Things to do to shine in PGY-1

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letmeinwillya

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Hi all,
I matched, thanks to God Almighty! Obviously I have no clue how to be better prepared before starting PGY-1. I'm an US-IMG if that makes any difference.

Are there apps that I should have on my phone? Should I subscribe to any websites to get myself prepared before the start of the residency?

I'm looking for type of advice you wish you had when you started? Nothing is too trivial and I'm a clean slate..grateful to be here and learn from those who have been there.

Good luck to all who are SOAP'ing and my best wishes for those who matched!
 
Learn how to write a decent H&P and progress note from scratch that doesn't involve copy and pasting other people's crap and hiding it somewhere in 4 pages of lab values and pre-populated histories and med lists that are either irrelevant, outdated, or flatout wrong. In the beginning it's about surviving and you gotta do what you gotta do to go home on time, but if you can leave intern year having mastered concise and effective documentation, we all will be better for it.
 
It's extraordinarily difficult to "shine" as a PGY-1 due to the fact that you are not really prepared to be successful at your job by medical school. It's a rough feeling, but the veneer of competence you had as a MS4 is going to be stripped away. The advantage is that everyone expects you to be bad at your job early in internship. Get your senior involved if someone looks sick, don't make the same mistake twice, and never pass on information that isn't accurate. The phrase "I don't know but I'll find out" is infinitely more acceptable than fudging the facts and hoping to recover on the back end. Don't bring your ego to the game, it's not needed as an intern.
 
I am in a surgery related field so maybe this won't apply to you, but a mentor I really respect told me there are three rules for success in intern year. They are in this order:

1. Available - As corny as it sounds be a "yes-man"( or woman). If someone offers you a procedure, especially if they are willing to teach you through one you've never done, the answer should always be"I'll do it". Part of being available is time management and prioritizing. This skill will come with time.
2. Affable - try your best to always be polite and have a good attitude.
3. Ability - this comes over time. At the start everyone expects you to bring nothing to the table. But over time and with experience slowly you'll bring ability to the table.

Sounds kind of lame but I like it.
 
Be interested in learning from your attending and senior residents. Don't be in a hurry to get home. Your senior resident will want you to work efficiently and be a good team player. Your attending will want you to demonstrate an interest and improvement in medical knowledge.

It always helps to ask your senior resident and attending what their expectations and goals are for you.

And as others mention, show up early, be reliable, and say "yes."

Bonus points if you get to know your nurses on a first name basis and they come up and tell you what happened to your patient overnight or if there's anything they're worried about. I know we complain all the time about getting stupid pages, but remember that aside from the few bad apples (some of us are pretty bad apples as well), they are paging you because they're concerned about their patient and they think you need to know something, or they're not sure what to do and need guidance.

Also, it doesn't hurt to learn where the good bathrooms are--might be the only peace and quiet you get all day!
 
agranulocytosis said:
Show up on time, which for an intern, always means 5 minute early.
Click to expand...

Unless you were the two co-interns who both independently decided to show up 15 minutes before rounds because it was the residents day off and each thought the other would cover, which of course means one of your patients decided to crash about 30 minutes after you were supposed to pick up the pager from me. I am sorry for LOLing at you on my way out at 7:45 am as you were getting off the elevator.
 
letmeinwillya said:
Hi all,
I matched, thanks to God Almighty! Obviously I have no clue how to be better prepared before starting PGY-1. I'm an US-IMG if that makes any difference.

Are there apps that I should have on my phone? Should I subscribe to any websites to get myself prepared before the start of the residency?

I'm looking for type of advice you wish you had when you started? Nothing is too trivial and I'm a clean slate..grateful to be here and learn from those who have been there.

Good luck to all who are SOAP'ing and my best wishes for those who matched!
Click to expand...

1) Don't completely punt fourth year. Every Intern is unprepared but every Intern is not equally unprepared. Don't be the guy who hasn't held a stethoscope in 6 months.

2) Make sure you're good to go on day one. Be COMPLETELY moved in on day 1 of orientation, and be half an hour early for orientation.

3) Buy time. The right apartmet is the closest one you can get to the hospital. The right flight for your vacation week is the fastest one, not the cheapest one. The right food is cooked in a crockpot.

4) Set yourself up for sleep hygiene. You need to have a completely dark room to sleep in during the middle of the day. Have a bottle of melatonin by your bedside and use it every time you switch your schedule. Prioritize sleep over everything else.

5) Don't argue with ANYONE until you've rotated through all of your major services at least once. Not the attending, not the resident, and most of all not the nurse. If you 100% HAVE to argue with someone for patient safety purposes then you need to involve your senior.

6) Dress professionally. Hair needs to be a normal color and an acceptable length/cut for a corporate lawyer. Cover your tattoos, take out any piercings. If you're not in scrubs you need something that looks business like. Again think lawyer, not hipster.

7) Remember its a marathon: exercise daily, try to get at least 30 minutes of sunshine a day, prioritize sleep and try not to let your most important personal relationships completely atrophy

If you must read something my recommendations are:
1) Learn EKGs: start with Dubin, then do 5 problems on the website wavemaven every day
2) Learn ICU trivia: There is a podcast called ICU rounds by Dr. Jeffery guy that will make you sound much smarter than you are. One a day is great medicine
3) Learn basic radiology. learningradiology.com
 
You are an intern and therefore you are less than human. You are less than a dog for that matter. You are essentially a cat...a dumb cat, actually.

Do NOT ever undercut any of your other interns...and NEVER NEVER NEVER try to show up a senior resident or an attending. There is no faster way to be alienated from your piers and be labeled the "bad" resident by your senior residents and attendings. The truth is that you don't know anything and you will make mistakes...everyone does. But whether or not you are a scumbag will determine how patient your residents and attendings are with you...which means everything in the world regarding your survival.
 
Perrotfish said:
1) Don't completely punt fourth year. Every Intern is unprepared but every Intern is not equally unprepared. Don't be the guy who hasn't held a stethoscope in 6 months.

2) Make sure you're good to go on day one. Be COMPLETELY moved in on day 1 of orientation, and be half an hour early for orientation.

3) Buy time. The right apartmet is the closest one you can get to the hospital. The right flight for your vacation week is the fastest one, not the cheapest one. The right food is cooked in a crockpot.

4) Set yourself up for sleep hygiene. You need to have a completely dark room to sleep in during the middle of the day. Have a bottle of melatonin by your bedside and use it every time you switch your schedule. Prioritize sleep over everything else.

5) Don't argue with ANYONE until you've rotated through all of your major services at least once. Not the attending, not the resident, and most of all not the nurse. If you 100% HAVE to argue with someone for patient safety purposes then you need to involve your senior.

6) Dress professionally. Hair needs to be a normal color and an acceptable length/cut for a corporate lawyer. Cover your tattoos, take out any piercings. If you're not in scrubs you need something that looks business like. Again think lawyer, not hipster.

7) Remember its a marathon: exercise daily, try to get at least 30 minutes of sunshine a day, prioritize sleep and try not to let your most important personal relationships completely atrophy

If you must read something my recommendations are:
1) Learn EKGs: start with Dubin, then do 5 problems on the website wavemaven every day
2) Learn ICU trivia: There is a podcast called ICU rounds by Dr. Jeffery guy that will make you sound much smarter than you are. One a day is great medicine
3) Learn basic radiology. learningradiology.com
Click to expand...

Do you think it's okay if I live 25-30 minutes away from my residency in FM? My SO works an hour away so we were planning to live somewhere in the middle. Is it worth living apart for the benefit of living next to my hospital?
 
DrMeowMeow said:
Do you think it's okay if I live 25-30 minutes away from my residency in FM? My SO works an hour away so we were planning to live somewhere in the middle. Is it worth living apart for the benefit of living next to my hospital?
Click to expand...

I think that 25-30 minutes is doable. Of course, the closer the better...ideally within 20 minutes. I wouldn't live any further than 30 minutes...that borders on dangerous.

EDIT: You probably want to check with your program to ensure they don't have range limitations...many programs do. Keep in mind that most hospitals have call rooms...so living more than 20 minutes away but staying in the call room on call days may be an option. Work it out with your program.
 
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Download GoodRx (http://www.goodrx.com/) to your phone. Learn what meds are generic and cheap and give your poorer patients without health insurance printed free coupons so that they can afford their meds. You never want to discharge a patient from the hospital and give them a $200 antibiotic to go home with.
 
hello lady! said:
Download GoodRx (http://www.goodrx.com/) to your phone. Learn what meds are generic and cheap and give your poorer patients without health insurance printed free coupons so that they can afford their meds. You never want to discharge a patient from the hospital and give them a $200 antibiotic to go home with.
Click to expand...
needymeds.org is a great resource too...has practically every assistance program, rebate, coupon listed...and how to apply.
 
letmeinwillya said:
Hi all,
I matched, thanks to God Almighty! Obviously I have no clue how to be better prepared before starting PGY-1. I'm an US-IMG if that makes any difference.

Are there apps that I should have on my phone? Should I subscribe to any websites to get myself prepared before the start of the residency?

I'm looking for type of advice you wish you had when you started? Nothing is too trivial and I'm a clean slate..grateful to be here and learn from those who have been there.

Good luck to all who are SOAP'ing and my best wishes for those who matched!
Click to expand...

Epocrates is nice if you have full subscription for all med things.

Learn how to do write morning notes and do orders quickly so that you don't have to wake up at 4:30 every day. Especially if you have end up having to cover your whole service. Sometimes the biggest troubles can be just learning how to do orders and write notes quickly or efficiently.

Have your discharge summaries pending on your people ASAP if you know they are going home in the next few days or before you will be off service.

You will eventually learn your attendings' styles and how much info they want presented etc. Sometimes the more info you give the more trouble you can get in.

Disclaimer: This is from somebody who just did a medicine prelim. Good luck.
 
Wow. This thread is definitely more important than USMLE Step1 !! Thanks to all inputs.
 
For PGY-1 and beyond, you are a worker, not a student, so while clinical knowledge is important so are general work skills. I've found what separates interns/residents from each other are their work habits and people skills, everyone's clinical knowledge is more or less the same at this point. Be a good worker, stay organized, be diligent and take ownership and pride in your work, and be as efficient as possible. Be a good person, a team player, considerate, respectful, professional and just well liked overall. If you really want to shine, learn to think ahead and learn how to read people (both co-workers and patients) and have situational awareness.
 
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wow! that's some great advice. I think this thread has the potential of becoming a very actionable guide to anyone about to start PGY-1. I appreciate your input as this is is new for me and being an IMG, lot of it is news to me not the general professional aspects but the specific tools, websites and apps that may be commonly known to AMGs.

Are there any books that I should plan on reading before or during the residency? I have had rather long break after completing med school so anything that can give me crash course of sorts is much appreciated.
 
fasteddie911 said:
For PGY-1 and beyond, you are a worker, not a student, so while clinical knowledge is important so are general work skills. I've found what separates interns/residents are their work habits and people skills, clinical knowledge is more or less the same at this point. Be a good worker, stay organized, be diligent and take ownership and pride in your work, and be as efficient as possible. Be a good person, a team player, considerate, respectful, professional and just well liked overall. If you really want to shine, learn to think ahead and learn how to read people (both co-workers and patients) and have situational awareness.
Click to expand...

Clinical knowledge is NOT more or less the same. So many residents fall prey to this line of thinking. They learn what usually happens in a given situation, and regurgitate again and again.

Some interns, residents, and attendings are just more clever than others. Many just get by.

Some attendings are not that bright, or maybe they are, and they havn't read anything new in 10 years.

Everything you are saying is important, but to discount the continual acquisition of clinical knowledge is a mistake.
 
HooliganSnail said:
Clinical knowledge is NOT more or less the same. So many residents fall prey to this line of thinking. They learn what usually happens in a given situation, and regurgitate again and again.

Some interns, residents, and attendings are just more clever than others. Many just get by.

Some attendings are not that bright, or maybe they are, and they havn't read anything new in 10 years.

Everything you are saying is important, but to discount the continual acquisition of clinical knowledge is a mistake.
Click to expand...

I'm not sure where I discounted continuous studying, I figured that's a given and I'm sure the OP knows that.
 
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Just don't, for God's sake, be a complainer even if the job sucks (it will sometimes). I'm an intern and there are several whiners in my class--I'm not talking just bitching among ourselves at happy hour, but legit complaining to attendings and senior residents that they work us too much. No quicker way to single yourself out as an ass. And be on time.
 
First of all, there is no "shining" as an intern. There's just differing levels of pain and humiliation. Create a reasonable goal for yourself, which isn't shining special snowflake, but surviving.

http://forums.studentdoctor.net/thr...sier-or-more-difficult.1156652/#post-16827967
is probably my best most organized post on the topic of how to be good
http://forums.studentdoctor.net/thr...sier-or-more-difficult.1156652/#post-17277146
I also list how to be baaaad

http://forums.studentdoctor.net/threads/comfortable-shoes-for-wards.1135824/#post-16672564
For shoes, this is "step one" of your success
This goes with my advice, always buy a good bed, and a good pair of shoes, because if you're not in one you're in the other.

http://forums.studentdoctor.net/threads/directions-out-of-burn-out-central.1198973/#post-17736204
more on basic self care

http://forums.studentdoctor.net/threads/creating-rounds-list-on-epic.1150544/#post-16708114
A *detailed* guide on setting up Epic if that is your system, but can be easily adapted as a system for collecting prerounding data in the am

http://forums.studentdoctor.net/threads/stressed-out-already.1147775/#post-16694851
some basic tips, below that is a post on what your job really is

http://forums.studentdoctor.net/threads/stressed-out-already.1147775/#post-16711328
same thread, post that is a *detailed* guide on organizing your to-do list and notes that you carry for presenting in your pocket
the pharmacist is your friend, get good at typing and holding a phone to your shoulder at the same time (depending on your system you can bring a plug in headset in your pocket to really go hands free!)

http://forums.studentdoctor.net/thr...eaching-at-new-program.1149092/#post-16696984
thoughts on approaching the program about problems

http://forums.studentdoctor.net/thr...eaching-at-new-program.1149092/#post-16766795
more on efficiency, same thread

http://forums.studentdoctor.net/threads/how-does-one-fail-a-rotation.1154493/#post-16780399
more on efficiency, and asking for feedback, what your job as an intern actually is

http://forums.studentdoctor.net/thr...pts-and-eliciting-info.1154447/#post-16778229
taking a faster history, railroading your patients in conversation and smoothing their feathers

http://forums.studentdoctor.net/threads/what-interns-should-know-day-1.1130633/#post-16691602
what to know, what to carry, post below the immediate one linked is my list of useful topics to have a handle on for clinic and wards

http://forums.studentdoctor.net/thr...ks-charts-food-and-ect.1127144/#post-16691626
more on what to have with you, custom pockets

http://forums.studentdoctor.net/threads/night-float-weekend.1147541/#post-16691527
Some ideas about night float - I recommended the book from the EM Resident Association "Top Clinical Problems in EM" for night float, ICU, & EM rotation
especially as an intern, my first concern was not missing emergencies!

http://forums.studentdoctor.net/threads/what-do-you-log-as-work-hours.1173435/page-2#post-17244724
why you must not only lie about work hours, but how to not get caught in the EHR doing so

http://forums.studentdoctor.net/threads/resident-friend-joked-about-suicide.1116935/#post-16240366
Setting up medical care, particularly mental health, for yourself NOW

http://forums.studentdoctor.net/threads/alcoholics-anonymous-in-residency.1138505/#post-16691390
If you have any substance abuse issues that need looked after. There's also a section in there where I talk about disabilities and how they can mesh with your program (given how common substance abuse and chronic pain our in our cohort I thought it worth adding here)

http://forums.studentdoctor.net/thr...ability-accommodations.1179885/#post-17333196
I wrote this guide for a disabled med student, but the lessons learned here are useful for residents with disabilities as well

http://forums.studentdoctor.net/threads/disability-insurance-in-residency.1136662/#post-17270705
definitely think about disability insurance! if it happens to you, you'll likely wish you were dead instead depending how much life insurance for your family you bought unless you bought enough disability insurance

http://forums.studentdoctor.net/thr...quit-intern-year.1150554/page-2#post-16769635
thoughts about maintaining a professional facade

http://forums.studentdoctor.net/thr...under-anesthesia.1145407/page-2#post-16691284
watch your mouth at all times

http://forums.studentdoctor.net/threads/feeling-overwhelmed.1174509/#post-17244199
work place topics to avoid

http://forums.studentdoctor.net/thr...ital-environment.1144219/page-2#post-16682830
my 3 rules for how to get along better ie kiss ass better is buried here

http://forums.studentdoctor.net/thr...e-format-for-residents.1147202/#post-16691188
Now that you have a nifty title, how should people address you?

http://forums.studentdoctor.net/threads/discussing-code-status.1143485/#post-16705243
http://forums.studentdoctor.net/thr...reases-quality-of-life.1155602/#post-16807604
My thoughts on code discussions & setting goals of care...
"annoying" time consuming "chores" shunted to interns in some institutions.... and arguably where you have the *most* impact on patients' sense of well being

http://forums.studentdoctor.net/threads/how-to-run-a-code.1182485/#post-17401848
not just on running a code but... closed loop communication! that concept will spare you headaches

http://forums.studentdoctor.net/thr...stay-alert-on-test-day.1154625/#post-16808078
my test tips and tricks.... the ITE matters more than you will be led to believe, and may be helpful for step 3... don't **** those off

http://forums.studentdoctor.net/thr...ion-in-your-experience.1047791/#post-17528742
a few pearls on nausea, anti-nausea meds, anti-emetics, delirium

Be as CYA saavy as @Law2Doc . He is a shark and just the sort of mindset you will be dealing with and needing to impress in many of your attendings/admin. Everything that @Perrotfish ever said, just remember almost none of your attendings will be as cool as him. I think @Doctor4Life1769 gives great advice especially on politics. @aProgDirector gives great level advice but I wouldn't go in expecting your PD to be as reasonable as they are. Check out their past posts on stuff to learn more about how things work.

My personal mantra, is that your job is to be safe, fast, and pleasant, in that order. Also, you are a notemonkey making love to a pager. Keep your head down and don't make waves.

As I say in my posts above, get as much admin crap out of the way before you start, learn your EHR if you can, gather resources to make your life easier (white coat pocket cards, USEFUL review books, and phone apps), and as others said, live as close to the hospital as you can, get all your affairs settled (dental work, car repairs, new tires, rental car benefit on your auto insurance, disability insurance, preventative care, IUD, dry cleaning, moving, and finding all the stuff you need in your new town like a new doc, drycleaner's, auto mechanic, etc) because you won't have time later.
 
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Thank you for the replies, really appreciate your time. Wow! a treasure trove of advice..soaking it all in.

The senior residents at my program recommended Intern guide at https://onlinemeded.org/ , it's concise and to the point. I already bought the physical book.

It also has a premium subscription option that allows you to access cases with notes, MCQs etc.. Does anyone has experience with the premium option?
 
Good advice here.
Make sure you get enough sleep.
Iron your clothes when not in scrubs (if in scrubs you can usually toss the back in the dryer).
Wash your white coat.
Shower daily and use deodorant.
Be early.
PMA (positive mental attitude).
Do not expect your fellow residents to change their life to accommodate your children or husband's schedules.
Read some every day.
Be nice and descent person to the nurses.
Do not make up things about your patients. If you do not know, say you do not.
Learn the Walmart $4 list or download the PDF along with your state's Medicaid drug formulary.
If brand name is needed for a cash paying patient, the drug website will have patient assistance forms for the to fill out. A lot of the coupons or co-pay cards require commercial insurance to use.




Sent from my iPhone using SDN mobile app
 
Agree with the above, to add in a few things that I appreciate:

1) Replete electrolytes without me constantly having to double check that the potassium was repleted
2) Put in orders for PT, the appropriate diet, etc
3) Double check inpatient meds and make sure obvious things like heparin DVT ppx isn't right there with their home coumadin
4) Read more into the patient's PMH if you have the time so the attending can't make you look like you don't know what's going on with the patient
5) The REALLY efficient interns have their notes mostly done by rounds and it isn't a completely copy and pasted document from the H&P. The purpose of a progress note is for someone else to read it and understand why we are doing what we are doing.
6) Once you get more into intern year and are capable and comfortable with the above, come up with your own plan and discuss with the senior resident. This prepares you well for being a PGY-2

Expect to make a few mistakes -- no one is perfect and no one expects you to be (though it doesn't mean they won't chastise you). Try to learn and accept feedback, learn to differentiate instructive criticism from personal animosity. If people keep telling you the same thing over and over, that means it is something you need to work on, not "everyone else's problem"
 
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