Procedures, as FM intern

[George85]

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Here I am, 10 months into my intern year, and I'm seriously questioning my program choice. I'm at a top academic institution with programs in all other specialities. I have hardly done any procedures. The attitude when rotating through other services is that "you're in FM and won't need to do this". Quite frankly, FM is not well respected here, even though most people admit it's one of the toughest programs when it comes to hours and hospital in patient work load.

I had more practical exposure during Ob/gyn and surgery as a med student. During 2 months of ob I didn't get to do a single delivery on my own. Surgery was a complete joke. I was assured that surgery was when I would get good suturing skills - I closed skin on about 10 occasions in 2 months of surgery- that was to total of my suturing experience. The only time I got to assist was if there wasn't a surgery resident or medical student available - even then I would often be 2nd assist to a surgical tech. On several occasions I was bumped off a case by a surgery intern who was on another rotation, but was hanging out because things were slow on his rotation.

I'm now finishing up 4 weeks of ICU. 2 intubations, 2 art lines, and 3 cental lines. And, that's not because there's a lack of opportunity - most procedures are not considered "suitable" for me, even though I'm "aggressive" about procedures.

I would appreciate hearing other intern's experiences regarding procedures - especially FM residents.

 

[deleted87716]

I'm at a top academic institution with programs in all other specialities. I have hardly done any procedures. The attitude when rotating through other services is that "you're in FM and won't need to do this".

In a big academic program, you're going to have to fight for things more than you would if you were in an unopposed community program, there's simply no way around it. It's up to you to correct the inaccurate presumption that you "won't need to do this." Who are they to assume that you don't intend to do hospital medicine, urgent care, etc., where procedural skills are relevant? Tell them, "I'M MAD AS HELL, AND I'M NOT GOING TO TAKE THIS ANYMORE!" 😡

Just kidding, don't do that. 😉 Be nice about it, but stand up for yourself. You might even want to share your concerns with your program director. Your education is in your hands. Good luck.

 

[George85]

>>Your education is in your hands.
Absolutely. I'm certainly looking around for other opportunities - trouble is this a one horse town when it comes to residencies and both institutions are very competitive.

I specifically brought the subject of procedures up at my evaluation last week. I pointed out that I was about to finish my intern year with few, if any, practical skills - my complaints fell on deaf ears, even when I pointed out this was contrary to what I was told when interviewing - I was specifically looking for a program with good ob and surgery exposure.

I do whatever I can. I put in all my own IV's and foley's when time permits. Now in the ICU, I do all my own ABG's. I make it very clear to everyone that I'm interested in procedures. In the ICU the excuse is how ill the patient is - I wasn't aware that the ICU was full of healthy patients. In ob there is no residency program, only FP residents rotate through. Nevertheless, the attendings seem more inclined to use their own NP's for C-sections and unit nurses for deliveries.

Don't get me wrong - this isn't because individuals are unpleasent - far from it, everyone is very pleasant and helpful (to a certain level) - there just seems to be an underlying negative attitude towards FP at an institutional level. For example, outpatient clinic - we have to see pt's every 15 mins, while IM have 20 mins - there's more pressure on us in terms of numbers. There's even rumors of the program closing because there's nothing to differentiate it from IM - very few pediatric patients and no ob pt's at all. Ob is a 2 months rotation. No continuity clinic.

I think my message here is don't believe the answers you get during interview, even from the other residents. And, it's not that anyone is being deliberately deceitful - the whole process is about "selling" their program to you. Looking back, I'm not how I would have been able to find out the truth about the programs I interviewed at.

How do others feel about their programs now compared to the view they had before starting?

 

[secretwave101]

I can only hope your's is a singular experience, because what you describe sounds like my own personal hell and I'm starting internship June 19th.

If I were you, I'd finish my intern year and transfer out.

 

[sophiejane]

How is it that you can do research on a program's curriculum (which I am assuming you must have done beforehand) and talk to other residents and spend the day at a program and STILL not see the truth? Did you in fact see FM residents doing OB and procedures the day you were there, or did you just take someone's word for it?

This is why I have scheduled 3 one-month rotations in my 4th year at the 3 programs I am considering as my top choices. Yeah, it's a lot of FM and all of them are inpatient rotations, but I need to see for myself what they offer, and I don't feel I can do that on a one-day interview. I've spent hours on the internet researching programs. I go to residency fairs, I talk to docs who are graduates of these programs. And I'm steering far away from "top academic institutions" for all the reasons you mentioned.

Hopefully you can still salvage your education and get what you need.

 

[deleted87716]

How do others feel about their programs now compared to the view they had before starting?

I wasn't disappointed, as I had done quite a bit of research along the lines of what sophiejane described. I pretty much knew exactly what I was getting into. Sometimes, you've gotta make your own luck. 😉

 

[lowbudget]

Dude, you might have to stop being polite and start getting real. I got into a cussing match in triage with an OB intern on call fighting over patients. And it all started out weeks prior when the OB intern wanted me, an FM intern, to give up my deliveries to 3rd year medical students. Uh... NO MA'AM. I don't take orders from another intern.

I never scutted my students. I never pimped them or made them feel bad. I let them sleep the whole night on call. I even taught them OB and basic medicine. But I was honest when I told them they can start having my deliveries when I get my numbers. The gunners hated me, the others who didn't care about OB wanted to be with me so they could study for their shelf. So that's how I deal with med students. Throw your authority around, but keep in mind what is important to them, and appeal to that.

As far as other residents, that's a little more difficult because you are off-service and at university programs, residents take care of their own and crap on off-service residents AS A RULE. If you're pissed off about it, you need to be nice to everyone, make friends with the other residents and faculty, and straight up tell them "hey, I'd like to be 1st assist on this next case" and if they say no, put it back on them "ok, so which case can I be 1st assist on?" and go up to the senior resident if you have to. I would just negotiate it "hey, senior, all I want to do is get a couple of good suturing experience in, can I get in on a case where I can close, maybe one with you."

And if you don't get what you want, SCREW IT. Do an elective somewhere else where there are no residents (i.e. rural rotation with a volunteer surgeon/OB) or find a busy ER. It sucks, but hang in there.

 

[deleted6669]

I can only hope your's is a singular experience, because what you describe sounds like my own personal hell and I'm starting internship June 19th.

If I were you, I'd finish my intern year and transfer out.

agree- find a pgy-2 spot at some unopposed community program. I work at a hospital with such a residency.the interns and residents do it all- run the icu, run the ob service with ob on call for sections(many of which they do with the ob assisting them), they do treadmills, sigs, work in the er, etc
why did you elect to do fp at an academic ctr in the 1st place?
do you want to go into academics?

 

[Peeshee]

agree- find a pgy-2 spot at some unopposed community program. I work at a hospital with such a residency.the interns and residents do it all- run the icu, run the ob service with ob on call for sections(many of which they do with the ob assisting them), they do treadmills, sigs, work in the er, etc
why did you elect to do fp at an academic ctr in the 1st place?
do you want to go into academics?

I agree!

 

[dr.smurf]

your frustration is all too common in a place where FP is surrounded by IM, OB, PEDS, SURG and other specialties. I feel your pain, b/c I had those frustrations too. We have IM, OB, SURG here where I am. When I was an intern I had to fight like hell b/c I wanted tons of procedures. Lucklily my hard work paid off and I had a good rapport with the other residents in other residencies mainly b/c I went to school with a lot of them. just stay aggresive and let everyone know you want to do procedures. the problem is most of my colleagues in my residency could care less about procedures so this causes a generalization that fp could care less about procedures. and the RRC/ACGME for FP doesnt make us have to have certain procedures say lines, intubations, chest tubes, etc. that surgery and medicine has to have for graduation. I think this should change and maybe if we all complained and wrote to our academy or when RRC comes to your residency make them aware how you feel. in hindsight sometimes I wish I would have gone unopposed for these reasons. but, as one previous post stated...you are in charge of your education and if you continue to work hard youll make the best of it. i had to an extra elective in ICU and ANESTH to pick up more lines and procedures, but if thats what it takes then so be it. you may want to consider using your conferenc/education stipend to attend a procedure workshop. try the national procedures institute. they have several. cant remember the web site. google it. good luck and stay with it.

 

[stapedius]

you may want to consider using your conferenc/education stipend to attend a procedure workshop. try the national procedures institute. they have several. cant remember the web site. google it. good luck and stay with it.

http://www.npinstitute.com/

I went this past February to the Hospitalist Procedures course in Santa Fe, NM. I must say that it exceeded my expectations. Sort of pricey for a resident's salary, but our program reimburses so free for me, and got a nice little vacation for my wife and me. I'll be going to other courses by NPI. Currently looking at the Hot Topics in Procedures I & II.

 

[jeff2005]

I plan on doing geriatrics after FP residency. Should I care about procedures?

 

[secretwave101]

I plan on doing geriatrics after FP residency. Should I care about procedures?

Nope. Your job is often to prevent them from undergoing procedures.