Mar 21, 2016
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Just some musings from a study break on a rainy day off....

1. I don't care if you were the valedictorian at BMS, you WILL struggle your first few days. I used to get tons of compliments on my presentations and how well I knew my patients.... All FOUR of them. Suddenly I have 15, most of whom have been known to the service since before I even submitted ERAS. And I feel like a first-class idiot.

2. Things that used to be easy- pre-rounding, writing basic notes... Become exponentially more difficult when you don't know what unit is where, where the bathroom is, how to find the nurses and so on. Your brain will be on overload, and this will make you stupid.

3. Even if your attending is Stalin himself, you probably won't care. You'll be too busy berating yourself for your mistakes. This is also true if your attending is the equivalent to Mother Teresa. Getting scolded stops mattering REAL QUICK when you realize that you have actual patients depending on you.

4. The med students are afraid of you. This is ironic, because you will feel like you know a lot LESS than they do- after all, they know where stuff is and who people are. Plus, they just studied for step 1 or 2, while you have been in Tahiti or somewhere for the past month. The med students are also out to protect their own hides, because they have to be. Bad grades= poor match=stunted career before it even starts. If they one-up you on rounds, try to forgive them and realize that it's your job to a) write notes, b) do random scut and c) learn stuff. Their jobs are to keep their heads off the chopping block, so let them do this.

5. Even if you can recite Lawrence word for word, there are a lot of piddly things you don't completely know how to do, like prepping, draping, positioning. These will make you look and feel stupid. Make friends with the techs- everyone will benefit if you get them to teach you these things.

6. You will form a connection with your chief that will be really cool and unique. Even if they're not always nice to you, they'll be the first person to really teach you anything, and they'll have your 6 when you need them to.


....what else?
 

operaman

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Hmmmmm....

1) MS3: "gee, sure wish someone would read my notes; wish they would actually count; why do they make us write these when nobody ever reads them anyhow?"
Intern: "damn I hope nobody ever actually reads these notes"

2) Not sure if anyone could have convinced me that I would learn so much while feeling like such an idiot.

3) It is really freeing to realize you no longer care about impressing people above you because your grade depends on it

4) At its core, intern year is ridiculously easy. No matter what happens, all you ever have to do is see the patient, call your senior, and write a note. Pretty much never wrong if you do those things. Just don't do them out of order. I seriously think I could take a group of 10 solid pre-meds and throw them into intern year with a short little few weeks of "boot camp" and have most of them get through the year without anyone realizing they never set foot inside a medical school. They might be terrible, but I bet they could learn to get by.

5) Sometimes you really will be the only doctor around and all those conversations that should be done by the attending will sometimes fall on you.

6) No matter how smart you are, at some point you will need help. It's not a matter of intellect or ability, it's a matter of time and obligations. Eventually there's a mismatch and you need to lean on your colleagues.
 
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Brahnold Bloodaxe

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Hmmmmm....
I seriously think I could take a group of 10 solid pre-meds and throw them into intern year with a short little few weeks of "boot camp" and have most of them get through the year without anyone realizing they never set foot inside a medical school. They might be terrible, but I bet they could learn to get by.
Would this actually stop being true at some point in residency, or could these direct-path interns get through all of residency and make competent surgeons? Is medical school really that useless, that you can acquire the relevant depth of medical knowledge just by monkey see monkey do with the odd didactic during 5 years of residency?
 
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LucidSplash

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He said he could get them through the year. Not residency. Just intern year. So no, you can't learn the relevant depth of necessary knowledge and skill without medical school.
Would this actually stop being true at some point in residency, or could these direct-path interns get through all of residency and make competent surgeons? Is medical school really that useless, that you can acquire the relevant depth of medical knowledge just by monkey see monkey do with the odd didactic during 5 years of residency?
 

ProfMD

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He said he could get them through the year. Not residency. Just intern year. So no, you can't learn the relevant depth of necessary knowledge and skill without medical school.
I think you could probably get some bright premeds to serve as beginning of the year interns, but they would not progress through the year the way an medical school graduate intern would. They would basically stay first-month interns forever.
 

Doctor-S

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....what else?
Pay attention, observe, appreciate, and learn from staff members, including nursing staff, because you're the wide-eyed newbie on the block who hasn't yet proven your knowledge, skills or expertise (or lack thereof) to anyone. Staff often know more about a patient than anyone else does because they see patients throughout the day and night. Be respectful to everyone. If you're stressed-out, sleep-deprived, or in a prickly mood, do not take it out on them. They might be feeling the same way.

To this day, I still bring boxes of candy to staff members: their dedication to health care and to patients has never been taken for granted.

Thank you.
 

dozitgetchahi

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I think you could probably get some bright premeds to serve as beginning of the year interns, but they would not progress through the year the way an medical school graduate intern would. They would basically stay first-month interns forever.
Yup.

This seems to be a somewhat popular idea in the surgical subspecialties...I heard an OB attending claiming something similar back in the day.

However, I doubt it would work. Wouldn't be long before you heard attendings saying 'god, these new interns suck! They don't know anything about medicine! Maybe we should have them go to some kind of school before they become residents...maybe they'd have a couple years of basic and clinical sciences to learn the fundamentals. Maybe then they'd have a couple years on the wards to get a basic idea of WTF to do. And maybe we'd call this thing (dun dun dun) MEDICAL SCHOOL, because it taught the basics of medicine. Yeah. I think that'd be a good idea.'
 

Wordead

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Hmmmmm....

1) MS3: "gee, sure wish someone would read my notes; wish they would actually count; why do they make us write these when nobody ever reads them anyhow?"
Intern: "damn I hope nobody ever actually reads these notes"

2) Not sure if anyone could have convinced me that I would learn so much while feeling like such an idiot.

3) It is really freeing to realize you no longer care about impressing people above you because your grade depends on it

4) At its core, intern year is ridiculously easy. No matter what happens, all you ever have to do is see the patient, call your senior, and write a note. Pretty much never wrong if you do those things. Just don't do them out of order. I seriously think I could take a group of 10 solid pre-meds and throw them into intern year with a short little few weeks of "boot camp" and have most of them get through the year without anyone realizing they never set foot inside a medical school. They might be terrible, but I bet they could learn to get by.

5) Sometimes you really will be the only doctor around and all those conversations that should be done by the attending will sometimes fall on you.

6) No matter how smart you are, at some point you will need help. It's not a matter of intellect or ability, it's a matter of time and obligations. Eventually there's a mismatch and you need to lean on your colleagues.
You must have some great interns. Both my ENT and and anesthesia interns have been....frustrating.
 

operaman

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Would this actually stop being true at some point in residency, or could these direct-path interns get through all of residency and make competent surgeons? Is medical school really that useless, that you can acquire the relevant depth of medical knowledge just by monkey see monkey do with the odd didactic during 5 years of residency?
Oh no doubt they would eventually get found out. And they probably wouldn't glean as much from their intern year as someone who has already been through medical school. I think the point when they got found out would vary considerably between fields, but it would almost certainly happen. Perhaps a small few could make it all the way and be decent at it of they put in enough effort. But intern year itself....yeah I could probably teach them enough in a few weeks to let them get by for the whole year.

Maybe this is more a surgical thing; I kinda think the non surgical terns would get caught first because they typically round and get pimped more often by attendings who would pick up on major knowledge gaps. Surgical terns could probably fly under the radar much longer since they have much less face time with the higher ups and could hide away banging out notes and other paperwork that doesn't require any actual knowledge.
 

Psai

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You must have some great interns. Both my ENT and and anesthesia interns have been....frustrating.
But ENT interns are some of the smartest people in the hospital. They got great step 1 scores, research, clinical grades, letters, etc. If they suck then what chance do I have?
 

Wordead

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But ENT interns are some of the smartest people in the hospital. They got great step 1 scores, research, clinical grades, letters, etc. If they suck then what chance do I have?
We probably suffer from too much ego. The ENT thinks she already knows how to do everything and just makes a huge mess that I have stay and clean up after a day in the OR.