In our program they had us do 3 mo of straight IM (just like any IM PGY I intern, with the same responsibilities and case load), plus 1 mo. of ER medicine (like real EM, alongside EM, IM, and FP PGY I interns, and alongside EM residents; this was the most fun of all, but it was so short that I doubt I learned too much useful stuff; all the trauma cases went to Surgery PGY I's plus EM PGY'II's, on a "separate track", while the PGY I's FP's, IM's and Psychs who rotated through ER were assigned mostly "smaller" stuff-that one would probably tend to see more in an Urgent Care Clinic type setting, like dealing with narcotic seekers or suturing small lacerations, or, in more "dramatic" cases which warranted admission, begging around for someone from "inpatient" IM to write admission orders and accept the patient; one of our attendings I mostly hung around with, whenever he was around, was doubly boarded in Psych. AND ER, and he was really a very good teacher!). Then we did 2 months of Neuro, which were very easy but very boring too. I don't think I really learned too much on that rotation because of the way it was set up; PGY I's who were not categorical Neuro's mostly did scut H&P's and wrote Rx. for seizure pts. (the few select ones who were categorical Neuros always got all the attention from the senior residents and the attending; the rest of us were considered too dumb to understand neuro anyway, so they never expected anything from us, neither did they teach anything; they barely spoke 2 words to PGY I's who were not categorical Neuros during that rotation!). I learned more Neuro during my Geropsych. rotation as a Psych. resident than I ever learned on Neuro! (The spinal taps I already knew how to do from Internal Medicine!)
From my point of view, IM was pretty scary to start with, right in July, but since everybody else was just as "new" and kind of scared, I guess all PGY I's felt "in the same boat" to a certain degree. In retrospect, I think that the quality of the experience depends A LOT on the immediately hierarchical supervising senior, the PGY II. Mine, as I remember my perception from back then, was some sort of aloof slave-driver, who kept telling me to do stuff, but never showed how to do anything. So I sort of ended up asking around a lot, from whoever else I could grab, especially in the first 4 weeks. I was lucky to have a very nice/approacheable attending, a great co-intern IM PGY-I, and really good nurses ("old horses" with lots of experience in mentoring anxious new PGY I's). None were EVER annoyed by my asking questions, even if it was completely inane questions like "how and whom do you call for an Infectious disease consult?". By the end of the rotation I was already so sleep deprived and had gotten into the routine of things, that I forgot to be "scared" of anything, and I was almost functioning on auto-pilot. The "big" stuff that I really learned which I don't think I ever did before myself, although I had seen them done as Med Student, were how to do taps (pleural, peritoneal, and lumbar). They are really easy to do, although the first one you do yourself, is probably scary. By the end of the rotation I was teaching the MS's who were tagging along me and the other PGY I how to do them themselves, and they were really happy about it. I remember wishing I had learned to do them myself during Med School, istead of PGY I. The rest of the time I remember running around a lot, doing lots of blood gasses, labeling them, and running with them myself on ice to the blood gas lab, running to the x-ray room to get older x-rays to compare with the new ones, repeatedly begging the surgery residents to come put in central lines (they didn't allow us to do it in that program, they were supposed to be done by the surgery or anesthesia residents, and they always hated it, and always kept nagging us why don't we do it ourselves!).
I also remember being paged to call my first "death" (in my panic, I first told the nurse "why don't you call the resident to call it?"), and she said..."well, it's usually the intern on call that's supposed to do it"), and subsequently being called by medical records to fill my first death certificate. I was really freaking out over that one too; the med records lady said: you called it, you have to write it! I told the med records lady that I had never filled or signed a death certificate, and shouldn't we call instead an "experienced forensic pathologist expert" who would SURELY KNOW WHAT to write better than I did (LOL!), and she smiled and said that you don't usually bother to call a pathologist because this wasn't a case that had been autopsied, and then showed me how to fill that certificate.
Boy...what memories! It was fun, you know...but it surely was exhausting. It was a university based program, so you could always find someone to ask something without them getting annoyed too much. I remember learning a LOT from the consultants that we called on our patients, like the Infectious Disease fellows, or the Rheumatology fellows; some of the G-i fellows were nice too; the Radiology and Pathology attendings were very cool and extremely approacheable too, if you happened to pass by their office and say hello, and ask some questions while you were either grabbing an x-ray or dropping by some sort of lab specimen of some sort, or even if you called them on the phone. The hospital pharmacists too, I remember, if I ever called them on the phone in some sort of frantic panic, were always ready to answer the most inane questions like "does this medication come in this dose" without ever telling me to "look it up" myself. So...all in all...I think I was lucky. But I do remember being VERY stressed and VERY anxious all the time!
So I guess...if you know/learn how to do blood gasses, and taps, you are pretty much home free, and don't really need to "know" much more, except, of course, the theoretical basis of what you are trying to do and why you're ordering all those damn labs and x-rays, and how to use their perpetually changing computer systems. (I swear I have seen the hospital computer systems getting more and more user-unfriendly by the year, instead of the other way around, in spite of hordes of medical-IT-consultants perennialy implementing some "new" program or system changes!) But the theoretical part is always easier to figure out anyway! You should already know that from Med school!
Also, in retrospect, I think I should have behaved in a more "brown-nosing" way towards my PGY II. I think I was expecting a lot more hand-holding from them that would have been realistic anyway. So when I didn't get it, I labeled them as "uncaring aloof slave-drivers"! In retrospect, probably, if I had been more diplomatic, and if I had more empathy myself for their probable burn-out (after all they had just survived through a WHOLE year of IM PGY-I, so they deserved a little break!), I might have gotten more from them too. But it's too late for that now!
I hope this helps. Sorry for the humongous post. I just sort of enjoyed remembering about some of this stuff. I think the most important thing is not to be scared to ask people if you don't know something. Make sure you sleep and feed yourself too. Also, take care how you drive home when you are post-call, or sleep deprived, or very stressed out. Even if you can't wait to get out of the hospital madness and be home ASAP, go slow.
