Performing highly during intern year

[neoexile]

So I just matched to my number #1 IM program on list and I feel great. I had some problems in medical school didnt match during my senior year.

I want to make sure it is a nonissue during my residency and that I CAN perform. My Step 3 is already done and so I want to know: What can/should I do during intern year to perform at a high level?

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[Psai]

Come on time.
Make a list of the stuff you need to do and check it off as you do it.
Don't piss people off.

 

[witzelsucht]

Work hard, don't be late, read about your patients on uptodate. Don't try to be a rock star by being too independent. Run stuff by your senior because there may be times that you find a correct answer on line or you remember how it was done in med school, but there are lots of hospital specific protocols. Everyone expects you to be an idiot as an intern, so use the opportunity to ask questions you are 80% sure of, so that you are now 100% sure. Make sure you have a plan for WHY you are calling a consult (not just, this person has the organ that you specialize in so we want you "on board").

 

[evilbooyaa]

If you're calling a consult that's BS because your senior/attending wants it, start off with the following when discussing with the other resident (never tried it directly with an attending):

Hey, I know this is BS, but my senior/attending made me. Anyways, it's this guy/lady we got, blah blah, etc.

I was much nicer (when I was a surg intern) to the ED residents who started off BS consults (come lay hands on the patient nonsense) with that line. The fact they understood that it was dumb to do that and that the attending was twisting their arm made me appreciate them.

 

[TeddyBoomBoom]

If you're calling a consult that's BS because your senior/attending wants it, start off with the following when discussing with the other resident (never tried it directly with an attending):

Hey, I know this is BS, but my senior/attending made me. Anyways, it's this guy/lady we got, blah blah, etc.

I was much nicer (when I was a surg intern) to the ED residents who started off BS consults (come lay hands on the patient nonsense) with that line. The fact they understood that it was dumb to do that and that the attending was twisting their arm made me appreciate them.

I take your point, but I would be very cautious about throwing around phrases like “BS consult” when speaking to other services, even if it’s another resident. I’m just a graduating MS4, so what do I know, but as an intern I’d err on the side of caution.

 

[shoal007]

Agreed. Your attending can hurt you much more than a consultant. The consultant knows when it is BS And doesn’t need you to tell them.


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[neoexile]

Agreed. Your attending can hurt you much more than a consultant. The consultant knows when it is BS And doesn’t need you to tell them.


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Ya I really would rather not piss off my attending. Last thing I want to be is labeled.

 

[operaman]

Hahaha yes the “sorry man but my attending really wants to get you guys on board...” is universally understood to mean “I think this is bull but we all know how residency works.” No need to call it bs.

Sometimes it’s legit and the intern just doesn’t understand what’s going on. A great thing you can do as an intern is ask your chief or attending who wants the consult exactly what the question is. Usually truly bs consults don’t really have a question and sometimes this helps them realize it, or they explain the nuance that went over your head the first time and now you learned something. Saves me the consultant from wasting time trying to figure out what your questions should be and focus on answering it.

 

[Winged Scapula]

T

Hahaha yes the “sorry man but my attending really wants to get you guys on board...” is universally understood to mean “I think this is bull but we all know how residency works.” No need to call it bs.

Sometimes it’s legit and the intern just doesn’t understand what’s going on. A great thing you can do as an intern is ask your chief or attending who wants the consult exactly what the question is. Usually truly bs consults don’t really have a question and sometimes this helps them realize it, or they explain the nuance that went over your head the first time and now you learned something. Saves me the consultant from wasting time trying to figure out what your questions should be and focus on answering it.

This is the best approach. Calling things BS especially as an intern (when you may be reasonably assumed to not know what is BS and what isn't), is apt to get around.

Better to use the well understood code phrase above. Means the same thing but you can always claim ignorance if someone says you called the consult "BS"

 

[neoexile]

T

This is the best approach. Calling things BS especially as an intern (when you may be reasonably assumed to not know what is BS and what isn't), is apt to get around.

Better to use the well understood code phrase above. Means the same thing but you can always claim ignorance if someone says you called the consult "BS"

I'll use this method. I REALLY don't want to get on my attending's bad side. As an intern, my job is to shut the hell up, do I'm told, show up early and learn. I don't want to have an opinion on anything until I know more (which will be when I'm an actual attending).

 

[randomcollusion]

I would also like to know tips about how to brush up on my clinical skills. I am 3 years out from graduation and really want to prove any reservations the program had about my gap in clinical experience wrong. I'm working in research up to the time I start my intern year - there's no getting around that, believe me - and brushing up on clinical knowledge so I don't have to consult up-to-date for every little thing would give me a bit of breathing room. I know usually the answer is "forget all that, go have a great vacation, you're going to need it before these grueling next years," but there are a few special circumstances surrounding me that prevent me from doing that.

I've been recommended to take a look at:

• My old Step 3 study materials
• AAFP apparently has some solid stuff
• Dynamed is an alternative to UpToDate once the year starts
• Continue to go to didactics and workshops offered by the program, why the heck not, free food

I don't really have an option for anatomy though. I used to be really good at it, but that was poring over netter's, watching prosection videos, doing dissection actively, and reading custom clinical correlation stuff the faculty prepared for us during medical school that gave context to things like nerve fiber types, anatomy specific physical exam pearls like muscle functions, what attaches to what, and etc. that I no longer have access to (because I'm dumb and didn't properly archive all of that). I tried Thieme's and it was just a waste of money. I'm too lazy to consolidate all that stuff into a single clinical/atlas anatomy resource and was wondering if there already was one I could just get and not be the idiot who doesn't know that the semitendinosus is one of the hamstrings or doesn't gasp appropriately when shown a really bad head CT.

 

[neoexile]

I would also like to know tips about how to brush up on my clinical skills. I am 3 years out from graduation and really want to prove any reservations the program had about my gap in clinical experience wrong. I'm working in research up to the time I start my intern year - there's no getting around that, believe me - and brushing up on clinical knowledge so I don't have to consult up-to-date for every little thing would give me a bit of breathing room. I know usually the answer is "forget all that, go have a great vacation, you're going to need it before these grueling next years," but there are a few special circumstances surrounding me that prevent me from doing that.

I've been recommended to take a look at:

• My old Step 3 study materials
• AAFP apparently has some solid stuff
• Dynamed is an alternative to UpToDate once the year starts
• Continue to go to didactics and workshops offered by the program, why the heck not, free food

I don't really have an option for anatomy though. I used to be really good at it, but that was poring over netter's, watching prosection videos, doing dissection actively, and reading custom clinical correlation stuff the faculty prepared for us during medical school that gave context to things like nerve fiber types, anatomy specific physical exam pearls like muscle functions, what attaches to what, and etc. that I no longer have access to (because I'm dumb and didn't properly archive all of that). I tried Thieme's and it was just a waste of money. I'm too lazy to consolidate all that stuff into a single clinical/atlas anatomy resource and was wondering if there already was one I could just get and not be the idiot who doesn't know that the semitendinosus is one of the hamstrings or doesn't gasp appropriately when shown a really bad head CT.

You got in? Congrats!!!!! I know you struggled for years.

 

[siliso]

Work hard, know your patients, assume the role and responsibility as their primary physician always and project a positive mental attitude. Be trainable and respond positively to feedback. Show up early and always be prepared.

 

[evilbooyaa]

I take your point, but I would be very cautious about throwing around phrases like “BS consult” when speaking to other services, even if it’s another resident. I’m just a graduating MS4, so what do I know, but as an intern I’d err on the side of caution.

Obviously don't say that if you're calling the consult directly in front of the resident/attending who is making you do it.

I think the "hey man I know this sucks but my attending wants you on board" is a fine paraphrase of that.

 

[DOFOSHO]

omg. i had an attending who would tell us to call a consult service (often general surgery) and say the phrase, "please familiarize yourself with this patient should your services become necessary."
I would actually just NOT do that. Sometimes having respect from other services is more important than obey dumb requests from attendings.

 

[Donald Juan]

Write things down, make checklists during rounds of what you need to do. Don't think you'll remember everything.

Regarding the calling consults BS, I agree I would not start a consult by saying that, it gives off a weird vibe. Now, if I'm calling a consult based on my attending/chiefs order and I start getting a lot of pushback, I politely say, "Yes, you're probably right, there may not be anything for you to do or add with this patient, but my attending does want you guys to see the patient and make sure you don't have any other recommendations."

Now, OP, go have fun and stop worrying about residency. Enjoy your few months off before the crapfest of residency starts.

 

[JustPlainBill]

Work hard, know your patients, assume the role and responsibility as their primary physician always and project a positive mental attitude. Be trainable and respond positively to feedback. Show up early and always be prepared.

This....especially this.... I managed to screw myself by not understanding this and being hesitant to do this --- I came from an environment/culture where the junior person had absolutely no say so and the organization was very hierarchical -- As a med student that works very well....however, in residency, you need to make that transition as the whole purpose of training is to backstop you while you learn how to handle patients as the one solely responsible for their care. To give you an idea of the magnitude of my screwup -- I once answered an attending, who asked what study I wanted to order on a particular CHF patient with "Well, I'm not sure, but it's your license so what study do you want to order?" --- wasn't trying to be a smarta**, hadn't slept and didn't think about how I was saying that --- it went downhill from there -- the correct answer would have been, "Well, guidelines recommend xyz but I'm unsure of that in this particular instance due to the following a/b/c -- I think I should do this because ..." If they disagree, then ask them to correct your understanding.....

My failure to learn that particular tidbit basically put me on probation for 6 months in a program that was already toxic and tried to fire residents on a regular basis....

 

[siliso]

It’s a common difficulty in transitioning to internship for sure. Especially since medical students hardly get to do anything in a lot of places. You can go too far and be overconfident and argumentative (thus my advice to be teachable) but at least present a tentative plan with whatever questions you have and then take primary responsibility to execute the plan that your team decides on. Rule #1 of my learnings from intern year: It IS your problem/responsibility, get it done. Whatever it is.

 

[Jimmy B]

Work hard, don't be late, read about your patients on uptodate. Don't try to be a rock star by being too independent. Run stuff by your senior because there may be times that you find a correct answer on line or you remember how it was done in med school, but there are lots of hospital specific protocols. Everyone expects you to be an idiot as an intern, so use the opportunity to ask questions you are 80% sure of, so that you are now 100% sure. Make sure you have a plan for WHY you are calling a consult (not just, this person has the organ that you specialize in so we want you "on board").

Co-sign the above. Consult services don't like it when folks call so we can "be on board"

 

[Jimmy B]

Be nice to the nurses. If you piss them off your intern year is going to suck balls.

 

[engineeredout]

T

This is the best approach. Calling things BS especially as an intern (when you may be reasonably assumed to not know what is BS and what isn't), is apt to get around.

Better to use the well understood code phrase above. Means the same thing but you can always claim ignorance if someone says you called the consult "BS"

Agree with this. A nice neutral "Hey my attending asked to give you guys a call about..." is understood and doesn't make you seem like an ass hat, especially if you end up being wrong and the consult was indicated.

I'll reiterate what was said above. You don't need to recite Harrison's at the beginning of internship (I can't/won't do that at the end of residency), or spew out the latest AHA guidelines word for word, what NEJM just published etc. If you want to be seen as a rockstar intern, you do the following things:

1. Show up on time. This relatively simple easy to do task can either make or break you. If you want to make sure you are on time, plan on getting there at least 20 minutes early every single day. As a PGY5, I show up to my shifts 30 minutes early. I'll have a list printed, I'll have briefly glanced over my patients, and then I am sitting down ready to go as soon as sign out begins. It is noticed if you come sprinting in to the room with a winter coat still on, out of breath, with no list. That doesn't count either.

2. Don't whine. At least not to your seniors, attendings, PDs. Nobody wants to hear it, especially from a brand new intern. You may have legitimate issues that you would like to address, and that's fine. There are ways of dealing with those. Don't go to your program director and complain that you think you are working too many shifts this month. Saying to your senior resident "I have too much to do right now, you need to help me do some of the work" is not going to go over well. Telling everyone in sight that someone is being mean to you because they did not give you a procedure will eventually get back to the first person (nobody owes you procedures). You want to go to the bar and bitch everything out with your co interns? Sure that's acceptable. You want to ask your senior "Hey I feel like I'm always behind on what I need to do, is this normal?" Fine. But don't whine.

3. Try. The best interns are not the best because they have the most medical knowledge. They are seen as the best because they work hard. They do everything they can to get their work done, they take ownership of the patients, they try to do some supplemental reading (easier said than done) and are not obnoxious to be around.

Follow these simple rules and you will be seen as an excellent intern. Doesn't matter if you have no idea what to do with a stroke patient on day 1.

 

[neoexile]

Agree with this. A nice neutral "Hey my attending asked to give you guys a call about..." is understood and doesn't make you seem like an ass hat, especially if you end up being wrong and the consult was indicated.

I'll reiterate what was said above. You don't need to recite Harrison's at the beginning of internship (I can't/won't do that at the end of residency), or spew out the latest AHA guidelines word for word, what NEJM just published etc. If you want to be seen as a rockstar intern, you do the following things:

1. Show up on time. This relatively simple easy to do task can either make or break you. If you want to make sure you are on time, plan on getting there at least 20 minutes early every single day. As a PGY5, I show up to my shifts 30 minutes early. I'll have a list printed, I'll have briefly glanced over my patients, and then I am sitting down ready to go as soon as sign out begins. It is noticed if you come sprinting in to the room with a winter coat still on, out of breath, with no list. That doesn't count either.

2. Don't whine. At least not to your seniors, attendings, PDs. Nobody wants to hear it, especially from a brand new intern. You may have legitimate issues that you would like to address, and that's fine. There are ways of dealing with those. Don't go to your program director and complain that you think you are working too many shifts this month. Saying to your senior resident "I have too much to do right now, you need to help me do some of the work" is not going to go over well. Telling everyone in sight that someone is being mean to you because they did not give you a procedure will eventually get back to the first person (nobody owes you procedures). You want to go to the bar and bitch everything out with your co interns? Sure that's acceptable. You want to ask your senior "Hey I feel like I'm always behind on what I need to do, is this normal?" Fine. But don't whine.

3. Try. The best interns are not the best because they have the most medical knowledge. They are seen as the best because they work hard. They do everything they can to get their work done, they take ownership of the patients, they try to do some supplemental reading (easier said than done) and are not obnoxious to be around.

Follow these simple rules and you will be seen as an excellent intern. Doesn't matter if you have no idea what to do with a stroke patient on day 1.

Just want to reinforce this in my head for the hundredth time: Whining/complaining is considered a felony in internship right? As in you cannot complain at all and just be efficient in what you do?

 

[evilbooyaa]

Just want to reinforce this in my head for the hundredth time: Whining/complaining is considered a felony in internship right? As in you cannot complain at all and just be efficient in what you do?

Not directly to your seniors, not unless it's a patient safety issue. Bitching about it with co-interns outside the hospital is fine. Efficiency is learned over time for most - if you can be efficient from the get-go you will likely be ahead of many of your peers.

 

[neoexile]

Not directly to your seniors, not unless it's a patient safety issue. Bitching about it with co-interns outside the hospital is fine. Efficiency is learned over time for most - if you can be efficient from the get-go you will likely be ahead of many of your peers.

I actually failed the other day. I work in an outpatient office and long story short, I was so emotionally drained by 8 PM (I got in at 9:30ish AM) that I called my attending and asked to go home.

Yaaaaa...I dont think that's happening in residency.

 

[siliso]

Positivity is much appreciated on the job and a negative Nancy is no fun to work with. Better to laugh about the struggle than complain, although you’ll be forgiven for an occasional gripe. You don’t have to be 100% Susie Sunshine (Steve Sunshine?) either, just pleasant to work with and not a drag on morale or a person who is demanding of special favors. The happy warrior type does the best.

It’s more important to be good and thorough than efficient especially in the beginning. I think it’s impossible to be really efficient at a job you are just starting to learn unless you’re cutting corners, which don’t do.

 

[neoexile]

Positivity is much appreciated on the job and a negative Nancy is no fun to work with. Better to laugh about the struggle than complain, although you’ll be forgiven for an occasional gripe. You don’t have to be 100% Susie Sunshine (Steve Sunshine?) either, just pleasant to work with and not a drag on morale or a person who is demanding of special favors.

Oh damn. I just realized. Is this why the interview is important?

So you can see people who will be a drag early on and be like "f*** that?"

 

[siliso]

YES.

 

[engineeredout]

Just want to reinforce this in my head for the hundredth time: Whining/complaining is considered a felony in internship right? As in you cannot complain at all and just be efficient in what you do?

Do your senior residents, who have gone through your exact year recently, who have more responsibilities and take care of more patients (including watching all of your patients and everything you do) want to hear you gripe about how busy you are and how hard it is? Nope.

Doesn't mean we aren't understanding, doesn't mean that we aren't looking out for you guys. A good senior resident is looking out for you in ways you don't even realize. If you weren't feeling pushed beyond what you think your limits are, then your program is not working you hard enough. You may not realize how much you are growing until the following year, when you get a direct comparison about what you are capable of vs the new incoming class.

There are ways to find out if what you are feeling or experiencing is normal. You can discuss with your co-interns. You can ask your senior residents (some programs create a "buddy system", or ask anyone you've met that you feel comfortable talking to). There are ways of saying "Hey I feel like I'm behind compared to everyone else, I feel like I'm struggling with the work load, is this normal for where I am at?" vs "I have to discharge this patient and then the nurses keep calling me and care management is making me fill out this form and then I have to go do an admission and they just don't leave me alone wahhhhhhhhhh"


Note: This does not apply to feelings of depression, worthlessness, anhedonia, suicidality. If you are experiencing any of this, please talk to someone. That is absolutely not in the category of the "intern felony" to which you referred.

 

[qxrt]

Agree with this. A nice neutral "Hey my attending asked to give you guys a call about..." is understood and doesn't make you seem like an ass hat, especially if you end up being wrong and the consult was indicated.

I'll reiterate what was said above. You don't need to recite Harrison's at the beginning of internship (I can't/won't do that at the end of residency), or spew out the latest AHA guidelines word for word, what NEJM just published etc. If you want to be seen as a rockstar intern, you do the following things:

1. Show up on time. This relatively simple easy to do task can either make or break you. If you want to make sure you are on time, plan on getting there at least 20 minutes early every single day. As a PGY5, I show up to my shifts 30 minutes early. I'll have a list printed, I'll have briefly glanced over my patients, and then I am sitting down ready to go as soon as sign out begins. It is noticed if you come sprinting in to the room with a winter coat still on, out of breath, with no list. That doesn't count either.

2. Don't whine. At least not to your seniors, attendings, PDs. Nobody wants to hear it, especially from a brand new intern. You may have legitimate issues that you would like to address, and that's fine. There are ways of dealing with those. Don't go to your program director and complain that you think you are working too many shifts this month. Saying to your senior resident "I have too much to do right now, you need to help me do some of the work" is not going to go over well. Telling everyone in sight that someone is being mean to you because they did not give you a procedure will eventually get back to the first person (nobody owes you procedures). You want to go to the bar and bitch everything out with your co interns? Sure that's acceptable. You want to ask your senior "Hey I feel like I'm always behind on what I need to do, is this normal?" Fine. But don't whine.

3. Try. The best interns are not the best because they have the most medical knowledge. They are seen as the best because they work hard. They do everything they can to get their work done, they take ownership of the patients, they try to do some supplemental reading (easier said than done) and are not obnoxious to be around.

Follow these simple rules and you will be seen as an excellent intern. Doesn't matter if you have no idea what to do with a stroke patient on day 1.

The main takeaway from this post is this: Attitude is far more important than book knowledge as an intern. This is why such a heavy emphasis is placed on interviews during residency applications. There is too much of an emphasis on these forums and among medical students on measures like Step scores or research publications, when as senior residents, fellows, and attendings, we are more concerned with whether you'll be pleasant to work with or an irritating ****.

 

[neoexile]

The main takeaway from this post is this: Attitude is far more important than book knowledge as an intern. This is why such a heavy emphasis is placed on interviews during residency applications. There is too much of an emphasis on these forums and among medical students on measures like Step scores or research publications, when as senior residents, fellows, and attendings, we are more concerned with whether you'll be pleasant to work with or an irritating ****.

So in a way you are still being interviewed in intern year

 

[siliso]

Well, in a way yes, but we’ve already committed to you in your intern year and have great incentive and desire to help you succeed by any means necessary. Including unpleasant corrective feedback with regard to attitude and communication style. You’re our baby now, once you’re on board, and we will go to great lengths to help you adjust as necessary for success.

We still want good academic performance so we can have good board pass rates but the best interns are not by any means only those with high step scores. Medical knowledge deficit is the most straightforward thing to correct through clinical experience and motivated study plans. Attitude and personality problems are fairly entrenched traits by the time you’re already 25+ years old and take more effort on the part of both parties - but a person with willingness to accept feedback that their performance is subpar and change behavior based on feedback can still grow into a solid competent resident. And growing to be such a resident/graduate is what we want most for everyone in the program.

The toxic combination is someone with poor clinical performance and comorbid inability to recognize their deficits and be willing to improve. The heartbreaking combination is someone with poor fund of knowledge and deficits in clinical reasoning and synthesis who is truly motivated and insightful and willing to respond - but ultimately unable for whatever reason to remediate those deficits sufficiently to progress toward safe independent practice. Both people might in the worst unusual case have to be dismissed, but the latter person will have our full support and positive recommendations (within the limits of honesty and integrity) to help them move to a more suitable environment or path.

Whereas if you’re unpleasantly flagrantly weird or obnoxious or dysphoric at the interview we can cut our losses and just make you code status DNR: Do Not Rank. When I interview people my primary objective is to see if we can have a sustained pleasant conversation about any topic in the world, not that I actually care about their particular knockout mouse or most meaningful patient encounter in med school (though I might if it catches my interest, but I’m just as happy to talk about their travels, pets, family, whatever). That and do they actually love or at least think they love our specialty so they’ll be happy working hard as a resident with us.

 

[sliceofbread136]

Agree with this. A nice neutral "Hey my attending asked to give you guys a call about..." is understood and doesn't make you seem like an ass hat, especially if you end up being wrong and the consult was indicated.

I'll reiterate what was said above. You don't need to recite Harrison's at the beginning of internship (I can't/won't do that at the end of residency), or spew out the latest AHA guidelines word for word, what NEJM just published etc. If you want to be seen as a rockstar intern, you do the following things:

1. Show up on time. This relatively simple easy to do task can either make or break you. If you want to make sure you are on time, plan on getting there at least 20 minutes early every single day. As a PGY5, I show up to my shifts 30 minutes early. I'll have a list printed, I'll have briefly glanced over my patients, and then I am sitting down ready to go as soon as sign out begins. It is noticed if you come sprinting in to the room with a winter coat still on, out of breath, with no list. That doesn't count either.

2. Don't whine. At least not to your seniors, attendings, PDs. Nobody wants to hear it, especially from a brand new intern. You may have legitimate issues that you would like to address, and that's fine. There are ways of dealing with those. Don't go to your program director and complain that you think you are working too many shifts this month. Saying to your senior resident "I have too much to do right now, you need to help me do some of the work" is not going to go over well. Telling everyone in sight that someone is being mean to you because they did not give you a procedure will eventually get back to the first person (nobody owes you procedures). You want to go to the bar and bitch everything out with your co interns? Sure that's acceptable. You want to ask your senior "Hey I feel like I'm always behind on what I need to do, is this normal?" Fine. But don't whine.

3. Try. The best interns are not the best because they have the most medical knowledge. They are seen as the best because they work hard. They do everything they can to get their work done, they take ownership of the patients, they try to do some supplemental reading (easier said than done) and are not obnoxious to be around.

Follow these simple rules and you will be seen as an excellent intern. Doesn't matter if you have no idea what to do with a stroke patient on day 1.

Not sure I entirely agree with part of 2. I wouldn’t put it exactly the way you said it, but sometimes things get crazy and senior needs to help off load some of the work.

 

[siliso]

Norm in our program is that seniors should not be leaving until their interns do, barring special circumstances like post call and pm clinic. Corollary being they would all like to finish up and will collaborate on work remaining post signout time. Reason: interns require senior resident supervision.

 

[OrthoTraumaMD]

Come on time.
Make a list of the stuff you need to do and check it off as you do it.
Don't piss people off.

I wish there was a way to like a post more than once.


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[neoexile]

I wish there was a way to like a post more than once.


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I'm curious. How many interns have you met that don't do what Psai said?

 

[OrthoTraumaMD]

I'm curious. How many interns have you met that don't do what Psai said?

Of his 3 statements:
1. 5%-10% (rare for us because it’s orthopaedics and you have to round early)
2. 30%
3. 10%-20% depending on whom you are pissing off (the higher number is if you include ortho senior residents in that number instead of just other services)
Many times it’s the same person doing all three things.


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[Psai]

I'm curious. How many interns have you met that don't do what Psai said?

It's easy to say, tough to do.

 

[FutureInternist]

Agree with show up on time (which for me means earlier than the senior), work hard, know when you are in over your head and have a good enough relationship with fellow interns to ask them (although the senior would be the “best” resource).

While you will lag behind in clinical knowledge for a while, you can help the team by attending to social issues.. does the pt have a ride home, has their O2 been delivered etc.

I always make a “DC in AM” list everyday and work on their DC summaries, getting bedside delivery for their meds (or call in to their pharmacy so if there is an isurance issue you can get it sorted ahead of time), arranging for a cab ride/bus pass.

If you are unable to read a bunch after your day, then try to idenitify the slam-dunk Qs that you will get on your pts the next day.
Got a CHF-er —> know NYHA claasification
Got a PE —> Know provoked vs unprovoked and treatment duration
Got a GIB —> know which meds to give and why certain meds are not given

While Harrison’s, UpToDate etc are the gold standard, they are impossible to read for a full scope of an issue.

I would read the MKSAP for the rotation I was on, do UW Qs for boards and what I found most helpful was NEJM “Review” articles that I would summarise and save in dropbox.
You do get different attendings asking to present on bread and butter topics (see above) multiple times so doing them well once and saving them helps

 

[cbrons]

Agreed. Your attending can hurt you much more than a consultant. The consultant knows when it is BS And doesn’t need you to tell them.


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Attendings don't typically care if you blame them for the consult. They know how the game works.

 

[siliso]

Yes if I asked you to get a consult and you have to invoke my name to get it, that’s fine, certainly more fine than not getting it. If you don’t understand why I want a consult then you can ask “could you help me formulate the question for this consultant?”

And if any consulting resident or fellow thinks my question doesn’t merit their seeing the patient, I can accept that so long as they will document as much in the chart countersigned by their staff. Having your name on the bottom line tends to sharpen up your focus.

 

[hmockingbird]

Not sure I entirely agree with part of 2. I wouldn’t put it exactly the way you said it, but sometimes things get crazy and senior needs to help off load some of the work.

For #2 I’d probably recommend approaching it as “I feel really overwhelmed right now, can you help me prioritise?” In our program towards the end of the year the seniors know the interns know how to do stuff so it becomes more of a team sport (seniors helping out with tasks like printing scripts, discharge papers, etc). But demanding the senior do your work for you is rude.