Intern year

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axm397

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So there are always questions after the match about intern year. What electives to take, what's required, etc.

In terms of transitional year. Here's how the current ACGME requirement reads (effective July 2006):

One year of the four years of training is to develop fundamental clinical
skills. This year of training in fundamental clinical skills must consist of an accredited Transitional Year or include at least six months in accredited
training in family medicine, internal medicine, emergency medicine,
obstetrics-gynecology, pediatrics, or surgery, or any combination of these
patient care experiences. The remaining months of this year may include
any combination of accredited specialties or subspecialties.
Accredited training in any of the specialties or subspecialties selected must be for a period of at least four weeks. No more than eight weeks may be
in non-direct patient care experiences, such as pathology, radiology and
research. Training in fundamental clinical skills must be completed within
the first two years of the four year training program.



There's no specific requirement about doing inpatient medicine months but I did hear from several PDs that they would recommend doing at least 6 months of inpatient medicine. In addition, I would recommend rheumatology, ER (to get procedures and see kids), cardiology or ICU ( to learn how to run codes), Neurology/PM&R - maybe get some exposure to EMGs.

The point of your intern year is to get all the basics of how to handle emergencies in PM&R. So learning what to do with acute chest pain, resp distress, codes are great. Also should learn basics of insulin management, HTN management, infections (pneumonia, c diff) and current standard of care for many of the more common diagnoses in rehab (stroke, SCI, TBI, Ortho, Cancer, MS, etc.)

Any other current or past residents want to add?

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Hey axm397, thanks a lot for the advice! Very helpful!
 
Thanks for the advice...
I am thinking of setting up my transitional year as follows... Let me know if you think this would be good preparation for PM&R or not...

medicine inpatient (3 months)
ICU (1 month)
ER (1 month)
Neuro, Rheum, Heme/Onc, Cards, ID, Rads (1)
Ortho Surg (1)
 
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please keep in mind that electives are a break from the tedious grind of floors. I would highly recommend not doing an intense elective, unless you really want to, it will help lessen burnout. Keep in mind most prelim and transitional programs will require 5-6 months of floors, 1-2 months ICU/CCU, and some require ER

So my recommendations for easy electives that are useful:
Rads - for plain films and MRI
Derm - you will see lots of rashes in your career
outpt ortho/sports - inpt typically = scut monkey
Rheum (usually clinics)

Others that are busier:
Neuro
ID
CArds if you still can't read ekgs

Don't forget some programs require you to complete step3 before starting pgy2! FActor in an easy month into your year so that you can study some and take the 2 day test, so you can avoid taking it over your precious vacation.
 
Definitely take an easy elective month or vacation at the end of the year to allow you to transition into your PGY2 PM&R year. Some programs have orientation beginning in June and many of you will have to move.

I did 2wks of ER shift work and took my 2wk vacation at the end of June alllowing me to move and get a bit of a break before jumping into rehab.

Definitely take step 3 if you can. Some states will not allow you to take step 3 until you finish 1 yr after med school. Step 3 is a requirement for getting a permanent license in Illinois (step 3 + 1 yr clinical work) which would (in theory) allow you to moonlight.

Also, see if you can get ACLS and PALS during your intern yr - it may cut down on your "orientation" time.

If you are moving from one state to another, definitely start your license paperwork 3-4months before moving. My initial application got rejected and I had to revise it. I barely made the deadline despite starting my paperwork in February. Also keep all your receipts for moving, flights, license fees (if not reimbursed), etc. May be used to itemize tax returns...
 
Thanks for starting this thread AXM397....I was just starting to put together the rotations I would want to request for intern year. Other residents must have some more wisdom to instill....let's hear it =)
 
eddo said:
Thanks for starting this thread AXM397....I was just starting to put together the rotations I would want to request for intern year. Other residents must have some more wisdom to instill....let's hear it =)


Has anybody done an intern year in family practice? I did not apply to any prelim programs because in the past, my school would give all students a prelim position if needed. Unfortunately, due to substantial funding cuts, the number of prelim spots were rediced and to make a long story short, I am doing a year of family practice.

For people who did a year of family practice to satisfy their PGY1 requirement, did you have to have your schedule modified? I know that the board of PMR requires 6 "months" of inpatient medicine, and most family programs have a substanial requirement for outpatient clinic, OB, peds, which I beleive do not count towards the inpatient requirement needed for PMR. I would appreciate any advice, feedback, or suggestions.
 
Hi Axm397...I was hoping for any advice to my tentative schedule.

12 months, 4 weeks each.

2 - Gen Med
2 - ICU
1 - Cards
1 - Rheum
1 - ID
1 - Rads
1 - Derm
1 - ER
1 - Neuro
1 - Neurosurg

in the following order:

IM - ID - IM - ICU - DERM - CARDS - RADS - NEURO - NEUROSURG - ER - RHEUM

All input is welcomed!!!....PLEASE! :D
 
I think our program in Utah may have the best elective on the planet. I spent the month of January at a ski clinic in the Cottonwood canyons during January. 2-6 patients a day and lots of deep powder! Got to reduce dislocated shoulders, stich people up, and lots of other practical stuff.
 
eddo said:
Hi Axm397...I was hoping for any advice to my tentative schedule.

12 months, 4 weeks each.

2 - Gen Med
2 - ICU
1 - Cards
1 - Rheum
1 - ID
1 - Rads
1 - Derm
1 - ER
1 - Neuro
1 - Neurosurg

in the following order:

IM - ID - IM - ICU - DERM - CARDS - RADS - NEURO - NEUROSURG - ER - RHEUM

All input is welcomed!!!....PLEASE! :D

So hard - medium - hard - hardest - easy - hard - easy - medium - harder - medium - easy?? Looks pretty good. Although December Cards is prime MI season with all those snow shoveling out of shape ppl.... :scared:

I don't know how truly necessary neurosurg will be for you but it may be good to see some of the acute neurosurgical cases. Definitely agree with the rest. If you can concentrate on neuroradiology as well as basic chest xrays and KUBs I think the radiology rotation will be more useful. Learn basic UTI, pneumonia, and soft tissue/cellulitis management on ID and you'll fly through inpatient rehab.

Do you have vacation time? how about CME money and conference time/money? Most prelim/transitional programs have more CME money than PM&R programs.
 
Hey eddo,

Since my previous post, I talked with my PD about what would be an "ideal" transitional year preparation. I had 3 months of general med before and she recommended 6 months :scared: of general inpatient medicine floors as a solid foundation for anything you'll see inpatient in PGY-2. The other 6 electives were recommended mainly to strengthen the internal med background ICU, ER, Neuro, Heme/Onc, Cards, and ID. Might have well matched in internal med prelim with that advice, huh? ;-)

Anyway, talk to your PD too and see what they recommend. :thumbup:




eddo said:
Hi Axm397...I was hoping for any advice to my tentative schedule.

12 months, 4 weeks each.

2 - Gen Med
2 - ICU
1 - Cards
1 - Rheum
1 - ID
1 - Rads
1 - Derm
1 - ER
1 - Neuro
1 - Neurosurg

in the following order:

IM - ID - IM - ICU - DERM - CARDS - RADS - NEURO - NEUROSURG - ER - RHEUM

All input is welcomed!!!....PLEASE! :D
 
Hemisphere said:
Hey eddo,
you need 6 months of inpatient medicine as per ACGME, which you might have, but I'm not sure if the electives count?
Since my previous post, I talked with my PD about what would be an "ideal" transitional year preparation. I had 3 months of general med before and she recommended 6 months :scared: of general inpatient medicine floors as a solid foundation for anything you'll see inpatient in PGY-2. The other 6 electives were recommended mainly to strengthen the internal med background ICU, ER, Neuro, Heme/Onc, Cards, and ID. Might have well matched in internal med prelim with that advice, huh? ;-)

Anyway, talk to your PD too and see what they recommend. :thumbup:

Good point Hemisphere, sorry I forgot -

clarification: although the ACGME does NOT require 6 mo of in patient medicine, many PDs want 6 months of inpatient medicine months.

so eddo, you have 2 months of IM, 1 month ICU... Are Cards, neuro, heme/onc and ID in patient? I ended up doing 2 months IM, 1 month ICU, 1 month GI, 1 month Cards, 1 month heme/onc all inpatient, and 1 research, 1 elective, 1.5ER, .5 Rheum, and 1 IM consult and I'm forgetting 1 month...
 
ahh you confused me now :confused: :)
i assume you were talking to eddo while replying to me?
I have:
general med (6)
ICU (1)
ER (1)
Cards (1)
Neuro (1)
Heme/Onc (1)
ID (1)

I don't know yet if electives are inpatient (i hope not, i will ask for consult services if possible cos i already have the 6 months of inptatient general med plus ICU)


axm397 said:
Good point Hemisphere, sorry I forgot - you do need 6 months of inpatient months. Many PDs require 6 months of inpatient medicine months. so you have 2 months of IM, 1 month ICU... Are Cards, neuro, heme/onc and ID in patient? I ended up doing 2 months IM, 1 month ICU, 1 month GI, 1 month Cards, 1 month heme/onc all inpatient, and 1 research, 1 elective, 1.5ER, .5 Rheum, and 1 IM consult and I'm forgetting 1 month...
 
is this the blind leading the blind or what :)
actually, i made a mistake... to clarify I think 6 months of inpatient internal medicine experience is recommended.

Per ACGME, completion of an accredited transitional year would be enough I believe, anyway read it for yourself if you like.http://www.abpmr.org/certification/

sorry if this created any confusion, but as I said check with your pd, if your program involves taking care of a degree of inpatient issues just make sure you get prepared ;)
 
Thanks for the advice gang! Axm....I like the idea of NEUROradiology and a research month in there somewhere. So after grinding through it neurotically...for a few seconds, this is what I have decided:

IM - ID - IM - ICU - DERM - CARDS - NEURORADS - NEURO - ICU - ER - RHEUM - RESEARCH

Changes in BOLD

I don't know about the general consensus, but I didn't mind my ICU rotation at all. In fact, the scary truth is that my ICU rotation made me conider IM residency until my PM&R rotation brought me back to the light! :idea:
 
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