transitioning from 3rd year to sub-i? is it hard?

[abc56]

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im starting to feel like i'll be unprepared for 4th year. i know the whole "goal" of 3rd year is to learn how to function as a sub-i, and the goal of sub-i is to learn how to be an intern

i just feel like, yes, i do understand the concepts behind when/why we do things (like, when to do blood or urine cx, u/a, cxr, when to order abx, when to order fluids, etc) but everything seems so subjective and different everywhere i go. i feel like i'm going to start my sub-i and have no idea which orders to write, which tests i need, which fluids to start, when to stop them, which abx to choose, how much insulin, nph, etc things people need. the list goes on and on. i dont want to be that intern that orders every test and wastes everyones $$.

is this normal? should i be more confident at this point during 3rd year? i started with medicine and knew nothing. i wish i could do medicine again before sub-i so i could have more practice!!

please tell me that i have not gone through 6 months and made hardly any progress! i do feel that ive learned a vast amount, but get the jitters when it comes to not having an intern to work with/look over my shoulder

thanks a bunch!

 

[Tired]

is this normal? should i be more confident at this point during 3rd year? i started with medicine and knew nothing. i wish i could do medicine again before sub-i so i could have more practice!!

please tell me that i have not gone through 6 months and made hardly any progress! i do feel that ive learned a vast amount, but get the jitters when it comes to not having an intern to work with/look over my shoulder

Yes, it's normal, and yes, people will still be looking over your shoulder. Go with what you know, and adjust your orders based on the feedback you get. If you go with what you know, even people who practice differently will still know where you are coming from, and not come down on you for it.

For example, during one of my 4th year rotations, I wrote an order for Zithromax for an outpatient with community-acquired pneumonia. The attending changed it to levofloxacin. When he asked me why I chose the macrolide, I replied that it was the recommended antibiotic in the practice guidelines. He commended me on my knowledge, and said levo was just his preference.

In other words, my experience has been that it is more important that you can justify your orders, than it is that you practice exactly how the various attendings and residents prefer.

 

[abc56]

thank you, that is reassuring

i do feel proud of myself for understanding when and why we should do certain things. the little details (how much, how long etc) are still what get me. i guess a lot of this is personal preference


🙂

 

[Tired]

the little details (how much, how long etc) are still what get me. i guess a lot of this is personal preference

My favorite question to ask on rounds was, "So what is our endpoint for treatment?" Many times I saw residents initiate empiric antibiotics without taking cultures, or start empiric anticoagulants pending ultrasound studies, etc. Asking about endpoints frames the discussion in terms of outcome, and shows that you are anticipating two or three steps down the road. This was usually well-received.

Good luck to you, I'm sure it will be fine.

 

[jdh71]

im starting to feel like i'll be unprepared for 4th year. i know the whole "goal" of 3rd year is to learn how to function as a sub-i, and the goal of sub-i is to learn how to be an intern

i just feel like, yes, i do understand the concepts behind when/why we do things (like, when to do blood or urine cx, u/a, cxr, when to order abx, when to order fluids, etc) but everything seems so subjective and different everywhere i go. i feel like i'm going to start my sub-i and have no idea which orders to write, which tests i need, which fluids to start, when to stop them, which abx to choose, how much insulin, nph, etc things people need. the list goes on and on. i dont want to be that intern that orders every test and wastes everyones $$.

is this normal? should i be more confident at this point during 3rd year? i started with medicine and knew nothing. i wish i could do medicine again before sub-i so i could have more practice!!

please tell me that i have not gone through 6 months and made hardly any progress! i do feel that ive learned a vast amount, but get the jitters when it comes to not having an intern to work with/look over my shoulder

thanks a bunch!

Basically . . . everything you need to know, you know . . . you just may not know it yet. When you hit your sub-i all the third year responsibilities will be second nature and picking up new sub-i type of responsibilities will be much like learning your third year responsibilities for the first time. You will make mistakes. You will not know everything. That's why there is a whole team. Sub-i is fun. So have fun. If a phone call or page needs to be made - make it - get used to talking to different services, especially following consults (is it just me or if you don't bug cardiology, they may never show up?). F/u any important lab on any team patient, even if it is not your own, especially on rounds. If know know the team is waiting for a downward trending Creatinine on a floor patient before d/c, sneak away and check the lab for the team if the lab was not in prior to rounds (your third years will probably not be that on top of things, because they are learning too). Stuff like that. You'll pick it up and you'll have fun.

Sub-I should be the leat of your worries.