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It's too early, but what the hell,
Things New Interns Should Know
1) Communicate frequently/often/always with your senior residents. It is a common misconception to think that you're 'bothering' them (which is what most interns think).....in actuality the reverse is true. The best residents I've ever seen are the ones always giving updates. Communicating often is not a bother - it makes you look like you're on top of things....and allows your Chief to think, "I can rest easy and concentrate on my case because if there's something going on out there, so-and-so is going to make sure I know about it." It makes you look like a star, it makes the Chief look like a star, and the attendings love it.....all because frequent communication facilitates patient care (the reason we're all here). So, my advice:
Text page, visit in the OR or hunt down your Chief in some way every few hours throughout the day for any updates on the patients: "Just wanted to let you know...", "Just wanted to give you an update ....", "CT results back on Smith - no abscess", "Just wanted to let you know...."
Always notify your Chief about any change in patient status
Always discuss a situation you have any doubts about with a senior resident, "This is what happened......this is what I did for these reasons.....I think it was the right thing to do... but just wanted to make sure I wasn't missing anything."
2) Devise a reading schedule with help from senior residents. The most common advice was to read in this order:
Your patients' problems
General surgical problems for your level
What's coming next rotation (cardiac, vascular, etc.)
High-yield ABSITE topics.
Interesting journal stuff.
3) Use surgical texts, like Sabiston, Cameron. Find something you like to read that can give you a quick overview of a topic with a touch of data for concreteness. You should have lots of time to prepare for the ABSITE.
4) Learn early how to start workups that need to happen quickly, like how to r/o MI & PE. Ideally, when you suspect something like this, you should not have to wait for your senior resident to answer your page before you secure the ABCs, begin appropriate monitoring, and order the initial studies (EKG, stat CXR, labs). My most common cross-cover issues:
Hypotension
Low urine output
Pain (chest, abdomen)
Shortness of breath
Vomiting
Mental status changes
5) You will be dictating most of the discharge summaries. Figure out quickly how to be complete yet brief, and fast.
6) Develop a way to organize and carry information about your patients with you. Whatever worked well in medical school should be your starting point.
7) Write everything down. Everything.
8) Be nice to the nurses.
Be nice to the nurses.
Be nice to the nurses.
In reality, the first 6 weeks of internship are about how to help the nurses, not the other way around. If you've got ego issues your life on the ward will be twice as hard. Try this instead: "OK, thanks for the call, there's a couple of ways I could treat this (headache, insomnia, constipation) but what would you like to do?" That still allows you to veto aspirin for a pre-op patient, but most of the time the nurse gets what she or he wants and you won't get called again about it.
9) Finally: remain calm.
Do not become angry
Do not become angry
Do not become angry
When angry, do not become frustrated
When angry and frustrated, remember: they can hurt you but they cannot stop the clock.
Things New Interns Should Know
1) Communicate frequently/often/always with your senior residents. It is a common misconception to think that you're 'bothering' them (which is what most interns think).....in actuality the reverse is true. The best residents I've ever seen are the ones always giving updates. Communicating often is not a bother - it makes you look like you're on top of things....and allows your Chief to think, "I can rest easy and concentrate on my case because if there's something going on out there, so-and-so is going to make sure I know about it." It makes you look like a star, it makes the Chief look like a star, and the attendings love it.....all because frequent communication facilitates patient care (the reason we're all here). So, my advice:
Text page, visit in the OR or hunt down your Chief in some way every few hours throughout the day for any updates on the patients: "Just wanted to let you know...", "Just wanted to give you an update ....", "CT results back on Smith - no abscess", "Just wanted to let you know...."
Always notify your Chief about any change in patient status
Always discuss a situation you have any doubts about with a senior resident, "This is what happened......this is what I did for these reasons.....I think it was the right thing to do... but just wanted to make sure I wasn't missing anything."
2) Devise a reading schedule with help from senior residents. The most common advice was to read in this order:
Your patients' problems
General surgical problems for your level
What's coming next rotation (cardiac, vascular, etc.)
High-yield ABSITE topics.
Interesting journal stuff.
3) Use surgical texts, like Sabiston, Cameron. Find something you like to read that can give you a quick overview of a topic with a touch of data for concreteness. You should have lots of time to prepare for the ABSITE.
4) Learn early how to start workups that need to happen quickly, like how to r/o MI & PE. Ideally, when you suspect something like this, you should not have to wait for your senior resident to answer your page before you secure the ABCs, begin appropriate monitoring, and order the initial studies (EKG, stat CXR, labs). My most common cross-cover issues:
Hypotension
Low urine output
Pain (chest, abdomen)
Shortness of breath
Vomiting
Mental status changes
5) You will be dictating most of the discharge summaries. Figure out quickly how to be complete yet brief, and fast.
6) Develop a way to organize and carry information about your patients with you. Whatever worked well in medical school should be your starting point.
7) Write everything down. Everything.
8) Be nice to the nurses.
Be nice to the nurses.
Be nice to the nurses.
In reality, the first 6 weeks of internship are about how to help the nurses, not the other way around. If you've got ego issues your life on the ward will be twice as hard. Try this instead: "OK, thanks for the call, there's a couple of ways I could treat this (headache, insomnia, constipation) but what would you like to do?" That still allows you to veto aspirin for a pre-op patient, but most of the time the nurse gets what she or he wants and you won't get called again about it.
9) Finally: remain calm.
Do not become angry
Do not become angry
Do not become angry
When angry, do not become frustrated
When angry and frustrated, remember: they can hurt you but they cannot stop the clock.
