cush ones to look forward to. Hope this helps.

Totally agree with this. Seems like everyone learns most from their ICU months, almost everything else is BS. The Cornell transitional year has only 6 weeks, thats right, only 6 weeks of medicine, the rest of the year is made up of mostly cushy ICU (12 beds, closed unit, q5-q6, really sick patients but great learning, very reasonable hours that are much better than medicine) and some months of surgery, electives, ER, vacation, and anesthesia. Every rotation in the year is relevant to my future career, and has gone by very smoothly. Highly recommeneded.

 

[MAC10]

I can't speak for CA-1 prep, but seriously DO NOT study for Step 3. Assuming you passed Steps 1 & 2 without much problem and have had no intervening neurologic injury, you'll pass Step 3.

Now on to my other soapbox - you left out a great option - surgery prelim. (I'm serious). Find a surgery prelim year at a well-staffed, 80 hour compliant program and I bet you'll enjoy your year far better than medicine. At my institution, the GS program is dead serious about complying with 80 hours and the interns take Q7-Q14 call except for 1 month Q3 in the unit. The medicine interns are Q4 most of the year and they flagrantly violate the work hour regs, routinely staying well over 30 hours post call.

I passed step I and II without problems and all year I said I was not going to study for step III. That was untill I dished out $625 for the test and $300 for my license, now i figure i better make sure I pass with that kind of money spent. But thats just me.............

 

[Skrubz]

i'll throw my vote in for moderately cushy with good ICU time (whether it's transitional or prelim). and like vent said, don't underestimate the power of electives like cards and pulm. transitionals do tend to offer more flexibility in scheduling.

my relatively easy prelim year is set up as:
5 months wards
1 month unit
1 month night float
1 month ED
3 months subspecialties (cards, pulm, endo)
1 month vacation

i've managed to switch one of my remaining ward months for a 2nd unit month, not only for the learning experience but also because i'd rather take q4 unit call w/o short call than q4 ward call w/ short call on post-post-call days. i'd go for a 3rd month, but the only other 2 months that i can switch don't have residents that i want to work with.

 

[powermd]

Someone had asked about my experience at LIJ here, or in some other thread, since I'm starting to get recognized I've been a little reluctant to talk, but I know this is useful info for people, so here goes...

LIJ prelim medicine is not really cush, but it's far from malignant. You take care of a lot of very old, very sick people, and see a good bit of diversity among cases. In the past two weeks I have seen pernicious anemia, central diabetes insipidus, DTs, diabetic gastroparesis, refractory ulcerative colitis, AML, FAPC s/p colectomy with new mets in a young person, and, of course, the usual cancers/CHF/ESRD/CAD/COPD/PNA/urosepsis/DKA/cirrhotics/GI bleeder stuff. We don't see very much HIV/HepB/C/TB at LIJ. It's there, but you don't always have someone with these problems on your census.

The residents are very friendly and supportive, so you never feel like you don't have someone to call when you can't figure out what to do. Camraderie is good, but we're all so busy there isn't much socializing outside the hospital. The administration is very supportive, pays us well, and for $50/mo caters out lunches at noon conference with decent food. Noon conferences are good for two reaons - lunch, and attendance is loosely monitored. If you have things to do, or just don't like the speaker or topic, no one complains if you skip out.

We have a 1 month rotation in advanced clinical skills (ACS), which is like a vacation. You attend seminars and learn very practical skills for communicating with patients, handling advanced care planning discussions (which, given our patient population, come up all the time), handling difficult/annoying patients, etc.

Ancillary services are excellent for a NYC area hospital. When you order an AM lab, you can expect it back by 10 am on most floors, 12-1pm on others. Labs in the units are back by 8:30am. On cross-coverage calls you can expect at least one phone call from a nurse about a "hard-stick", or a patient who needs IV access and no one can get it. Patient transport is never an issue. Social work is effective, but they are not miracle workers, so you always have a few patients living on your service with only dispo issues. We do have a program called "alternate level of care" (ALC), which you can have a patient transfered to if they have no medical issues whatsoever and are just awaiting placement. PAs will follow the patient, and you only need to write one note per week. I have only ever done this successfully once.

Calls are okay. Ward call is q4, from 7:30-9pm. You will likely leave by 11pm if you get a patient at around 9. After 9pm, admissions are handled by the PGY-2 float, and passed on to the following day call team. On call I usually leave by 9:30pm. Interns cap at 12 patients, residents cap at 24. Ward teams can have 1, 2, or 3 interns with one resident. One-intern teams will almost always be close to the 12 patient cap, but the resident is free to help with a lot of the scut work, so this is not really a bad deal. Two-intern teams, can have 24 patients, but more commonly each intern will carry 6-9. Three-intern teams are the best- you will likely have only 2-5 patients at any given time. There are no golden weekends on wards at LIJ, patients must have a note in the chart 6 days per week. On non-call weekends you round and go home early, usually on Saturday. On wards you also take two "short calls" per month, which means you take up to two new patients by 1pm, then cross-cover the ward teams from 4:30-7:30 when the night float comes on.

Cross-coverage call, which you do as short-call, or float can be easy or rough. Weekend calls are the worst, particularly Sunday- you may have a list of 40 labs to check, and the nurses will ruthlessly page you for random stupidity. Oddly I never seem to get such stupid pages on my own patients during the week as I do on other people's patients while cross-covering. The nurses love paging you at 3am to correct paperwork in the chart, since there are plenty of nurses that will sit there all night going through charts because they have nothing better to do. The float rotation is usually split into two 2-week blocks, of which you will take 4-5 7:30pm-8am cross coverage calls per week (no weekends). People on electives, ACS, or the heme-onc, or neurology rotation will each take two 24-hour weekend cross-coverage calls per month.

Units are generally good experiences. Calls are 24 hours, with post call day off, and will be q4 or better. It can be as good as q7 if there are extra rotators from OB, surgery, etc.

Here's how my intern schedule breaks down - there are thirteen 4-week blocks:

4 months wards
1 month float
2 months heme-onc (like wards, only no call, and the hours are 8am-5pm)
3 months units (some get 2 months CCU, 1 month ICU, or vice-versa)
1 month neurology (like heme-onc, only easier)
1 month endocrine (almost a vacation, next year prelims will do ID instead)
1 month ACS
1 month vacation (two 2-week blocks)

If I had it to do over again, I might choose a transitional just to work in some greater variety. I would love to do a month of peds, a month of surgery, and a few medicine electives, but the above schedule is very rigid. For prelim medicine, LIJ is not bad. I've developed a lot of confidence in taking care of sick people, and that counts for a lot to me.