MD Slacked off hard and SOAPed into IM - how to prepare?

[washboardEarth]

I did not match into a specialty with a narrow knowledge base and am thankful to SOAP into a IM categorical spot.

I slacked off hardcore since the start of 4th year and did not even try that hard in 3rd year... Not the definition of a good medical student by any means... Took the easiest electives possible in 4th year (online, research, etc) and haven't presented a patient for months (and my presentations are absolutely trash). And I did not do a medicine sub-I. I am very nervous for residency but thankful to be starting this summer. I am not kidding when I say that I think most 3rd years and some of the 2nd years are better than me clinically.

What can I do to bring my knowledge base up to par? I also SOAPed at a FMG-heavy program and FMGs tend to really know their stuff so I am worried for looking bad starting Day 1. I got good board scores so I can learn and spit back the IM material but I don't know where to start or whats relevant to start as an intern.

PS: I am not gunning and trying to hit the ground running so I can become a structural cardiologist 8 years from now.. Where I am currently in my skills would probably bring me to the PD's attention within my first month. I could barely come up with 3 differentials for my ER patients a few months ago and I am no longer amused by this fact but TERRIFIED

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[yeet]

what specialty were you intending to bring your talents to?

 

[washboardEarth]

Irrelevant to my question

 

[efle]

OnlineMedEd was gold for my Medicine rotation

They even have an "intern bootcamp" product if you want a cherry on top after brushing up on all the Medicine bread and butter

 

[IMGASMD]

Irrelevant to my question

Sort of isn’t.
If you were thinking neuro, hopefully you won’t beef up your cva, lesions, maybe you can read some scans.
Ortho, hopefully you have some fundamentals of msk exams.
You get the idea. But you’re right too, if you just didn’t give any s—ts about nothing, then nothing will help and you’d have to relearn medicine.

Cards isn’t something that if you don’t at least love some medicine can get into easily.

But it gets real now, isn’t it? You will have have someone’s actual life in your hand in no time.

Good luck, op.

 

[washboardEarth]

Sort of isn’t.
If you were thinking neuro, hopefully you won’t beef up your cva, lesions, maybe you can read some scans.
Ortho, hopefully you have some fundamentals of msk exams.
You get the idea. But you’re right too, if you just didn’t give any s—ts about nothing, then nothing will help and you’d have to relearn medicine.

Cards isn’t something that if you don’t at least love some medicine can get into easily.

But it gets real now, isn’t it? You will have have someone’s actual life in your hand in no time.

Good luck, op.

Its so real now my dude. I barely have any idea what to expect because I did not do a medicine subI and our MS3 IM clerkship let you be a total piece of **** as long as you passed the shelf. All I remember is signouts talking about full code, being bored watching paracentesis, and residents arguing over Lasix doses.

I appreciate the OME recommendation. I didn't know if I should start reading through Step 2 FA or something.

 

[NotAProgDirector]

Slacking off and getting a Cardiology spot are incompatible. I worry because in general people who slack off in medical school slack off in residency.

You didn't mention whether you matched to a Univ, Univ affiliated, or community program. You also didn't mention whether your program has a cardiology fellowship. And you didn't mention your USMLE scores and whether they also reflect slacking.

You should determine whether graduates of your future program commonly go into cardiology. If not, you may find getting a Cardiology spot is a big uphill battle and may require you to finish residency and do some time as a cardiology hospitalist or in an non-accredited fellowship first.

In any case, you need to get as ready as you can to start and hit the ground running, you'll want to start developing research projects early, and networking will be key.

Best of luck

 

[washboardEarth]

Slacking off and getting a Cardiology spot are incompatible. I worry because in general people who slack off in medical school slack off in residency.

You didn't mention whether you matched to a Univ, Univ affiliated, or community program. You also didn't mention whether your program has a cardiology fellowship. And you didn't mention your USMLE scores and whether they also reflect slacking.

You should determine whether graduates of your future program commonly go into cardiology. If not, you may find getting a Cardiology spot is a big uphill battle and may require you to finish residency and do some time as a cardiology hospitalist or in an non-accredited fellowship first.

In any case, you need to get as ready as you can to start and hit the ground running, you'll want to start developing research projects early, and networking will be key.

Best of luck

I can see why my last sentence is being taken as me gunning for structural cardiology but what I was trying to say is I am not gunning for that. There are often threads posted by MS4s who want to prepare for residency and excel and match prestigous fellowships. I am just trying to even get into the 25th percentile of my future co-interns right now.

 

[washboardEarth]

For example. I am reading a intern handbook right now and it says this for hypotension

Determine what your IV access is: Make sure there are two large bore IV’s and start Normal Saline wide open while you are thinking, unless the patient is in cardiogenic shock.

It does not expound on cardiogenic shock. I have no idea how to determine cardiogenic shock. This is bad. It seems like the handbooks take for granted a certain level of competence by the incoming interns and I am not at that level and need to get there - fast.

 

[Dro133]

For example. I am reading a intern handbook right now and it says this for hypotension



It does not expound on cardiogenic shock. I have no idea how to determine cardiogenic shock. This is bad. It seems like the handbooks take for granted a certain level of competence by the incoming interns and I am not at that level and need to get there - fast.

https://lmgtfy.com/?q=cardiogenic+shock

 

[deleted407021]

You’re going to have to identify your knowledge gaps and fill them in on your own along the way. If you don’t know about something look it up and go from there. Up-to-date is my favorite resource for this.

 

[attitudeofgratitude]

I like how most people are trashing him rather than answering his question. SMH.

OP I'm in the same boat as you. Know nothing about IM but now I'm an internist I guess. I reached out to my school's IM faculity and they're going to help me. But they're a bit busy now with the virus.

In the mean time I'm doing the OME intern videos and reviewing the Zank Step 2 deck IDK if thats on point but figure it's gonna help

 

[washboardEarth]

I like how most people are trashing him rather than answering his question. SMH.

OP I'm in the same boat as you. Know nothing about IM but now I'm an internist I guess. I reached out to my school's IM faculity and they're going to help me. But they're a bit busy now with the virus.

In the mean time I'm doing the OME intern videos and reviewing the Zank Step 2 deck IDK if thats on point but figure it's gonna help

Thats SDN for ya. Just witty replies for the Likes

 

[Ludwig2000]

I did not match into a specialty with a narrow knowledge base and am thankful to SOAP into a IM categorical spot.

I slacked off hardcore since the start of 4th year and did not even try that hard in 3rd year... Not the definition of a good medical student by any means... Took the easiest electives possible in 4th year (online, research, etc) and haven't presented a patient for months (and my presentations are absolutely trash). And I did not do a medicine sub-I. I am very nervous for residency but thankful to be starting this summer. I am not kidding when I say that I think most 3rd years and some of the 2nd years are better than me clinically.

What can I do to bring my knowledge base up to par? I also SOAPed at a FMG-heavy program and FMGs tend to really know their stuff so I am worried for looking bad starting Day 1. I got good board scores so I can learn and spit back the IM material but I don't know where to start or whats relevant to start as an intern.

PS: I am not gunning and trying to hit the ground running so I can become a structural cardiologist 8 years from now.. Where I am currently in my skills would probably bring me to the PD's attention within my first month. I could barely come up with 3 differentials for my ER patients a few months ago and I am no longer amused by this fact but TERRIFIED

Sorry to say, but you CANNOT just WALTZ into a cardiology fellowship with this kind of talk mister!!!

J/k. I feel for you man. Don’t have any advice because I’m an M4 too.

 

[IMGASMD]

Thats SDN for ya. Just witty replies for the Likes

Yes! Can I trade my likes now for a pizza?

Seriously though, you wasted two years of your education and did not get into whatever speciality that you wanted, and you are criticizing us? Rly?

I like how most people are trashing him rather than answering his question. SMH.

OP I'm in the same boat as you. Know nothing about IM but now I'm an internist I guess. I reached out to my school's IM faculity and they're going to help me. But they're a bit busy now with the virus.

In the mean time I'm doing the OME intern videos and reviewing the Zank Step 2 deck IDK if thats on point but figure it's gonna help

Because no one knows how he studies. No one knows how deficient he really is.

Up to date was always my go-to when I was training. There isn’t a cookbook for medicine. It takes time, experience and knowledge.

Know your horses well, know your common differentials, know your common symptoms.

No one expect an intern to know everything.

 

[washboardEarth]

I guess my question is, this guy on Reddit says that the only thing you need to know for Day 1 is how to replete electrolytes and the rest you learn on the job.



So do I need to read through Step 2 FA or another book?

 

[libertyyne]

Couldnt you just grind Dorian step 2 IM, and then do some intern bootcamp book to augment ?

 

[KnuxNole]

If an intern knows where the bathroom is, and knows how to log into the EMR, and can write a note, they should be fine.

In all seriousness, you know more than you think. I think right now there is a LOT of fear, which is understandable. I mean, you went through almost 4 years of medical school. You passed all your classes and rotations and passed Step 1 and 2. These things will come back to you. I'm sure in your medical school career you went over cardiogenic shock at some point. You might not recall any of it, but as you get into the groove of things, it'll come back.

Remember, that interns are supervised by upper levels. They will catch your mistakes, as will attendings. Get ready to hit the ground running, eager to learn.

Have a good handbook, antibiotic guide, Maxwell. Practice presenting a case or two with a classmate if you feel like that is a weakness. Intern boot camp on OME is a good start too.

Want to know how to really prepare?
1. Show up early.
2. Always, always help your team.
3. Know where to look up things.
4. Know WHO to ask for help, and how to get a hold of them.

 

[radsisrad]

I thought people were exaggerating when they said interns aren't expected to know anything.

They weren't. You can know just about nothing other than how to do a physical exam, and you'll be fine. I honestly can't recall whether I'd known what Colace was before I started. There are plenty of residents who barely passed their Steps (and a number who failed their Steps multiple times). Show up with a three-digit IQ and you will survive.

Half-joking comments aside...

-FA for USMLE Step 3
-Medscape app for the floors (helpful for dosages)

 

[Money-Moniker]

Don't worry OP, we'll be starting intern year during the peak of what is possibly the greatest public health crisis this country has ever faced. We'll be fine.

 

[Moose A Moose]

OP, I appreciate how honest you are on here and with yourself. I can empathize.

Best advice: know the basics of each system and you’ll be fine. There will be a ton of learning on the job. Review basic pathophysiology for each system. Watch some videos, read here and there.

You will be fine come July.

 

[aSagacious]

I slacked off hardcore since the start of 4th year and did not even try that hard in 3rd year

Took the easiest electives possible in 4th year (online, research, etc)

our MS3 IM clerkship let you be a total piece of **** as long as you passed the shelf

If the above statements are truly reflective of your disposition, it seems like you may be the type to do the minimum amount of work to get by. This mentality is toxic and will hamper your proficiency throughout your career.

Before you pick up any intern handbooks or figure out where the ED stashes free Uncrustables you gotta get your mind right.

Nobody can force you to be intellectually curious and read at home regularly. Nobody can force you to stay abreast with the latest trials and guidelines when you're an attending. But life moves quickly and it becomes abundantly clear who's been on top of their stuff along the way.

Pro tips to being a decent chap:
- Come early, stay late, or work from home to finish your tasks, even when your shift is technically over.
- Offer to help your upper level by covering some or all of your cointern's patients on their day off.
- If a new grad nurse sounds concerned about a patient at 2 AM, leave your call room and go see the patient, even if (s)he sounds incompetent.
- Swing by the patient's rooms regularly to update them and their family with new developments and the plan. It doesn't help you in any way but makes them feel better.
- Give your medical student a chance to shine by interviewing the patient in front of you, pimping them regularly, and letting them write notes and enter orders - even though it'll slow you down.

“The true test of a man’s character is what he does when no one is watching.” - John Wooden

 

[Angus Avagadro]

It was the first day of my internship and the Chief was running morning report. A 2nd yr was presenting and said the patient had COPD and was prescribed a theophylline compound. The Chief said, "What is the mechanism of action for that medicine"?. The 2nd yr began to sweat profusely and sort of explained how he thought it worked. The Chief went into great detail expounding on the pharmacology and asking the 2nd yr why he would order a medicine for a patient when he didn't completely understand how it worked? I began sliding down in my chair while asking myself why I had gunned for the this high end university program? This may be a big mistake. I was far from a slacker in med school, but was intimidated by most of my residency classmates, several, boarded in other specialties.
To the OP.. that feeling of not being adequate won't go away soon in residency. Above all, ask questions and for advice, even at the risk of annoying your colleagues or senior residents. They have taken you and you are now their responsibility. They would rather you ask for advice than you "Wing it" on your own, and possibly hurt someone. Make them chase you out of the hospital with a stick every day, read about every patient you have with respect to pathophysiology, meds, their pharmacology, and differential diagnosis. Then, you can consider how to begin the work up. You admittedly slacked off and are now behind. But you can overcome this with the proper attitude and humility. Remember, you are there to be taught. I hope you are not in a Sweat Shop IM program where they will just abuse you with work and not teach you. The first few months are the hardest, and remember, your classmates will be adjusting too. Work hard and you can do this. Good luck and Best Wishes!

 

[Giovanotto]

It was the first day of my internship and the Chief was running morning report. A 2nd yr was presenting and said the patient had COPD and was prescribed a theophylline compound. The Chief said, "What is the mechanism of action for that medicine"?. The 2nd yr began to sweat profusely and sort of explained how he thought it worked. The Chief went into great detail expounding on the pharmacology and asking the 2nd yr why he would order a medicine for a patient when he didn't completely understand how it worked? I began sliding down in my chair while asking myself why I had gunned for the this high end university program? This may be a big mistake. I was far from a slacker in med school, but was intimidated by most of my residency classmates, several, boarded in other specialties.
To the OP.. that feeling of not being adequate won't go away soon in residency. Above all, ask questions and for advice, even at the risk of annoying your colleagues or senior residents. They have taken you and you are now their responsibility. They would rather you ask for advice than you "Wing it" on your own, and possibly hurt someone. Make them chase you out of the hospital with a stick every day, read about every patient you have with respect to pathophysiology, meds, their pharmacology, and differential diagnosis. Then, you can consider how to begin the work up. You admittedly slacked off and are now behind. But you can overcome this with the proper attitude and humility. Remember, you are there to be taught. I hope you are not in a Sweat Shop IM program where they will just abuse you with work and not teach you. The first few months are the hardest, and remember, your classmates will be adjusting too. Work hard and you can do this. Good luck and Best Wishes!

Man, I'm getting the craziest imposter syndrome after having matched at my #1. I already know this is going to be me.

 

[Angus Avagadro]

Man, I'm getting the craziest imposter syndrome after having matched at my #1. I already know this is going to be me.

Fear is a great motivator, for sure. Work hard, read, ask for help when you need it. You'll be fine. Good luck and best wishes!

 

[Espressso]

It was the first day of my internship and the Chief was running morning report. A 2nd yr was presenting and said the patient had COPD and was prescribed a theophylline compound. The Chief said, "What is the mechanism of action for that medicine"?. The 2nd yr began to sweat profusely and sort of explained how he thought it worked. The Chief went into great detail expounding on the pharmacology and asking the 2nd yr why he would order a medicine for a patient when he didn't completely understand how it worked? I began sliding down in my chair while asking myself why I had gunned for the this high end university program? This may be a big mistake. I was far from a slacker in med school, but was intimidated by most of my residency classmates, several, boarded in other specialties.
To the OP.. that feeling of not being adequate won't go away soon in residency. Above all, ask questions and for advice, even at the risk of annoying your colleagues or senior residents. They have taken you and you are now their responsibility. They would rather you ask for advice than you "Wing it" on your own, and possibly hurt someone. Make them chase you out of the hospital with a stick every day, read about every patient you have with respect to pathophysiology, meds, their pharmacology, and differential diagnosis. Then, you can consider how to begin the work up. You admittedly slacked off and are now behind. But you can overcome this with the proper attitude and humility. Remember, you are there to be taught. I hope you are not in a Sweat Shop IM program where they will just abuse you with work and not teach you. The first few months are the hardest, and remember, your classmates will be adjusting too. Work hard and you can do this. Good luck and Best Wishes!

This is great.

 

[washboardEarth]

is it worth it to learn to read cxr before intern year starts

 

[GadRads]

There is an app called HumanDx and another called ClinicalSense. Attempt the cases and read up on what you don't know.

Make a commitment to learning something new almost everyday for the rest of your career.

 

[deleted407021]

is it worth it to learn to read cxr before intern year starts

Probably couldn’t hurt to review the basics or at least know really well what a normal CXR looks like.
Going into peds so esp for newborns, chests are pretty important.

 

[Angus Avagadro]

is it worth it to learn to read cxr before intern year starts

Yes. You need to recognize CHF, infiltrates, widened mediastinum, bony lesions, CVP and PA catheter placement, heart size, pulm vasculature, lungs,etc. You need to develop a systematic approach , bones, heart, lungs, etc.

 

[Lexdiamondz]

I'm gonna echo what others have said - the expectations of interns are pretty low in the beginning of PGY-1 year. Mostly we just want you to be eager, hardworking and ready to learn.


That being said, if you're starting an IM residency and you haven't really done much MS3/MS4 year to prepare for it, I would consider spending a bit of time on the floors before graduation if at all possible. Don't go overkill and sign up for a Sub-I (especially since most schools have shut down clinicals) but you should familiarise yourself with the pace of rounding, how to effectively pre-round, what taking and giving sign-out is like and how to present. Nobody expects you to run an inpatient team by yourself, but you will need these basic skills to be a functional intern at the bare minimum, and not having them will make your first couple of months much, much harder.

 

[sliceofbread136]

Yes. You need to recognize CHF, infiltrates, widened mediastinum, bony lesions, CVP and PA catheter placement, heart size, pulm vasculature, lungs,etc. You need to develop a systematic approach , bones, heart, lungs, etc.

people still use pa catheters???

 

[Angus Avagadro]

people still use pa catheters???

Yes, believe it or not. Not as frequent as years ago.

 

[WheezyBaby]

Bring a good attitude, be honest, work hard, be motivated to provide good patient care, and respond well to feedback and you'll be given a lot of grace with regard to knowledge base and other things you may now be deficient in. These are things immediately within your locus of control. Knowledge base is going to take time.

As an aside, I expect an average medicine intern to interpret a Swan about as well as they can write progress notes that don't read as a ****ty novella discharge summary without any sense of how the patient is actually doing. Regardless, outside of the cath lab I've seen less than 10 Swan's despite an adult advanced heart failure month and a peds CVICU month.

 

[washboardEarth]

Why wouldn't people use swans? I saw a few on a CCU rotation.

 

[IMGASMD]

Why wouldn't people use swans? I saw a few on a CCU rotation.

Familiarity. Know of a cardiac surgeon who would just leave it in, so the ccu/ctu nurse can report the number to him, then he can decide to come in or not.

Some people don’t have the know-how to use TEE. And if you don’t have a dedicated anesthesiologist, intensivist who is there 24/7/365. Better have something than nothing.

Trending. Like CVP is some regards, the initial number may or may not tell you something. But if you know the PAP >40 you know that’s not normal. You can try to “treat” the number and bring it down and see if the clinical course improves.

There are some utilities of having a PA catheter. If anyone’s reason for not having one is concern for infection, I’d prefer not to talk to you.

 

[WheezyBaby]

Why wouldn't people use swans? I saw a few on a CCU rotation.

Pulmonary artery catheters for adult patients in intensive care

www.cochrane.org

You can debate until your blue literature on swans. I think they went out of favor somewhat based on interpretations of the literature leading to progressive lack of familiarity with them. My feeling is they're underused, and in the hands of someone who can actually interpret the information they provide can be a boon in complex cardiogenic / mixed shock scenarios. But I'm not an intensivist / anesthesiologist. I did have a patient as a student who died after PA rupture from a swan