Pediatrics Internship Survival Guide?

[To be MD]

Hey SDN,

The stickied thread from '07 has some useful tips for those starting peds internship; however, I have been trying to find just like a handbook or something for new peds interns. Is there any like pediatric intern survival guide y'all have access to or know of? I saw one from WashU on amazon, but it's outdated and... isn't free 🙂

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[SurfingDoctor]

Hey SDN,

The stickied thread from '07 has some useful tips for those starting peds internship; however, I have been trying to find just like a handbook or something for new peds interns. Is there any like pediatric intern survival guide y'all have access to or know of? I saw one from WashU on amazon, but it's outdated and... isn't free 🙂

A lot of residency program have their own internal guides.

As for handbooks... with the advent of the internet and a workstation at every corner... they are kinda outdated. Maybe you'd need one for the clinic (I mean, I haven't been in a clinic for over 10 years), but for the hospital-based setting... they are obsolete.

As an aside and tangent... '07... good times. Y'all remember the first season of The Hills and then the ending of season 1 of Laguna Beach... the end song, got me in the feels...


RIP in Kelly Preston... I will loved you since "Space Camp"...

Man... now I feel old... Thanks!

 

[sliceofbread136]

UpToDate, PALs, know how to use an ambubag

 

[BigRedBeta]

Early on, don't worry as much about the medicine - you have three years of patients to see - instead focus on your skills as a physician. Getting good at your job will mean you'll have more time for learning later on.

• Work on efficiency. Did your last H&P in 30 minutes, next one should be in 29.
  • Figure out how to ask questions that get the answers you want without needing a follow up - "does anyone smoke?" works better than "are there any smokers in the home?" which invariably leads to the "well Dad smokes outside and Grandma smokes in the car" sort of hair-splitting that doesn't actually provide any clinically relevant information​
  • Despite some of your attendings asking inane things like what the pets names are, ignore the temptation until you have really honed your history taking skills and have earned that time to chit-chat.​
  • Realize that, especially in the age of electronic records, you don't have to know everything. Far better to say "let me go check" then to spend an inordinate amount of time trying to capture all the data so you have it ready just in case someone asks.​
• Your notes should be 90-95% complete by the times rounds start and they don't have to be perfect reflections of the day - patients and plans change. Your note filed at 830a may be out of date by 845 and that's ok. Also in an EMR try to avoid things that have to be updated every single day. "Space albuterol as tolerated" for your status asthmaticus patient is just as reasonable as "Wean continuous albuterol from 5mg/hr to 2.5mg q2h if wheezes have resolved"
• After rounds your work flow should always be discharges, orders on everyone else (if they weren't done during rounds), consults, then notes. But if those are mostly done, then they shouldn't take long to finish anyways
• If you get in the weeds, let your senior know. They're there to help. But depending on their style, they may not necessarily realize you're having trouble if you don't let them know.

Not the sort of thing that shows up in a handbook, but will make your intern year far more productive

 

[physicsnerd42]

1. Despite what some of your attendings might tell you, notes are the least important part of the job. I had an intern who had to stop between each new admitted patient to write the H&P. If three patients hit the floor in close succession your job is to evaluate and begin diagnosis and treatment, not to immediately write the H&P. The H&P should be the last thing done (and shouldn’t take more than half an hour in intern year and more than 10-15 min by graduation).

1b. No one ever died because a progress note was signed late.

1c. C+ notes are the goal, not A+ notes. (Can you tell how relatively worthless I think notes are? They exist mostly for insurance company billing, not to advance medical care.)

2. No one really expects you to know anything before intern year starts, other than how to write basic notes and when to call for help (which should be pretty damned frequently at the beginning of intern year). As a senior I didn’t mind when my interns asked me how much Tylenol to give someone; I did mind when they went rogue/radio silent and did things they didn’t even know were dangerous.

2b. Don’t be afraid to ask for help

3. Don’t be late.

4. Don’t lie. (“I don’t know” or “I missed that part of the exam” are the only appropriate answers when those things are true.)

5. Don’t screw over your colleagues.

 

[mvenus929]

I agree that notes should not be a priority--I disagree that they aren't important. There were more than a few times during residency when I was cross-covering a team and got asked a question on a patient that wasn't in sign out. Notes are helpful for that. In fellowship, I not infrequently see other people's patients. I dread seeing some people's patients because their notes are horrible and I rarely have a good sense of what is going on with the patient when I go in to see them... which then frustrates the patient.

But knowing how to communicate the information you need to communicate effectively and efficiently is a skill that you should absolutely hone during residency. You don't need to write novels for notes, but you should be able to pick up a note and get a good overall idea of what is going on with the patient.

 

[SurfingDoctor]

Coming from a program/unit where residents aren't required to write notes, I can say definitively it makes them worse at organizing a plan. But since we spoon feed them everything anyway... its whatever.

 

[sliceofbread136]

Coming from a program/unit where residents aren't required to write notes, I can say definitively it makes them worse at organizing a plan. But since we spoon feed them everything anyway... its whatever.

I can see that. I still use my notes to keep patient info and plan organized (given I cover up to 40 patients now as opposed to 8)