Hi there,
I originally posted this to another forum (Surgery and Surgical Specialties) but you may find it helpful.
njbmd
quote:
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Originally posted by Foxxy Cleopatra
Any advice on things I could do between now and July that would be helpful in starting internship? I've been hanging out in the sun with my Marino's ICU book, which I actually find to be a reasonably easy read. Any help will be appreciated!
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Hi there,
You will never be asked to perform any procedure alone, that you are uncomfortable with. There will be a more senior resident to talk you through putting in chest tubes, central lines and the like. After doing a few rotations where I didn't get that much OR time, I even had to think about knot tying so relax and enjoy your time off. About two weeks into your internship, you are going to kick yourself if you don't.
As an intern, ask the more senior residents to let you watch them perform procedures. I bugged the anesthesia residents to let me put in Swans and central lines as they start cases. Most are happy to accomodate you. Try to get a month in the SICU where you will be doing plenty of line and the like.
You should have an idea of how to work up things like RUQ pain, acute abdominal pain and the like. You are going to learn to handle disasters in ATLS so don't worry about that stuff. No resident was born knowing how to manage patients. We are all learning. Your chief is going to give you the guidelines of patient management.
Learn to be detail oriented and write everything down on morning rounds. You main tasks will be to follow-up on everything that has to be done for your patients. What did that culture grow out? What are the results of that AM chest film? Hunt down the radiologists and get readings on all radiographic studies early in the day. Set up consults early and call the consulting team. Speak to the consults personally after they have seen your patients.
Keep the medical students organized and be very nice to the nurses. I can't tell you have valuable it is to go to the nurse after AM rounds at tell them the plan for the day for Mr. So and So. If you do that, they will make sure that your orders get carried out. Check out every lab test and replace electrolytes promptly. Make walkrounds in the afternoons and speak with families. Know how to do a good signout sheet. Put stuff on there that you would want to know if you were covering for the night.
Answer every page promptly and try to help if you can. The right decision always involves getting up and seeing the patient rather than trying to fix something over the phone. If a patient is crashing, load the boat (call the chief resident early rather than later), have fresh vital signs (even if you have to take them yourself) and have a plan even if it is not correct. Before you go to bed, check on and write a post op note on all fresh post-op patients. Look at all wounds on any post op patient that has a fever before you attribute the fever to atelectasis. If you are cross-cover, write a note and explain what you found and what you did. [" Called to evaluate patient in respiratory distress by night nurse. Pt seen and examined etc..."]
Ask plenty of questions and get into the OR every time that you can. Don't expect too much operating time as an intern. You main job is to learn good patient care. Go to the clinic with a smile on your face and help the team even if your fellow interns slack off. Be nice to the nurses. BE NICE to the nurses. BE NICE TO THE NURSES! They can make your job hell. A good nurse is not going to call you for stupid stuff in the middle of the night so get up and see the patient. They will also help you make decisions about things but remember that you are the physician even though you are pretty new.
Finally, enjoy this year. It goes by much faster than you think. You will not have the luxury of not knowing things during your second year so use this year to get valuable experience. No one expects you to come in and start treating patients immediately. You will have plenty of time to learn and grow.
Also, if you find that you are hating life, better to hang on and do well during intern year. A good work ethic will get you further than having superior knowledge but poor work habits. Attending physicians will always look out for the good workers. You can always find something different after internship if you do a good job. If you screw up during internship, you are going to have a difficult time and second year is going to be tougher because everyone knows you screwed up.
Don't let your fellow interns psyche you out. They are just as green as you are and all of you are in the same boat. Let the braggers go and keep taking good care of your patients. You really will learn on the job!
njbmd
