nervous about practicing semi-independently as an intern

[americanidiot]

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I know we are all nervous about the Match but recently I've started feeling really nervous about the increased responsibility/independence as an intern. Since I've been doing so many consultation style medicine electives I feel very rusty at managing a regular, unknown patient from start to finish. Today I was working in the outpatient peds clinic with a walk-in patient and I KNEW that the little boy needed a rectal exam because of his history of bloody diarrhea and yet I let the intern I am working with do the exam. I am kicking myself for not taking the opportunity to practice. I just felt really sheepish and inadequate and that I was going to hurt the kid or generally look like a fool since I haven't done a PR since my regular peds rotation.

I've told my friends about how I feel nervous about elements of physical exam, placing IV lines, giving vaccines, and other hospital duties and they all say "well you're going to be a psychiatrist so who cares!"...I know that's BS and that all docs need to be able to practice general medicine competently, regardless of specialty.

I guess my question is this: is there room as an intern/resident to hone these skills or are we expected to hit the ground running? I feel like if someone asked me to place an IV line today I would probably blow it since I haven't done one since trauma surgery rotation. The interns at my hospital are kickass at a lot of this stuff so I feel like I must be totally deficient.

Sorry for the rambling incoherence. Any thoughts? 😕

 

[whopper]

Pretty much every resident I knew was too scared to do anything without the attending or senior resident giving the okay to do so.

This is a normal thing.

I wouldn't worry about it. At this point it's not going to help you other than maybe get your bowel movements going and ruining your day.

When you actually start as a PGY-I, you will not be alone.

 

[peppy]

I promise you that whatever hospital you go to has had interns more clueless than you come through and has already learned that letting interns have free rein to kill patients with their gross incompetence isn't worth all the lawsuits.

It is generally understood that an intern in July is basically just a medical student plus one day. They won't expect you to know much and most attendings/senior residents will want you to check with them about the assessment and plan before carrying through with it. When in doubt, call a senior to ask before you do anything that you're unsure about or feel could potentially hurt someone. You can never go wrong by asking for help.

At some hospitals, you won't have to do any IVs as an intern (my hospital relies exclusively on nurses to do IVs). If you do wind up at a place where that is expected then just ask someone (possibly even the patient's nurse 🙂 ) to walk you through it.

 

[strangeglove]

And you will get plenty good at rectal exams in, like, 2 days.

I think it's safe to say that most of us felt rather inept starting our intern year. Everybody's in the same boat. Nobody is quite yet doctor material. That's why they call it an internship.

 

[americanidiot]

I think it's safe to say that most of us felt rather inept starting our intern year. Everybody's in the same boat. Nobody is quite yet doctor material. That's why they call it an internship.

Well thanks guys for the all the calming info...as much as this forum makes me anxious, sometimes it helps to relieve anxiety as well!

 

[Sneezing]

I think the real problem is you chose the wrong degree. You should have gone to NP school where you'd be ready for autonomous practice two years ago! Or you should have become a Physician Assistant, I mean "Physician Associate" where you'll be just as good, also, after two years. But really, if you had become a psychologist who recently obtained Rx rights after 2 years you'd be better suited to self prescribe for your anxiety than a psychiatrist (and even unprescribe, too!).

 

[psychotrope]

I guess my question is this: is there room as an intern/resident to hone these skills or are we expected to hit the ground running? I feel like if someone asked me to place an IV line today I would probably blow it since I haven't done one since trauma surgery rotation.

where is it that you would be starting IV's(even during your off service months)? Everywhere I've ever rotated in several different academic hospitals I've never seen a resident start an IV. Same with foleys. ABG's are usually done by respiratory care, but some nurses do them as well.

All the blood draws/ancillary stuff/IM injections is going to be done by nursing on the psych floor.

during the two months of medicine you do(or 1 or 4 depending on where you are at), you may get to try a few LP's or central lines or something, but then again maybe not.

if you do a month of EM off service you may as well, but most of the time if you want to take the low acuity stuff in the ED they will let you pick up more of those patients(after all the other interns are going to want the procedures more than the sore throat)....

 

[psychotrope]

At some hospitals, you won't have to do any IVs as an intern (my hospital relies exclusively on nurses to do IVs). If you do wind up at a place where that is expected then just ask someone (possibly even the patient's nurse 🙂 ) to walk you through it.

just out of curiosity- if nurses aren't the ones doing the IV's, what *are* they doing?

I asked this question(about ancillary staffing) at every interview I went on, and none of them were doing their own labs or IV's......sometimes during their ED month they would get their own blood gas.

 

[SpiritiualDuck]

just out of curiosity- if nurses aren't the ones doing the IV's, what *are* they doing?


well, my friend, i find most of the nurses are usually on Facebook during the day and night and getting paid more than us....

 

[psychotrope]

just out of curiosity- if nurses aren't the ones doing the IV's, what *are* they doing?


well, my friend, i find most of the nurses are usually on Facebook during the day and night and getting paid more than us....

you're in nyc though....what is it about northeast hospitals and ancillary stuff? I really think it's just a northeast thing(and only at some northeast hospitals)......

 

[GmailQueen]

you're in nyc though....what is it about northeast hospitals and ancillary stuff? I really think it's just a northeast thing(and only at some northeast hospitals)......

I'm in the southeast, and the nurses here seem to like dating sites. And they like to use the computers mounted on the wall in the halls to surf their future potential dates so that everyone who walks by (doctors, patients, families, janitors, RT, PT, etc) can see.

 

[psychotrope]

I'm in the southeast, and the nurses here seem to like dating sites. And they like to use the computers mounted on the wall in the halls to surf their future potential dates so that everyone who walks by (doctors, patients, families, janitors, RT, PT, etc) can see.

well yeah, but they still manage to draw their labs and such at your hospital right?

 

[maranatha]

I know that you're asking about things like placing IVs and procedures, but I'll comment on the more general issue of anxiety as starting as an intern, which comes up every year, including the year I matched. Below is stuff that I believe is key to being a good intern. My wife, who is in medicine, also added to this.

Just to reinforce what was already said above and to add a view more thoughts:

1. Nobody will expect you to be working independently as an intern and the seniors and attendings EXPECT to have to help you out.
2. At the beginning of residency you will basically be at the exact same level of every other intern, no matter the specialty. Also, keep in mind that most every intern, no matter the specialty, are going to be nervous as well.
3. You know more then you think!
4. IT IS FAR, FAR MORE IMPORTANT TO KNOW WHAT YOU DON'T KNOW AND WHEN TO ASK FOR HELP! I can not stress the importance of this enough...
5. Be someone who IS RESPONSIBLE and SHOWS UP ON TIME. You'd be surprised how big of an issue this can be and how much they appreciate it if you're just simply reasonable!!!!
6. KNOW YOUR PATIENT VERY WELL AND WHAT IS GOING ON WITH THEM. So important!
7. If you don't already have this, I would highly recommend using this pocket book and make it your best friend: http://www.amazon.com/Pocket-Medicine-Massachusetts-Hospital-Handbook/dp/0781771447/ref=pd_sim_b_6

I followed these "rules" and did well in medicine. I even got the some of the best comments you can get when working on the medicine side: "You should think about going into medicine." And believe me, I'm no genus (I'm leaving my original spelling to prove the point ). I just worked hard, was easy to get along with, kept up on my patients, and knew when to look things up if I don't know something. It's really very simple. 😉

 

[NJWxMan]

The one thing that every intern should know how to do is getting an ABG. 9/10 times, after putting on the O2 mask and possibly calling respiratory to get a BiPap going, the next step in a rapid response/resp. distress case, will be to get an ABG. Looking back to my 6 months of medicine, I had to take at least 25 ABG's, but never had to do much anything else.

 

[psychotrope]

The one thing that every intern should know how to do is getting an ABG. 9/10 times, after putting on the O2 mask and possibly calling respiratory to get a BiPap going, the next step in a rapid response/resp. distress case, will be to get an ABG. Looking back to my 6 months of medicine, I had to take at least 25 ABG's, but never had to do much anything else.

you did *6* months of inpatient medicine? Heck, transitionals spend less time on inpt med than that....

5/7 of my top ranking spots all spend 2 or less(some zero) months on inpt......

I want as little time on inpatient medicine as possible.