Off-service intern advice

[Doctor4Life1769]

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Hi everyone,

I'm about to start my Intern year and I'll be rotating through the surgical department first. At this time, I'm not sure if it will be general, vascular, or trauma (we have 3 months of surgery in my intern year, and those are my 3). I've noticed some other forums have threads like this, but did not notice such thread in here.

I had only rotated through surgery once as a med student, and rotated through ENT once, but haven't done a surgical month since 3rd year overall. I'll be starting out fresh on my first month with surgery and, in addition to adjusting with a brand new hospital/staff/nursing, etc. I'll also be adjusting to my duties as an intern.

Any suggestions, words of wisdom, things you wish you knew when you were in this spot, things you wish your interns knew when they started? I will take any and all advice from you all that can make me feel a little more "ready" when I start next week. I did do a search, but came across something from 2003, but wanted some more updated feedback.

Thanks,

D4L

 

[Doctor4Life1769]

 

[smq123]

Hi everyone,

I'm about to start my Intern year and I'll be rotating through the surgical department first. At this time, I'm not sure if it will be general, vascular, or trauma (we have 3 months of surgery in my intern year, and those are my 3). I've noticed some other forums have threads like this, but did not notice such thread in here.

I had only rotated through surgery once as a med student, and rotated through ENT once, but haven't done a surgical month since 3rd year overall. I'll be starting out fresh on my first month with surgery and, in addition to adjusting with a brand new hospital/staff/nursing, etc. I'll also be adjusting to my duties as an intern.

Any suggestions, words of wisdom, things you wish you knew when you were in this spot, things you wish your interns knew when they started? I will take any and all advice from you all that can make me feel a little more "ready" when I start next week. I did do a search, but came across something from 2003, but wanted some more updated feedback.

Thanks,

D4L

As a family med resident, my first rotation as an intern was as an off-service surgery intern as well. (FM programs usually make you do a month of gen surg.)

Things that I learned:

* Keep up with the list. You should know the patients on the list as well as the chief does - what procedure they had done, what the indication was, how many days ago, major overnight developments, etc.

I don't know how it will be at your program, but at my hospital, there was one attending who wanted to round NOW NOW NOW. Which meant that whatever resident wasn't in the OR (i.e. me) had to take him around to all the patients, including those I hadn't pre-rounded on, and even some patients in the ICU.

That means really paying attention to signout, and taking good notes.

* Expect to be on the floors. My program let me be in the OR when I wanted to, but I learned a lot, especially as a brand new intern, on the floors. Answering pages and suddenly having to make actual decisions was kind of scary, but a good experience.

Many programs, which have a lot of surgical interns and PGY-2s, may expect you to be on the floors while their surgery categoricals actually operate.

* Stay on top of the pager. It's not unusual to have multiple pages come in at once, and it's hard to remember if you actually saw that consult, or answered that nurse's question, or talked to radiology, or took care of that critical result, etc.

* WRITE STUFF DOWN. Most surgery services are extremely busy; stuff happens almost faster than you can think. Staying organized and writing stuff down is absolutely key.

* Keep people in the loop. It looks really bad if, for instance, Mr. Jones had a post op ileus and (hurray!) you put the NG tube in, but neglected to mention it to your chief. It makes your chief look bad when it comes time to round, and most chiefs that I've had freak out if they don't know every single detail of their patients.

* Don't whine, and work as hard as you can. The thing is, as a off-service resident, you set the tone for your fellow residents in your program. If you're a bad resident? The categorical may expect all other off-service residents to be bad as well. I ran into that problem, and had to work very hard to prove that, hey, I was different from my predecessors from previous years.

* Write down the codes to all the supply closets. It helps to have all the supplies ready when your seniors want to put in a chest tube or something. And hey, if you help them prepare it, they might teach you how to put one in!

 

[Ronin2258]

smq123 listed the things to be and do while you are on service. Follow them. I have mentioned similar things elsewhere as a prelim intern.

Your advanced program will be keeping tabs on how you do as an intern. Do your best.

Being a CA-1 who gone through surgery as an internship (seeing you listed yourself as a CA-0):

This is your chance to work on that side of the ether shield. Try to understand the thought process of how a surgeon makes decisions, regardless of specialty.

Vascular is interesting, but the patients are sick, with several co-morbidities that will make life once you go to CA-1 challenging to say the least. Try to see how they are managed before and after they have to go to the operating room (and with most vasculopathic patients, it will happen sooner or later.)

Trauma is pain. Most of the things you will have to do on trauma will be temporizing measures to keep them going long enough to get the major problem addressed. Learn the concepts of what it takes to buy you time to get to definitive therapy.

General surgery is going to be basic concepts. It isn't a question of when you operate, it is a question of when *not* to operate. "Surgeons are medicine doctors that offer definitive therapeutic modalities." Learn the medicine and options that keep them from bright light and cold steel.

Get at least a full month of ICU, if not two. It is required of Anesthesiology residents to have four total months of ICU. MICU and SICU would be ideal (had it myself, a requirement of the program.)

Also, remember to study for Step III.

 

[Doctor4Life1769]

Smq and Ronin, thanks for the advice and tips!

My internship consists of 2 ICU months, as well. 1 month MICU and 1 month CCU. I believe I start in the SICU the following year. I think I have 5 ICU months by the time I finish.

I've tentatively signed up for Step 3 in December. Hopefully I don't have to push it back and then I can focus on anesthesia readings after Christmas.

 

[Chest Cutter]

One simple rule...

ABC

Always Be Chasing.

know who your patients are and chase test/lab/rad results.

The only thing I really expect from my juniors is that they know our patients well. If they can do that then I'll teach them everything else.

 

[DoctorDoom]

I'll be honest, when I was still in surgery residency and during my year as Chief Resident, as long as the off-service rotator helped my intern and didn't annoy me, I didn't care what they did. If you did all the good things advised above, I would make sure you were taught as applicable to your professional goals, but I sure didn't expect a maximum effort. If someone just wanted to do what they could and check the box, I was fine with that too. I had no investment in the off service rotators to the same degree that I had in the categorical and prelim surgery residents. I saw my job as preventing them from hurting my patients. Any net gain from having you on my service was a bonus.

Woe betide you if my intern complained about you being lazy or not helpful though.

Just my personal approach as someone who had to evaluate a lot of guys like you. I was pretty mellow, and I can't speak for everyone.