Tips for New FM Residents

[Toastayy]

Hello,
I will be starting my FM residency come July 1st with all the new interns. My non-finalized schedule shows I will be starting OB first then AMB/Peds then Surg. Can you guys offer any tips in terms of starting a new rotation, how you move from rotation to rotation (similar to med school but more at stake) and how to go about being/seeming competent.

I haven't done anything resembling OB since my 3rd year almost 1.5 years ago, and at that time was not required to do much in terms of note writing or even seeing patients. How do I go about learning these things and seem incompetent? The rotations are unfortunately only a month long so by the time I finally figure out how things work, i'll be moving on to the next thing.

Thanks

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[TheOther]

Following. Need any tips I can get too.

I’m with you, fam.

 

[Lurts]

As an incoming chief speaking to what I hope our class of incoming interns do:

1) work hard
2) be happy to see patients
3) don’t complain
4) be efficient

Notice none of those say that you need to know everything the textbook says about a particular disease process. A good and willing work ethic will get you everything you need next year. The medical knowledge will come as you go along.

Residency is way more fun than medical school, make sure you enjoy it!

 

[AMEHigh]

Yep agree with the above.
Once I started residency I realized we aren’t expected to know everything. It’s refreshing to see attendings still looking up things and having a curiousity for learning.

So just work hard, act interested and do your best to learn something new everyday. Family med is generally a friendly speciality so there will be people there that have your back so don’t be afraid to ask questions. Of course by 2nd and 3rd years there are expectations of clinical knowledge, but that knowledge will come.

 

[Toastayy]

Thanks for the input! I guess i'm nervous about starting on L&D with not much experience. Your comments have helped!

 

[Keona]

Comprehensive obstetrics and gynecology by Thomas Zheng. It’s a small pocket sized book that walks you through what to do and labs recommended at various trimesters, common knot ties. I’m an attending now who rarely sees ob and I still use it to refer to. I bought it when another intern recommended it to me.

 

[workoutDO]

watch all of House MD and memorize every esoteric dz on the show inside out and know how to draw and run any labs, bone marrow biopsies, Schilling's test, gastric emptying test, no one ever said.

But really, if you want a big jump in FM clinic, memorize the USPSTF guidelines cold and you will be ahead of the class by at least a few months, maybe even 1 year.

 

[deleted87716]

watch all of House MD and memorize every esoteric dz on the show inside out

 

[whateverdiamond]

watch all of House MD and memorize every esoteric dz on the show inside out and know how to draw and run any labs, bone marrow biopsies, Schilling's test, gastric emptying test, no one ever said.

But really, if you want a big jump in FM clinic, memorize the USPSTF guidelines cold and you will be ahead of the class by at least a few months, maybe even 1 year.

Is there a good website or resource to learn all those guidelines? Thanks in advance!

 

[DoubleBogey]

first day - know where the bathroom and cafeteria are

first 6 months:
Pick up management of acute issues in the hospital- SOB, chest pain, fever/rigors, hyperkalemia, hyponatremia, hypertension, hypotension (which can be applied to outpt)

last 6 months:
Refine management of chronic conditions(guideline based therapies)- CHF, CAD, HTN, DM, COPD, acute and chronic pain, HLD, preventive medicine, dermatologic conditions

As you progress through intern year you will refine efficiency with the EMR, rounding, answering pages, doing admissions

2nd/3rd year is strengthening the above and working on the uncommon conditions, what interests you have in certain areas of medicine, procedures, managing a team, working with medical students, research if that’s your thing

Show up, be humble, let your senior know when something is wrong (declining patient, delay in discharge etc) and there is always something to be learned with every patient contact/touch

Good luck!

 

[sunshinefl]

Is there a good website or resource to learn all those guidelines? Thanks in advance!

Website:

Search Results | United States Preventive Services Taskforce

www.uspreventiveservicestaskforce.org

App:

AHRQ ePSS by U.S. Department of Health & Human Services-AHRQ
‎AHRQ ePSS

 

[Atlas Shrugged]

let your senior know when something is wrong (declining patient, delay in discharge etc)

Good luck!

Initially it is better to over report than under. Even if you think something is obvious, let your senior resident know.

Asking to replete electrolytes seems dumb, but there are cases where you should not (notably people that are dialysis dependent etc.).

In the first six months an intern should probably not put in any orders without clearing it with the senior resident first. You must prove you are safe above all else.

 

[FrustratedFamDoc]

Advice I received as a rising PGY2 from one of my attendings was assume that my intern was actively trying to kill all my patients and I'd be ok.

The knowledge expectation for interns is pretty basic. The bigger part is always attitude, and it is the seemingly simple things that are impossible to some people. Show up EARLY EVERY MORNING. Don't be lazy and own your responsibilities. Be friendly. Be open to correction. Don't argue with your seniors. Try to not make the same mistake twice and own your mistakes.

Being a good worker with average skills is FAR better than being the smartest jerk in the program. Programs are looking for moldable clay, not stone.

Common things are common. Always consider the horse before you call something a zebra.

 

[Fatalis]

Hello,
I will be starting my FM residency come July 1st with all the new interns. My non-finalized schedule shows I will be starting OB first then AMB/Peds then Surg. Can you guys offer any tips in terms of starting a new rotation, how you move from rotation to rotation (similar to med school but more at stake) and how to go about being/seeming competent.

I haven't done anything resembling OB since my 3rd year almost 1.5 years ago, and at that time was not required to do much in terms of note writing or even seeing patients. How do I go about learning these things and seem incompetent? The rotations are unfortunately only a month long so by the time I finally figure out how things work, i'll be moving on to the next thing.

Thanks

was in the same boat as you regarding OB/GYN, dont worry as your residents and attendings assume you dont know much. As was said before, just be willing to work hard and you will be fine

 

[The Creeper]

As an incoming chief speaking to what I hope our class of incoming interns do:

1) work hard
2) be happy to see patients
3) don’t complain
4) be efficient

Notice none of those say that you need to know everything the textbook says about a particular disease process. A good and willing work ethic will get you everything you need next year. The medical knowledge will come as you go along.

Residency is way more fun than medical school, make sure you enjoy it!

first day - know where the bathroom and cafeteria are

first 6 months:
Pick up management of acute issues in the hospital- SOB, chest pain, fever/rigors, hyperkalemia, hyponatremia, hypertension, hypotension (which can be applied to outpt)

last 6 months:
Refine management of chronic conditions(guideline based therapies)- CHF, CAD, HTN, DM, COPD, acute and chronic pain, HLD, preventive medicine, dermatologic conditions

As you progress through intern year you will refine efficiency with the EMR, rounding, answering pages, doing admissions

2nd/3rd year is strengthening the above and working on the uncommon conditions, what interests you have in certain areas of medicine, procedures, managing a team, working with medical students, research if that’s your thing

Show up, be humble, let your senior know when something is wrong (declining patient, delay in discharge etc) and there is always something to be learned with every patient contact/touch

Good luck!

Advice I received as a rising PGY2 from one of my attendings was assume that my intern was actively trying to kill all my patients and I'd be ok.

The knowledge expectation for interns is pretty basic. The bigger part is always attitude, and it is the seemingly simple things that are impossible to some people. Show up EARLY EVERY MORNING. Don't be lazy and own your responsibilities. Be friendly. Be open to correction. Don't argue with your seniors. Try to not make the same mistake twice and own your mistakes.

Being a good worker with average skills is FAR better than being the smartest jerk in the program. Programs are looking for moldable clay, not stone.

Common things are common. Always consider the horse before you call something a zebra.

God, I love all of these recommendations. I second them.
I lived by "if you're on time, then you're late. I hated when I was on the wards rounding as a chief before my interns showed up. Work hard, be humble. Everything else will come with time and effort.

You are almost 2 weeks in now, hope it is all working out. You will have bad days, remember to keep your head up and think about how far you have come. Pick up your co-residents when they are having a tough time. Keep working hard and the light at the end of the tunnel eventually comes.

 

[Toastayy]

God, I love all of these recommendations. I second them.
I lived by "if you're on time, then you're late. I hated when I was on the wards rounding as a chief before my interns showed up. Work hard, be humble. Everything else will come with time and effort.

You are almost 2 weeks in now, hope it is all working out. You will have bad days, remember to keep your head up and think about how far you have come. Pick up your co-residents when they are having a tough time. Keep working hard and the light at the end of the tunnel eventually comes.

Thanks for checking in. It's working out, however will be much scarier now since essentially interns are left "alone" during the days to handle the floors. Of course, we report to the attending during those days, but it's much scarier without a senior checking to make sure what i'm doing makes sense. I have my first 24 tomorrow alone so we'll see how it goes. Highly stressed, but kind of loving it.

 

[FrustratedFamDoc]

Thanks for checking in. It's working out, however will be much scarier now since essentially interns are left "alone" during the days to handle the floors. Of course, we report to the attending during those days, but it's much scarier without a senior checking to make sure what i'm doing makes sense. I have my first 24 tomorrow alone so we'll see how it goes. Highly stressed, but kind of loving it.

Promise you, you are anything but alone and unsupervised. There are numerous calls behind your back and checking of your orders that you have no awareness of. If the floor nurse has ANY apprehension, your senior is getting called.

 

[brianmartin]

you'll be fine. Nobody expects you to be an expert on day 1. Just see patients, be humble, look everything up, ask questions, and yes it will feel like as soon as you figure out whats going on, you are off service and on to a new rotation. Don't ever say you did something you didn't do. Attendings will be asking you left and right "did you remember to do this? What about this?" The correct answer is "Sorry I didn't check that, I will"..."sorry I didn't ask the patient about that, I will go ask them." That's really it. It's supposed to be fun. Just enjoy what you are doing and do your best to read and absorb like a sponge. And remember to have a sense of humor and smile and laugh with people. Where a lot of people run into trouble is feeling like you have to know everything and seem like you know everything. You don't, and you can't, and we all know that.
You'll be surprised how quick you pick things up. When YOU are the one seeing the patients, writing the notes, it's amazing how much responsibility you will feel. And responsibility is not a burden. You will learn to appreciate and like the responsibility, and also know when you need to call someone for help.

 

[Atlas Shrugged]

you'll be fine. Nobody expects you to be an expert on day 1. Just see patients, be humble, look everything up, ask questions, and yes it will feel like as soon as you figure out whats going on, you are off service and on to a new rotation. Don't ever say you did something you didn't do. Attendings will be asking you left and right "did you remember to do this? What about this?" The correct answer is "Sorry I didn't check that, I will"..."sorry I didn't ask the patient about that, I will go ask them." That's really it. It's supposed to be fun. Just enjoy what you are doing and do your best to read and absorb like a sponge. And remember to have a sense of humor and smile and laugh with people. Where a lot of people run into trouble is feeling like you have to know everything and seem like you know everything. You don't, and you can't, and we all know that.
You'll be surprised how quick you pick things up. When YOU are the one seeing the patients, writing the notes, it's amazing how much responsibility you will feel. And responsibility is not a burden. You will learn to appreciate and like the responsibility, and also know when you need to call someone for help.

There are few rules of intern year. NEVER LIE is rule number one. People get hurt this way.

Quick example for labor and delivery: do not lie that you ultrasound and made sure a baby was cephalic presentation. Breech presentation is a big deal.

Seemingly small things can have big impacts, and your seniors/attendings cannot necessarily check ever single thing that you do. There is trust.

Don’t break it.

 

[Bacchus]

Thanks for checking in. It's working out, however will be much scarier now since essentially interns are left "alone" during the days to handle the floors. Of course, we report to the attending during those days, but it's much scarier without a senior checking to make sure what i'm doing makes sense. I have my first 24 tomorrow alone so we'll see how it goes. Highly stressed, but kind of loving it.

Where the heck is the senior?!

 

[deleted997790]

Not sure this will help this far into your first month, but...

1) as an intern, your a data gatherer. Gather the data perfectly. Learn how to write good HPI’s and give good presentations.

2) learn how to look up info quickly. This is the single most important skill an intern can learn (or maybe equivalent to being able to recognize which patients need to be transferred to a higher level of care). Uptodate, medscape, etc. Choose one and master it - know how to look up info quickly.

3) always have an assessment/plan, even if it’s not correct. Nothing more annoying than having an intern say “what do I do next” 1000 times a day. Try something like “hey my patient has new onset tachycardia now, I looked it up and it seems like the next appropriate step is to get an EKG”?...heck...even “i’m going to throw ice at him/her” is better than “what should I do next”. Always be ready to present a plan.

4) Relax. You’ll see everything 100 times during residency and will learn management of the bread and butter cases pretty easily from seeing/participating in cases.

 

[The Creeper]

Hi all,

Any suggestions for the applicants of this year?
What is the usual deadline for the application?

Where the heck is the senior?!

I also agree. I'm fairly certain that ACGME requires direct supervision of interns (for maybe the first 6 months?). Not quite sure how they are getting away with an intern on a solo 24 hour shift. In any event, godspeed and call your senior/supervisor for everything.

 

[Bacchus]

We didn't let our first years act independently until 2nd year, let alone towards the beginning of first year. I'm not sure of the inpatient rules, but outpatient you need direct supervision your first 6 months regardless of how benign the office visit is.

I question the program environment and successes if the interns are running amok by themselves.

 

[jm192]

I was on L&D very early in my intern year. Rely on your nurses. They look at monitoring strips all day every day. The OB often decides to come in or not based on what his experienced nurses are telling him. Respect them and ask for their help, and you'll look like a star.

I think that translates to other areas of the hospital as well. Pharmacists can help you a ton too.

I think the best thing to say is just be humble and be willing to ask for help.