Is there a thread for people who are terrified?

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This is my chance to act like an old school attending, and I'm taking it: You guys are capped at 16 hours! Back when I started intern year (5 years ago) we worked up to 30 hours in a row. You have it good.

Seriously though, relax and enjoy your next month and a half before starting. Congrats!
 
My biggest fear is getting fired. And after that, medical students outdoing me and making me look like an idiot.
 
I have to admit that I am anxious myself. I scramble into a surgical prelim in NY, which was highly unexpected. I underestimated the competitiveness of a medicine prelim. Completely unprepared for a surgical year (did a medicine sub I, last real surgical rotation 2 years ago, etc), not a procedure person at all.

However intern year is mostly floorwork anyway. Just have to get my work done and have a good attitude and the year will go by.
 
Expectations for your knowledge base will be pretty low, so don't worry about that part. they do expect youto pick up stuff quickly, which 99 times out of a hundred you will. The upper levels and attendings know they are getting new interns in July. It won't shock them if they have to show you things and explain everything. You will pick it up quickly.
 
A little fear is a good thing. It would be worse if you weren't concerned.

And it doesn't stop. I have to worry about a new crop of ICU fellows starting in July. We're used to this issue -- no one expects you to be independent from Day 1.
 
Presumably you are not the first intern class to go through this hospital. Expectations will be low and then you will slowly work your way into more and more independence. There is always someone there to back you up, don't be afraid to use them if you are in a situation that is beyond your skill level.

Survivor DO
 
Honest to God, take a deep breath and relax.

Everybody says this next thing, but I really mean it.

If I could do it, anybody can.

I was in the bottom quartile of my high school class, 4yrs in Marine Corps, planned on working in a liquour store for the rest of my life. That was what I thought was my upper limit of possible back then.

Spent med school just south of the peak of every bell curve, including national exams.

Got through internship year just fine. Got into a very nice residency and a great staff position at that institution. How, I don't know to this day. I fear every day they will realize the mistake they must have made.

Again, honest, you aren't even invited to be an intern if you aren't a very very smart person, so relax. You can do this.
 
This is my chance to act like an old school attending, and I'm taking it: You guys are capped at 16 hours! Back when I started intern year (5 years ago) we worked up to 30 hours in a row. You have it good.

Seriously though, relax and enjoy your next month and a half before starting. Congrats!


I call bull on this! I find that old-fogey attendings fail to truly understand how this affects us. We have the SAME amount of work, same amount of patients to admit in fewer number of hours!!! We also have way more paperwork to accomplish than days of years past. Yeah, we're not spending our entire lives in the hospital, but wait a sec! Many interns (especially in the beginning of the year) were violating work hours so we won't have to give incomplete sign outs, pass on late admissions or just to keep organized with the multitude of notes we have to write on a daily basis.

But otherwise, Intern year was f-ing fantastic. I still miss it as a PGY-2. Just figure out your role and your duties. Most are pretty monotonous.
 
My biggest fear is getting fired. And after that, medical students outdoing me and making me look like an idiot.

That should be the opposite of your fear. Med students that are good at what they do are worth their weight in gold. They make your job a ton easier, and it makes the team as a whole look good. As for showing you up on rounds, it almost never happens. Attendings know to pimp from the bottom up, so if you're being asked something, it's probably because the students don't know it either.
 
I've been numbing the fear the past 2 months. Planning on not thinking about it, and gonna cross the bridge in July...and hope it doesn't break on the first step 😳
 
I call bull on this!

We understand. If you recall, they capped work hours originally in 2003. So I had to hear the same "you guys have it easy" comments with 30 hour limits, and with the changes in 2011 it seems you may be hearing it again. Same story, different day.
 
The intern rules I lived by:

1. You don't know, what you don't know. Yes, you'll be the resident scutt monkey and be bogged down by paperwork, new experiences and emotions. But don't neglect your reading. It's one of our attendings' biggest complaints about residents. Make a conscious effort to set aside time for reading each day.

2. Load the boat. A timeless phrase. Keep everyone above you informed of what's up with the service, especially when the potential is high for **** hitting the fan. Nobody likes surprises.

3. Document EVERYTHING! If you had a phone conversation with your attending/senior about a patient issue at 2 AM, write a brief note about it in the chart. Or if you spent 30 min with a family member discussing a sensitive matter, drop a note, etc. As far as you're concerned, everything about your patient is relevant.

4. Write it all down. You've got too much going on and in too little time to remember it all. "I forgot" doesn't cut it and makes you look incompetent.

5. Most importantly, remember to breathe. Are you charging down the hall with purpose, not having stopped for 12 hours straight? Take a moment to stop, get a drink, and clear your head. Then charge on, you viking warrior!
 
Also, don't forget about first impressions. The reputation you develop in those first couple of weeks will carry significant weight. If you're a lousy intern, it's gonna be hard to shake that perception in the years to come.
 
This terrifies me. I want to be a really good intern, and I plan to work hard, read lots (already stockpiling some good sources), but I'm so nervous - what if against my best efforts - I suck? Is it normal to worry you will be the "worst intern in the bunch?" My goal is to study as hard and work as hard as I can...
 
This is my chance to act like an old school attending, and I'm taking it: You guys are capped at 16 hours! Back when I started intern year (5 years ago) we worked up to 30 hours in a row. You have it good.

Seriously though, relax and enjoy your next month and a half before starting. Congrats!

You had it easy. When I was an intern (15 years ago), we worked up to 36 hours in a row.
 
I've loved intern year for the most part.. way better than med school even considering the amazing time i had as an MS4

spending time in the hospital is more enjoyable when you can order stuff, introduce yourself as "doctor" when you meet patients, and gradually increase your level of responsibility. Trust me, the first time an attending tells you, 'pt in room X needs to be intubated." and doesn't follow you into the room is a good feeling.

plus you get paid.
 
The fear is universally normal and is actually a healthy thing. Remember that scores upon scores of people have done this before you. Nothing will truly break the anticipation until you actually start, either.

Best thing you can do in my opinion? Just prepare to give an honest, tremendous effort when the time comes.

Other bits of advice in no particular order:

1) Be on time.

2) Try very, very hard to complain as little as possible.

3) Keep a sense of humor.

4) Try not to lose your temper with your co-interns, nurses, residents, or patients (or family and friends).

5) Study the cases you have (unbelievably helpful for dealing with families and attendings).

6) Call or ask any time there is a question.

7) Keep the senior people informed about what's going on.

8) Document everything.

9) If there is a question about whose job something is...just volunteer and do it. Especially if everyone is post-call. This goes double for when the attending wants a presentation.

10) Reputation is everything. When you are well thought of, people will let you slide when you goof (and you will). When you are considered weak, it's harder to get out from under the microscope and change your image. Like someone said above, the most critical weeks are the first ones. In the beginning, your reputation is being solidified and you are possibly being watched by practically everyone from every corner of the hospital, from the ED, the custodial staff, the cafeteria people, radiology, your own seniors, and even your non-rotational attendings from your own program (even if you're in a different specialty). I'm just trying so say be nice to everyone, and always behave as professionally as you can (certainly for the intern year) in addition to trying to be the best intern you can be.

Do your best (your true best) and you'll be just fine.

Good luck.
 
The fear is universally normal and is actually a healthy thing. Remember that scores upon scores of people have done this before you. Nothing will truly break the anticipation until you actually start, either.

Best thing you can do in my opinion? Just prepare to give an honest, tremendous effort when the time comes.

Other bits of advice in no particular order:

1) Be on time.

2) Try very, very hard to complain as little as possible.

3) Keep a sense of humor.

4) Try not to lose your temper with your co-interns, nurses, residents, or patients (or family and friends).

5) Study the cases you have (unbelievably helpful for dealing with families and attendings).

6) Call or ask any time there is a question.

7) Keep the senior people informed about what's going on.

8) Document everything.

9) If there is a question about whose job something is...just volunteer and do it. Especially if everyone is post-call. This goes double for when the attending wants a presentation.

10) Reputation is everything. When you are well thought of, people will let you slide when you goof (and you will). When you are considered weak, it's harder to get out from under the microscope and change your image. Like someone said above, the most critical weeks are the first ones. In the beginning, your reputation is being solidified and you are possibly being watched by practically everyone from every corner of the hospital, from the ED, the custodial staff, the cafeteria people, radiology, your own seniors, and even your non-rotational attendings from your own program (even if you're in a different specialty). I'm just trying so say be nice to everyone, and always behave as professionally as you can (certainly for the intern year) in addition to trying to be the best intern you can be.

Do your best (your true best) and you'll be just fine.

Good luck.

solid advice
 
My biggest fear is getting fired. And after that, medical students outdoing me and making me look like an idiot.

God, this is what scares me the most (that and screwing up and harming a patient somehow). When I did my sub-I, I was fresh off step 2 and I knew a lot of stuff the interns had forgotten. At the time, I remember wondering how the hell these interns could have forgotten things that seemed so basic. Now, at the end of MS4 year, I understand exactly how this happens...I've been lightly reviewing somewhat to fill in really egregious gaps in my knowledge, but still.

One question re: 'weak' interns and reputation from the first few weeks - it would seem to me that everyone would be scrambling to get their act together in those first few weeks, no? I'm thinking back to the first few weeks of MS3 year, where it felt like nobody knew their ass from a hole in the ground and everyone was trying their best just not to look like total imbeciles...so how do you 'stand out' negatively in the first few weeks when everyone is still learning the ropes? Obviously if you have a nasty attitude and act like you don't care, that's bad (but I'm certainly not planning on being like that, and I doubt most people that ultimately get labeled as 'weak interns' start the year off deliberately trying to be d-bags, either). I would think that any judgement of someone's ability at that point would mostly have to involve medical knowledge, because everyone is still trying to learn the computers/what to do/etc..?
 
One question re: 'weak' interns and reputation from the first few weeks - it would seem to me that everyone would be scrambling to get their act together in those first few weeks, no? I'm thinking back to the first few weeks of MS3 year, where it felt like nobody knew their ass from a hole in the ground and everyone was trying their best just not to look like total imbeciles...so how do you 'stand out' negatively in the first few weeks when everyone is still learning the ropes? Obviously if you have a nasty attitude and act like you don't care, that's bad (but I'm certainly not planning on being like that, and I doubt most people that ultimately get labeled as 'weak interns' start the year off deliberately trying to be d-bags, either). I would think that any judgement of someone's ability at that point would mostly have to involve medical knowledge, because everyone is still trying to learn the computers/what to do/etc..?

To some degree, your knowledge base is evaluated, sure. Just as important is your ability to handle the stress, finish the workload in a timely manner, keep your patients informed and comfortable, and complete what needs to be done to a high level etc.

It's more than just what you know. Plus, lack of sleep and high stress level can bring out a bad attitude in anybody.
 
Just found out my first rotation of intern year is in the ICU.

This thread's title just means that much more now.

#beefiswheniseeyou
 
Just found out my first rotation of intern year is in the ICU.

This thread's title just means that much more now.

#beefiswheniseeyou

The best thing that happened to me in residency was starting intern year in the ICU. Everything after that was a cakewalk relatively speaking.
 
The best thing that happened to me in residency was starting intern year in the ICU. Everything after that was a cakewalk relatively speaking.

ICU first, then Cardiology.

Im guessing that is one way to look at it, once you conquer those, GIM wards and Ambulatory months are a cakewalk.
 
I'm terrified of getting fat(ter) once residency begins.... =/
 
Just found out my first rotation of intern year is in the ICU.

This thread's title just means that much more now.

#beefiswheniseeyou
Ack! I start in the ED. I rotated at this ED as a student so I am actually relatively excited about it because I like the attendings/residents.

None of us have the ICU until after the new year. Are you doing medicine at Geisinger? (Saw you're in Danville right now).
 
Since this is an advice thread, I piled up some good posts from a thread like this that I started before my intern year:

Most of the things that you need to know are things that any good PGY-1 is able to do (nothing surgery-specific). The biggest hurdle that I find most PGY-1s struggling with is dictating. A good discharge summary is a work of art and very useful for those who get the patient in the middle of the night in the ED and NEED good concise information on the patient.

I have found that most PGY-1 make the following mistakes:
  • Try to go day by day - not the least bit useful in the middle of the night.
  • Try to be too detailed - it's a "Discharge Summary".
  • Can't figure out what's important - comes with experience.
  • Get backed up on these - do them as the patient is leaving the hospital or do them the night before and add an addendum.

Learn how to dictate a good discharge summary, good operative report and keep up with your reading (I did minimum of 30 minutes daily and 2 hours on weekends) because you don't have loads of down-time that you won't have set aside for other priorities.

The good thing about my PGY-1 year was that it "flew by" and then I was a PGY-2 (you are expected to know things at this point) which was actually my most difficult year.

As a chief and now as an attending, I give the new PGY-1's a Powerpoint on how to handle floor emergencies that contained information on how to handle everything from chest pain to Mikey buttons "falling out" to central line coming out in a pediatric patient. You need to know how to handle the basic things and how to be a good "cross-cover".

Here's how you never get in trouble.

1. Load the boat. You never get in serious trouble by recruiting your upper level residents in matters you're not sure how to handle. The risk of annoying a lazy upper level is much less than the risk of harm to your patient, the chance that you didn't get something done at the end of your shift, or the chance that you do something stupid enough to get fired. Some of the worst interns are the ones who were all-stars in medical school and tried to do too much as interns. Most interns just don't have enough experience to really handle complex issues. Don't get into trouble. The upper level who gets mad at you for asking too much is probably a jerk whose opinion doesn't count. Load the boat.

2. Do your paperwork in a timely manner. Admission H&Ps, discharge summaries, clinic notes. Dictate those as soon as possible. My day isn't finished until I've dictated everything. I have seen a lot of people put off dictations for weeks on end, and that is a bad habit to pick up. Being late with dictations can compromise patient care and also really piss off your attendings and chairman.

3. There are others that should be obvious to any hard working person who cares about people. Don't lie, don't complain about stupid things, do your best to get things done without making a lot of sorry excuses, don't be a jerk to anyone unless it is essential to patient care, read often, sleep when you can, eat when you can, poop when you can, the patient is the one with the disease, if there is any question go see the patient, learn from both negative and positive feedback, etc.

1. Do your discharge summaries as you go, i.e. while you're sitting there writing the discharge orders.

2. Don't be a cowboy.

3. Get your first BM in before your first case. Seriously.

4. Never write down an exam in your progress note if you didn't do it. I think this is scarily common.

5. Read every day. Blade used to do 10 pages of Sabiston a day, which is great. I made sure to read journals at the dinner table, etc.

6. While preparing for cases, I like Carol Scott-Connor's Operative Anatomy.

7. Dictation books are a waste of money, as it will be second nature quickly, and the book will be irrelevant within a couple months. Look at some of your co-residents' dictations, or simply ask the staff what they want.

8. Make time for exercise. It is very cathartic.

9. I believe in the "box system" for completing tasks. There are just so many things to do every day, if you don't create a box and then check it off, you will inevitably forget to complete a task or two.

10. Eat breakfast every morning. Make time for at least a five minute lunch every day if possible. It is very stupid to skip meals.


Those are the ones that immediately come to mind.

1. Show up on time. On time is defined as 5 minutes early.

2. Don't lie. If you don't know what the Hemoglobin is, tell me that you'll look it up.

3. Don't dump work. Nobody likes that guy.

4. Load the boat. For the first six months of intern year, you should run just about every single order by your mid-level resident. Seriously.

5. Go see the patient. Telephone orders for fluid boluses are the privilege of the PGY-2. Interns go see the patient and write/enter the order themselves.

6. Exercise. You'll feel better. 30 minutes on the elliptical will give you better quality sleep.

7. Make friends with the other interns in both surgery and the other departments. It's good to have strong contacts throughout the hospital, especially as you advance.

8. Remember, they can always hurt you more, but they can't stop the clock.

9. Sometime between Thanksgiving and St Pat's you will be clinically depressed. You never see the sun. You barely talk to your family. The thrill of being a "real doctor" has worn off. Exercise, eat right, go easy on the booze, and if things are getting really bad make sure you talk to somebody.

Probably the best advice I can give is to be Socratic, i.e. know what you don't know....have an awareness of your ignorance. There's nothing worse than PGY-2s with sophomore syndrome. They've learned just enough to feel like experts, and they blindly condemn practices that they are not familiar with or are different than the way they do it.....it's a bad way to be.

If you have seen PCU, you will know what I am talking about, but ...

"Dont be that guy!"

Let me share some things not to do I have observed over the years:

1. Dont lie, ever, cause you will be found out! If you dont know an answer, say youll find it

2. Showing up in in time for rounds without prerounding while your PGY2,3 was forced to see your patients that moring while also seeing theirs, this dosent help you

3. Dont ever say your first name is doctor, realize who you are and how far out of medical school you are

4. Dont ever write in a daily progress note: "bowel and omentum look good, will continue to observe" if you can see bowel and omentum on a patient who is not supposed that have an open abdomen, thats probably not something you want to observe or have your senior discover

5. Dont go to the ER and admit a disaster patient whithout talking to ANYONE!! An interns job is not to think, it is to do, most of the time the thinking is wrong, you will learn alot by observing for your first year

6. COMPLAIN, complain, ComPLaiN . .. dont do it You will get a rep very bad very fast, just put your head down for a year and do as told

7. Dont ever tell a senior/chief that you dont want to see a consult, go to the ER, go do a hernia, drain butt puss, followup on a lab, stay the last 2 hours of your 30 because you are tired ... blah, blah, blah (not the keisha song) Surgery has lost some of it heirarchy in the last decade with the advent of the 80 hr work week, no more pyramids. As an intern you should be happy to go do or see whatever is asked of you.

8. Dont yell and meds students, make them cry, then tell them there is no crying in surgery, it is for sure going to get you called into the PDs office for a discussion

Its only one year, then things do get better, just keep that in mind

Conversely, even though you are "just an intern", don't forget that you are still a doctor, and graduated medical school. Don't let an "experienced nurse" or "experienced PA" or even "experienced resident" convince you of something you know is wrong. Don't let them bully you into writing an order. Go ahead and run it by your upper level, but remember, you are the doctor. Being humble is one thing, but don't ever let someone dismiss the amount of knowledge you've gained. It is easy to convince very smart people that they are "just an intern" and don't know anything, which is false. You may lack experience, but chances are, you learned something useful in medical school.

Some observations on the good and bad habits of the interns under my watch this past year:

- Doesn't complain or give excuses when I ask them to help cover minor cases (e.g. EUAs, debridements, lipomas, etc). It's good face time with the attendings, low stress, and an excellent opportunity to practice basics of good surgical technique.

- Returns all their pages to the floor and has good relationships with the nursing staff. I put my time in as a first year and when I can sneak a nap in between ED consults and ICU disasters, I shouldn't be getting floor pages at midnight from the nurses complaining about the intern not calling back or failing to address minor issues.

- Actually sees and lays hands on the patient when the nursing staff has a concern (especially fresh post-ops or patients at high risk for complications). Then documents their findings and troubleshoots the issue up the chain of command if they're unsure. No matter what the issue or time of day/night, I will never get mad at an intern who follows the above rule. It gains my trust in your judgement, provides an opportunity for me to teach you, and shows the nurses that they can rely on you to take care of business.

- Has good time management skills. Discharges are done in a timely manner, social and discharge planning issues are addressed early, and critical orders/plans are taken care of first. Unless it's one of the those rare, quiet days, you should be off like a shot first thing in the morning (work the phones, bug the social workers/case managers, check and correct the labs, flag any concerns and tell a senior). Don't let me catch you in the lounge at 12:30 drinking coffee if your work isn't done. And don't think you can lie to me, because I've been checking up on your orders and already know what you did or didn't do.

Intern year sucks hands down. But it's also the time when you earn the reputation that you will carry through the rest of residency. If your attendings and fellow your residents think you're lazy, untrustworthy, or difficult to work with in your first year, it'll be hard to shake that stigma in the coming years.

Couple of pearls I learned this year especially with regard to nights.

1. At night go hang out on the floor for a little bit around nurse shift changes. Can preemptively get a lot of pages answered and maybe earn yourself an hour of sleep.

2. Never bolus from the call room. Always go and see the patient when there is any question they might be sick. Nurses will downplay or upplay how sick a patient is all the time. It's up to you to go decide for yourself.

3. Load the boat. Have a low threshold to get seniors involved in your decisions. Always keep them in the loop.

4. Always write a note for any patient encounter at night. It can just be a few lines for a serial abdominal exam or wound check or more detailed if necessary. When you have gotten senior residents involved or informed the attending or called a consult, write it down and time it. This advice can save your ass when things go wrong, and it is bottom line just good patient care. In this era of frequent patient hand-offs a lot can get missed if you aren't documenting.

5. Don't get bullied by nurses. Yes you are just starting out, but you do know a lot. Do what you think is right for the patient, and if you aren't sure you should be talking it over with a senior resident, not a nurse, no matter how experienced the RN may be.

6. MLP's are increasingly a big part of the team. Especially in surgical residencies there can be problems/jealousies between residents and MLP's. Always treat people with respect and act professionally. If you are out of the OR you should have the pager, not the MLP. Be open to learning from them, because they are often very experienced and have a lot to offer you.

7. Don't fall into the shift work mentality. Yes you are now required to leave at a certain hour, but that doesn't mean it is ok to be signing out your daytime work to the night resident. In general, preops/consents and discharges should never be signed out.
Believe me, it will come back to bite you on the ass when you are night floating.

8. Get into the OR as much as possible. Get your work done early and go double scrub in the afternoon. If the floor is quiet at night, double scrub on that appy with chief. It will benefit you.

In general, as an Intern, anytime that you go see a patient at night, especially when there's a question, you should document something. Even if it's just a one-liner. I can't tell you how many times I've seen Interns get into trouble because there was no documentation about if/when they saw a patient and what they did or why they did it. Documentation is your friend.
 
One day at a time. Residency is a marathon, not a sprint. Survive.
 
Presumably you are not the first intern class to go through this hospital. Expectations will be low and then you will slowly work your way into more and more independence. There is always someone there to back you up, don't be afraid to use them if you are in a situation that is beyond your skill level.

Survivor DO

But what if you ARE?!?! My hospital hasn't had residents until my class starts July 1. There will be FM, IM, Cards fellow, Surg and TRI. No seniors to help! Hope it won't be too bad...
 
But what if you ARE?!?! My hospital hasn't had residents until my class starts July 1. There will be FM, IM, Cards fellow, Surg and TRI. No seniors to help! Hope it won't be too bad...

You're brave 🙂
 
I'm terrified too. It's been over a year since I've done anything clinical. I barely passed my boards. And I'm going someplace where many of my patients (~40%) don't speak English.
 
Its totally normal to be nervous and healthy to be aware of the large gaps in your knowledge.

My intern year advice:

-Never lie (and never document something you didn't actually do).
-Don't be afraid to ask questions and to ask for help. Both for patient safety and for your own education. You're expected to have a lot to learn when you start intern year.
-Be respectful to the nurses and listen when they have a concern...many do have a lot of experience with very sick patients. Especially early in the year, you will lack this experience.
-If the nurses like you, your life will be much better.
-Make checklists for ALL tasks. You will be very busy, they key is to actively prioritize important tasks.
-Maintain a positive demeanor, it'll help keep team morale up and you'll probably feel better too. Watch out for your fellow interns - you're all going to need some extra support sometimes.
-If in doubt, go see the patient
 
Best rotations for a 4th year student before internship? I have an ICU scheduled and some more medicine auditions. Haven't scheduled anything for blocks in jan-april.
 
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