What kind of intern were/are you?

[DOCTORSAIB]

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So did you guys jump at every opportunity to do procedures (central lines, intubations, LPs, etc) during PGY-1 year?

Or did you stand in the background knowing full well that you'd never have to do these procedures every again after internship so why "risk it?"

I'm 4-weeks into my internship and just finished an ICU month. Some of the ICU nurses thought I was nuts for not jumping at the opportunity at doing procedures. They understood (kinda) after I told them I'm only here for a year then doing something completely unrelated to hospital medicine.

Honestly, why do something once if you're not going to be doing them ever again -- not to mention the risk of causing a complication to the patient.

What do you guys think? Should I change my approach? What kind of intern were you?

 

[Jokestr]

I found it fun to do procedures....It's way better than sitting doing 12 admit notes and then following that up with 12 discharge notes for the 364 days of your intern year. It never hurts to know how to put a chest tube in or start a central line...May as well learn it while you have the opportunity. I understand your idea that you probably never will have any reason to do it ever again in your career, but I always wanted to have a little fun during the monotony. Either way, you will still feel like you know NOTHING when you start your ophtho.... Good luck and try to enjoy your year not having to read endlessly.

 

[orbitsurgMD]

I was a surgery intern. I did as much as I could get my hands on and to this day use the skills I developed that year.

 

[MR1]

I did a fair amount of "procedures", mainly b\c they were fun and it was my patient. The only time I turned one down was if a categorical intern needed the experience (sometimes even the upper levels needed the experience).

I have known and heard of all types though, one in particular did a ton of stuff and would actually ask the residents to wake him up a night to do stuff. Where as others avoided any extra work like the plague.

 

[toulouselautrec]

I was a medicine prelim intern at a place that has a strong categorical medicine program. Hence, not so cush for the prelims.

With procedures, I was neutral about them. I always tried to offer them to my categorical co-intern on the team first because they're the ones who need to get signed off on them, not me. And usually they were very grateful for it. If it was clear, however, that it was much more expedient and better for patient care that I did it myself, I jumped right in and did it. I never avoided procedures like the plague, though. I actually really liked them. Definitely more fun than titrating a heparin drip or doing a rectal.

But I can understand why you're less than excited. Still, I think the priority should still be about taking care of the patient....everyone's responsibility, no matter what specialty you're going into.

 

[4424]

I enjoyed doing procedures and it definitely was something I am glad I did plenty of. I dont expect to really ever put in another central line, run a code, etc but I enjoyed the experience. Plus as mentioned, it broke up the monotony.

 

[jj326]

I'm in the same boat. TY intern at the same place as my ophtho program, which is not particularly cush (but at least I have no ICU months). The way I am looking at it is like this. I may want to volunteer overseas at some point and have no clue what the healthcare system at any of these places may be like. If I am an doctor, and a patient really needs a line and it is related to their eye care or could save their life. I hope I would feel at least somewhat comfortable being able to step in. That being said, I haven't done anything more than an EJ and a paracentesis. Good luck in the unit. Glad I am only going there for transfers.

 

[DOCTORSAIB]

You guys make some good points. Perhaps I should step it up a bit --although I'm not going to ask to be awakened at 3am to put in a NGT!

I just want to make the most out of this year. It's the last time I'm going to be exposed to in-patient medicine. I would hate to be the type of ophthalmologist who can't even read an EKG.

 

[happy optho]

well let me put it this way,

I have never seen any ophthalmologist- or any specialist of that matter- who wanted to do these things if they had the choice, I do not want to say that they chose their fields just so they do not have to deal with these things but lets face it, they_ and we_ kinda did.

this is my own opinion, u should make intern year what u want it to be,I am going to use every chance to relax as much a possible, bec this is one year where u know that if u get a couple of hours of downtime today u may not get those for weeks to come.

by no means am I advocating being lazy, I am planning to work my a*s off during my ophtho residency bec I want to be the best ophthalmologist I can be but I honostly do not see the use of me learning how to put in a chest tube this year and then forgetting how to do it over the next ten or so years!!!!!!

final advice- use every second of sleep/downtime/chill u can get ur hands on, u dont know how big ur census is going to be the next day!!!!!!

 

[rubensan]

I was a surgery intern. I did as much as I could get my hands on and to this day use the skills I developed that year.

I agree. Opthalmology is a procedure-driven field. Putting in chest tubes and central lines require a certain skill set. Although you will not do these exact procedures as a first year ophthalmology resident, you will utilize the same skill set during your first year of ophthalmology residency. You have to make an incision with a blade to insert a chest tube right? You don't want to look like an idiot when your oculoplastics attending asks you to make an incision in a patient's gluteal region to harvest fat for a retrobulbar pat pad injection and your hand is trembling b/c you have never made an incision before. Securing a central line means that you have to tack it to the skin with sutures, right? Doesn't it make sense to practice your suturing on as many patients as you can before you start repairing lid lacs? In addition, a lot of neuro-ophthalmolgists do LPs, you should get comfortable doing those.
Doctorsaib, for the reasons I listed above, I agree with the ICU nurses. These are the skills, my friend that separate us from optometrists. A lot of people who shy away from stuff their intern year, end of shying away from stuff their first year of ophthalmology residency as well. Do as much as you can!

 

[200UL]

In my opinion the "take it easy" interns will make "take it easy" ophthalmology residents. Some of the best interns I have seen went into ophthalmology. And guess what - these same people became the best ophthalmology residents I have seen. Your approach to internship probably reflects more about your approach to learning in general - I do not believe in turning it on and turning it off.

Picking up the max from the intern year will only make you a better ophthalmologist (for many reasons). Yes, we pick up much from medical school that would allow us to function in a hospital/ER as ophthalmology residents and practicing ophthalmologists, but the more you know about all fields of medicine the better you will be.

As has been said, however, this is one of the many things that makes us different from optometry and something they will never in a million years have access to. Make the most of it.

 

[rubensan]

In my opinion the "take it easy" interns will make "take it easy" ophthalmology residents. .

👍👍

 

[Stark]

I did all the central lines and procedures that I could. I went into ophthalmology because the procedures are cool. It's a procedural specialty.

Also, tying in some central lines will give you a little suturing practice - it comes in handy later!

Thanks,

Stark

 

[Mirror Form]

To play the devil's advocate, how many of you would want an intern using your mom learn how to do central lines? What if you found out that intern actually didn't need to learn central lines and would never be placing them again after internship was over?

 

[DOCTORSAIB]

To play the devil's advocate, how many of you would want an intern using your mom learn how to do central lines? What if you found out that intern actually didn't need to learn central lines and would never be placing them again after internship was over?

Just when I thought I had such great advice from upper years you come and muddy the waters again!

 

[GAA]

Well, maybe the same mother that during residency you are going to do a Vitrectomy or a Buckle, and if you don't go to Retina, you will never do that again.
I think good to take advantage of the opportunities in a responsible way.
I did an LP during my first year of residency in a NeuroOphtho patient.
I felt confortable because I did many during my internship.

 

[orbitsurgMD]

To play the devil's advocate, how many of you would want an intern using your mom learn how to do central lines? What if you found out that intern actually didn't need to learn central lines and would never be placing them again after internship was over?

That is the great thing about experience, you can bring more to the battle without extra weight. Why be lazy?

I would want my mom taken care of by the intern who knew his limits but also knew why it was important to learn to do as many things as possible, and who knew when to ask for help if he needed it. You want to be the guy people turn to when the s**t hits the fan. It takes some work to get there. Do it.

I still use stuff I learned as an intern. You really should try to learn everything you can. Seriously.

 

[MR1]

This is the issue with training for anything, you are always going to have to do something the first time on someone. Being a hippocrite I wouldn't take my mom to a teaching hospital unless I had to. On the other side would it matter if the intern putting in a CVL for the first time was an ophtho, derm, etc intern or a categorical medicine, no it wouldn't at all. THe only thing that would worry me is that it was their first time.

 

[Jake the Snake]

To play devil's advocate again, if intern year were so important for learning things like as suturing, how to admit or stabilize a patient, then why doesn't ophtho residency come with its own specialized intern year to ensure that all residents are learning these neccesary skills? It seems as though ophtho residencies will accept just about any intern year you complete, whether it be IM, TY, surg, FP, cush or hardcore. On the other hand, ortho and ENT have taken control of their intern years to ensure that all their interns get proper prelim training. And as someone currently in the application process, I really wish ophtho had it's own intern year. It would save me lots of money and headaches from multiple applications and interviews!

On the same note, why have I been hearing that when I start ophtho residency, they expect me to know nothing and that PDs fully expect to have to teach me everything? From my MS4 point of view, it seems that a major point of intern year is not to acquire knowledge, but to work hard, do scut, and keep to tie up the loose ends in the hospital. It seems as if the most important skills gained during this year are prioritization and efficiency. Honestly, I think intern year is simply a right of passage. We all must suffer before we reach the promised land.

I'm not trying to get flamed. I know that I haven't even graduated yet, and therefore have limited insight. I just wanted to throw in another point of view.

 

[toulouselautrec]

On the same note, why have I been hearing that when I start ophtho residency, they expect me to know nothing and that PDs fully expect to have to teach me everything? From my MS4 point of view, it seems that a major point of intern year is not to acquire knowledge, but to work hard, do scut, and keep to tie up the loose ends in the hospital. It seems as if the most important skills gained during this year are prioritization and efficiency. Honestly, I think intern year is simply a right of passage. We all must suffer before we reach the promised land.

Intern year for me was about a lot of different skills. Priorization, efficiency, multi-tasking, problem-solving, learning how to be a team player, how to work with different personalities, improving my patience and my skill at dealing with different kinds of patients, learning procedures, AND acquiring a fund of knowledge. All of these will be important during ophthalmology residency. I think it's important to have a good fund of knowledge in medicine/surgery as almost every systemic disease can have some kind of ophthalmic manifestation. As a resident, you have to be a sponge. In internship, you gotta be a medicine/surgery/whatever sponge. Once you're done, you won't have that opportunity again...for the rest of your life, you'll be an ophtho sponge. So worrying about learning how to do ophtho while you're an intern may dilute your ability to absorb other knowledge. Or not. Maybe it depends on the person...

I didn't have much opportunity to be exposed to ophthalmology during internship, it was so busy. Some of my co-residents started residency having absolutely no ophthalmic clinical skills whatsoever. But the learning curve is steep, and they picked them up quickly...

 

[Jake the Snake]

Intern year for me was about a lot of different skills. Priorization, efficiency, multi-tasking, problem-solving, learning how to be a team player, how to work with different personalities, improving my patience and my skill at dealing with different kinds of patients, learning procedures, AND acquiring a fund of knowledge. All of these will be important during ophthalmology residency. I think it's important to have a good fund of knowledge in medicine/surgery as almost every systemic disease can have some kind of ophthalmic manifestation. As a resident, you have to be a sponge. In internship, you gotta be a medicine/surgery/whatever sponge. Once you're done, you won't have that opportunity again...for the rest of your life, you'll be an ophtho sponge. So worrying about learning how to do ophtho while you're an intern may dilute your ability to absorb other knowledge. Or not. Maybe it depends on the person...

I didn't have much opportunity to be exposed to ophthalmology during internship, it was so busy. Some of my co-residents started residency having absolutely no ophthalmic clinical skills whatsoever. But the learning curve is steep, and they picked them up quickly...

I wonder whether or not we really need to do internships in order to learn those medical and surgical diseases that have ophthalmic manifestations. As if we did not see or read enough about these diseases in medical school. I bet we would be just as good ophthalmologists whether we completed the intern year or not. We would learn everything we needed to learn during residency. And unless you're the rare person with a photographic memory (which apparently is highly prevalent here on SDN), all the extra information gained over the years will suffer from disuse atropy.

 

[4424]

i learned a lot during my internship that i certainly didn't know as a medical student. do i think it will make me a better ophthalmologist? i think a little bit yes. but i feel a lot better knowing that i can handle certain things that i had no clue about as a student. i know it will wear off as the years go on, but it still made me better and i prefer it.

plus at the very least it gave me perspective on the fact that i'm extremely happy that i chose ophthalmology that i certainly did not have as a student!

 

[toulouselautrec]

We would learn everything we needed to learn during residency.

You won't learn everything you need to know in residency. But hopefully, you'll learn a large majority of it. That will be largely dependent on your own level of self-motivation, no matter how awesome you think your residency program is or how much they hand you stuff on a silver platter.

I bet some your attendings trained during those years before phaco came out. They trained on extracaps and intracaps, and then had to learn phaco on their own out in practice. If you think you won't need to learn anymore after residency, I think you'll be doing yourself and your patients a disservice.

Residency goes by fast...you're gonna wish you have more time. There's an enormous amount of information to know.

 

[DOCTORSAIB]

Alright, so the consensus is do procedures during intern year but don't do them on people's mothers? 😀

 

[FutureOph123]

I think there is basically a break down of posters on this thread based on what type of intern year they did.

 

[Mirror Form]

That is the great thing about experience, you can bring more to the battle without extra weight. Why be lazy?

I would want my mom taken care of by the intern who knew his limits but also knew why it was important to learn to do as many things as possible, and who knew when to ask for help if he needed it. You want to be the guy people turn to when the s**t hits the fan. It takes some work to get there. Do it.

I finished intern year a few years ago, and I've already forgotten most of what I learned (half of which was outdated by 1 year post internship anyway). I did get used to taking care of a variety of sick patients and that is very beneficial and will be for a long time.

However, I would not feel comfortable putting in a central line anymore, and I really don't know what the point of me learning to do so during internship was. Fortunately I never caused any complications. However, I did see one patient sent to the ICU b/c she had a bleeding disorder and the medicine intern blew both IJ's, causing the patient's airway to close and necessitating intubation. At least it was a medicine intern who screwed that up (and really did need to learn central lines). But I don't know if you'd be able to explain that from an ethical standpoint if the intern was going into ophthalmology and really did not need to learn how to place central lines. I also learned how to do LP's during internship . . . that's a useful skill these days?

I guess being a relatively new cataract surgeon I sort of feel guilty already about practicing on live humans beings even when I do need to learn the skills. So I just don't understand why people want to practice procedures that they don't actually need to know on people.

I still use stuff I learned as an intern. You really should try to learn everything you can. Seriously.

Yeah, that's definitely good advice in general.