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Discussion in 'Internship' started by entropy, Aug 16, 2002.
please share your thoughts......
mine: sleep as much as possible.....
Just a few thoughts off the top of my head:
COMFORTABLE shoes...these will save your life. Doesn't matter whether they're clogs or sneakers as long as they're built for standing.
Consider some compression stockings - ugly little buggers but they can make the difference btwn tired legs and legs that don't feel have bad. Added benefit of reducing problems with varicosities.
Eat when you can (sleep when you can, *&^&* when you can). Old advice.
Exercise when you can (as you've abused the above advice and filled up on cookies and ice cream from the cafeteria at 2:00 am). If there's an on-campus gym, join it - you may find some time to go over during the day.
Have some comforts of home in the call room - your own pillow, a favorite blanket, etc. can make it really nice when you do get some sleep.
ORGANIZATION = SUCCESS. You will NOT remember everything. If you Chief/senior resident asks you to do something and you don't understand what they are requesting/the lingo, ASK. Ask the nurse, ask the other interns, ask someone. If you don't do it, YOU'RE at fault, not the Chief. FOLLOW-UP on orders, tests, etc. Just because you've written an order doesn't mean it was done. Check on your patients before evening check-out rounds so that you know if they've been febrile, N/V, if they haven't peed, etc. You didn't get paged about those things? Doesn't matter. You SHOULD know. Do preemptive rounds - find out things BEFORE you're paged.
Ok...well that should be good for a start.
1. Know your basic anatomy to survive in the OR
2. Do not underestimate the 'Pain' of your patient. Imagine yourself in their shoes.
3. Know when to call for the CR and also most importantly, when not to call for the CR
4. Know the tricks of apple-polishing
Just remember that it will be the worst year of your life and the best year of your life all rolled up into one. You will cry like a baby at some point, and you'll also save a life at some point. You will rethink you're choice of career at many points, but in the end you'll be sure you're doing the right thing. You'll learn more than you ever thought possible, and function on an unimaginably small amount of sleep. When it's all done, you'll have matured beyond belief!
very inspiring and i'm not even doing surgery. thanks!
Can't say this enough...pick the RIGHT program for YOU...or you will be miserable. I looked at Large/small(based on number of residents), big city/small town/, community/university program, expensive living/resonable expenses, and other criteria. Love the program I'm in,unfortunately amputated a foot this week,but I had the experience of doing this procedure almost entirely on my own,plus a few other minor (?) surgeries (such as removing lump from breast, removing tissue from the butt due to spider bite, nasty little creatures...) house staff is great and I do very little scutwork, moving to q4 this week. Sleep deprival raises it's ugly head on somewhat of a weekly basis, but I don't seem to require lots of sleep, if I can get in 15 or 20 mins then I'm good for another round. Not much different from studying or doing all nighters at the Fraternity and going to class the next day. Having said all that, it's only been since June 21st. Probably don't have the full picture, but I love the experiences I am having in surgery. Great program...and I can still maintain my workout schedule, so far.
Have a good working relationship with your fellow interns and cover for each other.
Write down everything and put little check boxes next to things that you have done.
Be nice to everyone and apologize if you are having a rough day. On some days, you just can't seem to get everything together. Take a deep breath and keep plugging away. Go look at the patient if the nurse asks your to. Nurses are really good at letting you know when things are not going right. Always get up and look at any patient that you are cross covering before you give a phone order unless you really know the patient well.
Enjoy your OR time as an intern. In some programs, you just don't get too much and it helps to keep you focused when you can get into the OR. OR time is the only reason to do all of that floor work.
Load the boat! If you have a patient who is doing poorly, call your chief or your senior resident and let them know what is going on. As an intern, don't be afraid to seek advise on anything that looks like a patient going bad. Your more senior residents can be good mentors so seek their advise often about everything!
Get a good signout from the services that you are cross covering. Try to do the same when you are signing out. Try to anticipate what your patients might do in the middle of the night and let the cross cover know what to do. I also tell them to call me up to about 9pm if they just want to ask a question. When I was on vascular service, the cross covers had a difficult time because the wounds are ugly and they need to be able to ask questions after they have checked in on your patients.
Try to enjoy internship! Your learning curve is very steep and you are actually doing what you went to medical school to do, that is treat patients. You are going to feel like you are being dumped on but things get easier as the year wears on. I always try to stand back and think about what is going on with each of my patients.
As Kim said, anti-thrombolism stockings can make a world of difference. I can also say the same for drinking enough water (not Coca-cola) and putting your feet up when you get the chance. You can read with your feet up.
I try to read at least 30 minutes per dayeven if I am post call. I do a brisk walk and then read. It helps to keep your mind focused and ABSITE comes in January.
Good luck and enjoy the process!
Most of this has already been said, but if enough of us are saying the same things, then they probably hold true across various programs and situations.
I would reiterate Kim's advice re. double-checking to make sure your orders (AKA "suggestions") have actually been carried out, patients are peeing, etc. I call them anti-sabotage rounds. Plus it gives you a chance to fend off any 2am calls that could have been handled at 10pm had you only known about the problem. Since we don't pre-round at my program, it's very easy to get caught with your pants down on AM rounds if you haven't taken some serious CYA measures--I usually do a quick flyby on everyone before rounds anyway, just to CMA.
I'm at a very top-heavy program, which I pretty much knew going into it, but I came from a med school where the interns operated a ton. Adjusting to that has been pretty frustrating, so reminding myself why I chose to come here (amazing critical care experience, fantastic co-residents) has been critical to my sanity. That being said, again, I would reiterate the advice about choosing your program very, very carefully, asking lots of questions, knowing as much as possible about what you are getting into before you sign up, etc.
Be nice to nurses, but don't let them push you around--nip assault paging in the bud! Tactfully, of course. (I got paged 5 times in under 3 minutes by one nurse while I was in the CT scanner with a ventilated patient just because she wanted to give an extra 5mg oxycodone, which I had already written for incidentally, to a patient who was going home the next morning.) On the other hand, good nurses can save your @$$ and alert you to impending badness before the $h*# hits the fan.
Did I mention exercise? This is a total sanity saver, plus most interns seem to gain weight, which doesn't do much for sagging morale.
Ditto writing everything down--your memory will fail you at a critical juncture if you don't--and check things off as you complete the tasks.
Make sure you have a good working relationship, if not actual friendship with your co-interns. Inevitably, one of them will pull you out of a hole at some point, and you'll do the same for one of them. They're going through the same crap you are and are probably the only people you will have regular contact with who truly understand your frustrations. On the other hand, knowing who you can and can't trust for good cross-cover, sign out, etc. is crucial!!! (I've been on service for 2 months in a row with another intern who I have to do anti-sabotage rounds on--any order he writes is bound to be written wrong/harmful to patients/confusing to nurses=me getting paged at 3am to fix a catastrophe unless I go back and redo his work. It's a pain in the @$$, but he's a known liability. Fortunately, the CR's know and the word is moving up the ranks. )
Oops--this turned into a little bit of post-call griping mixed in with advice, but read between the kvetching and take the rest with a grain of salt.
this is great info.. i hope this gets archived so its around when i need it.
I agree with these two principle points.
I've learned quite a bit of technical information from nurses. Just to be broad, you may know that a patient needs TPN at a certain point, but because of your inexperience, the nurses can help you set it all up. I've had them double check my lines, med orders, etc. They're a great help...most of them anyway...
Regarding the co-interns...definitely don't step on their shoes. I had the occasion not too long ago when a co-intern did something that caused me to be the brunt of an attending's fury. I simply approached the other intern in a respectful manner and we spoke about it. We ended up laughing about it in the end.
I say that if you're on call and you're done with your work, do what you can to get the other guy out of the hospital ASAP. They'll eventually do it for you.
What comes around goes around.
bump. I start in a week and am feeling very nervous about it all.
Couple questions: when do most people take Step 3? When do you start studying for ABSITE? My schedule is frontloaded up until about December.
A nearly 11 year old post resurrected... Gotta be a record.
I can't believe it was I who was resurrected in that post!
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Do Family Medicine.
get Cope's book on the abdomen.
I can answer some of this. I remember the year vividly.
I'm still alive, obviously.
Incredible learning opportunity. We were fairly abused -- 100-120 hour weeks. Q2 call. But, that doesn't happen anymore.
I spent the whole year reading about gen surg. I barely read any ENT stuff-- wanted to be the most informed intern, so I started studying right away. I took the exam, and I remember it was hard. It didn't really apply to us, so I wasn't concerned about it.
Took step III during my PGY3 year -- research rotation.
Take a deep breath. Soak it all up. Work hard.
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