Medical student in the ICu

[ExplodingUlcers]

Feel dumb on this rotation. I should theoretically be near the level of an intern as a 4th year but I'm nowhere near that. Any suggestions on how to improve? What are your expectations for medical students?

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[Katheudontas parateroumen]

Being an intern is hard. What we learn and do in medicine is hard. Just remember that. So break yourself some slack. But I am happy that you see yourself wanting to improve. That’s the most important step. In any case…

Expectations for medical students in the ICU are to usually see two patients a day. Know the patients as much as possible. Medical, surgical, H and P, home meds, outside records, etc. Medical student level is usually information gathering. The doctor stuff is trying to piece it together on how to get the patient better. Your attendings and interns and residents and fellows should be helping you with that. Typically we do problem based with each system. Think about what makes this patient critically ill primary issue and then secondary issues possibly relating to the primary. And just list all the problems and try to think of what work up or therapeutic may be helpful. Ask lots of questions and ask WHY. A lot of times in ICU and medicine in general there isn’t a clear cut answer. Unfortunately there are multiple issues happening at once. Also, use a check list like FAST HUGS BID. After rounds, make sure to frequently reassess. One of my wise attendings once told me that we cannot predict the future but the next closest thing we can do is frequent reassessment. Things in the ICU change hour by hour or even faster.

Enjoy your 4th year rotation. ICU can be very fun if you love medicine. It’s a time to really see the stuff you learned in medical school being applied physiology at its extremes. Get your hands into doing an art line or central line etc. these are things you can learn.

Some resources to read include internet book of critical care in EMCRIT. But just take your time and look up everything you don’t know or wonder about.

 

[ExplodingUlcers]

Being an intern is hard. What we learn and do in medicine is hard. Just remember that. So break yourself some slack. But I am happy that you see yourself wanting to improve. That’s the most important step. In any case…

Expectations for medical students in the ICU are to usually see two patients a day. Know the patients as much as possible. Medical, surgical, H and P, home meds, outside records, etc. Medical student level is usually information gathering. The doctor stuff is trying to piece it together on how to get the patient better. Your attendings and interns and residents and fellows should be helping you with that. Typically we do problem based with each system. Think about what makes this patient critically ill primary issue and then secondary issues possibly relating to the primary. And just list all the problems and try to think of what work up or therapeutic may be helpful. Ask lots of questions and ask WHY. A lot of times in ICU and medicine in general there isn’t a clear cut answer. Unfortunately there are multiple issues happening at once. Also, use a check list like FAST HUGS BID. After rounds, make sure to frequently reassess. One of my wise attendings once told me that we cannot predict the future but the next closest thing we can do is frequent reassessment. Things in the ICU change hour by hour or even faster.

Enjoy your 4th year rotation. ICU can be very fun if you love medicine. It’s a time to really see the stuff you learned in medical school being applied physiology at its extremes. Get your hands into doing an art line or central line etc. these are things you can learn.

Some resources to read include internet book of critical care in EMCRIT. But just take your time and look up everything you don’t know or wonder about.

Thank you so much for this very well thought out reply!

 

[Katheudontas parateroumen]

Thank you so much for this very well thought out reply!

You are very welcome!

The step up from medical student to intern is huge mostly in terms of work load. As a medical student, this is still your time to learn the medical knowledge as best as possible. If you can stay organized in your approach that can make things easier. Typically in the morning I come in and walk around the unit to just see how the patients look. Get sign out if I even get one. Then at the computer, i look at why the patient is here/critically ill and create a major problem list for each patient. Then i look at any notes in the past day to see if any consultants put anything I might have missed etc. Then i look at vitals such as fever etc, I/O including UOP/gastric intake etc, labs, micro, and imaging. Then I look at each med and think as to why that med is there. Then look at any continuous meds including IVF and think if that is still needed. Then I go through FAST HUGS BID as another check point. For each pt, depending on acuity/complexity, this takes me about 5-15 minutes per patient to prechart so sometimes I am precharting for a couple hours in the morning. Honestly, note writing comes in last for me. Then throughout the day, about every hour I am walking around the unit going into each room saying hi to the patient or family members or talking with the nurses/RTs. At then end of the day is usually when I complete my notes which means I usually don't get them done late, but it gives me another chance to revisit everything again as I put my thoughts to paper (EPIC lol). At some point things will get easier to both keep up with the increased work responsibilities and understand the critical medical decisions. It's truly an art and practice and life long learning.

 

[ExplodingUlcers]

You are very welcome!

The step up from medical student to intern is huge mostly in terms of work load. As a medical student, this is still your time to learn the medical knowledge as best as possible. If you can stay organized in your approach that can make things easier. Typically in the morning I come in and walk around the unit to just see how the patients look. Get sign out if I even get one. Then at the computer, i look at why the patient is here/critically ill and create a major problem list for each patient. Then i look at any notes in the past day to see if any consultants put anything I might have missed etc. Then i look at vitals such as fever etc, I/O including UOP/gastric intake etc, labs, micro, and imaging. Then I look at each med and think as to why that med is there. Then look at any continuous meds including IVF and think if that is still needed. Then I go through FAST HUGS BID as another check point. For each pt, depending on acuity/complexity, this takes me about 5-15 minutes per patient to prechart so sometimes I am precharting for a couple hours in the morning. Honestly, note writing comes in last for me. Then throughout the day, about every hour I am walking around the unit going into each room saying hi to the patient or family members or talking with the nurses/RTs. At then end of the day is usually when I complete my notes which means I usually don't get them done late, but it gives me another chance to revisit everything again as I put my thoughts to paper (EPIC lol). At some point things will get easier to both keep up with the increased work responsibilities and understand the critical medical decisions. It's truly an art and practice and life long learning.

Wow I wish I had asked for this advice before the rotation. Thanks again! I'll definitely start doing this now and as an intern.