- Joined
- Oct 3, 2005
- Messages
- 378
- Reaction score
- 0
Can those who have or are currently going through a surgical internship elaborate on why it is so 'bad' or 'difficult' as I've so often heard?
What makes a surgical internship so bad?
- Thread starter Chief Resident
- Start date
- Joined
- Jul 1, 2001
- Messages
- 64
- Reaction score
- 0
.
N
njbmd
Chief Resident said:
Hi there,
I was a Surgical intern under the pre-80 system. The hours were long but I enjoyed everything that I was learning and doing. I would get to the hospital around 4:45 AM to pre-round on my patients. Work rounds with the chiefs would start around 5:30AM and by 6:30AM they would be off to operate while I would stay behind to discharge patients, write orders, dictate charts and call consults like cardiology or pulmonology. I would also check labs and radiographic studies or order them if needed.
If I was lucky, there would be a first-year level case that I could get which was golden. If I scrubbed the case, I was responsible for dictating the case after the OR. It was great. I would get my floor work done as quickly as I could and troll for cases in the OR.
My post-ops would start arriving around noon. I was responsible for post-op notes and checks. I would also start to get the pre-ops in around this time too for any preoperative testing and consenting. Any admissions from the ER would need H & Ps which were my responsibility if there was no medical student.
Around 5:30PM, we would have evening rounds with the chief and if I was on call, I would receive sign out. During the night, I would be respoinsible for from one to three other services in addition to mine. I would have to admit patients and keep an eye on their post-ops for things like urine output. I would also handle any overnight emergencies like chest pain etc.
In the morning, I would pre-round and start the day over again. I did not leave the hospital until 6:30pm when I was post call. If there was another intern on my service, I might be able to get out around 4pm but I was a solo intern on some services so I stayed until rounds and conferences were over.
The big difference today is that I am out of the hospital post call. I am not allowed to stay more than 30 hours and I may not take on any new patients after 24 hours on call. I am generally out of the hospital by 8:30 AM on post-call days. At night, I cover more patients from more services. The floor interns have to cross-cover all surgical patients but they leave much earlier.
If I am not on call, I am in the hospital between the hours of 5:45AM and 6PM. There are no more pre-rounding duties by anyone. We do work rounds in the AM and then get to the operating room. Everyone gets to operate for the most part. The floor work duties are shared by first and second year residents with the first years doing the bulk of dictations and discharges.
In today's climate, you have to get to a higher level of performance faster. You are also more responsible for your education in that you have more time to read and you are expected to keep up with your reading.
Internship is worse then you can imagine but better than you think. The year goes by fast but there are more challenges during second year. I really think that my second year was more difficult than my intern year. By second year, you are expected to know some things and take on some responsibility.
njbmd 🙂
- Joined
- Mar 25, 2005
- Messages
- 371
- Reaction score
- 12
I've been a surgical intern for the last three or so months, and it's been better than I anticipated, but it's also been incredibly difficult in spots.
The hardest aspects in the beginning is that you literally feel as though you know nothing about anything. Everything is foreign, especially if you didn't got to med school where you are now training. From writing TPN orders to dictating, to trying to find the ORs, you don't know how to do. That's stressful. Also, you often are given a ton of work to do in a day, and racing to keep track of the results of all the studies, replete lytes, write TPN, check up on post-ops, dictate discharges, write notes, write admit notes, check on the patient who might have wound infection, open the wound on the patient that does have a wound infection, order the X-ray on the guy who sounds wet, check the Xray on the guy who sounds wet, run over to clinic because patients are stacked up and they need an extra hand, re-write insulin drips because the glucose control is uncontrolled, and on and on and on can be be overwhelming. I find the 80hr work week climate to be difficult, because on top of all the work you have to do, there is pressure to get it done by 6pm so you can check out to night float and stay under your hours.
That being said, there are also some positives to intern year. As long as you communicate with the residents above you, very few things are your fault -- the buck rarely stops with you. A co-intern and I were changing a wound-vac on a skin graft and it wasn't going well. Our solution? Call the R2 on the team. The wrong answer would have been to keep going and not tell anyone. Also, you're in the same boat with a bunch of other surgical interns, and if you picked a program that matches your personality, you love your class. With the 80 hour work week, you are often tired, but not so exhausted that you want to cry in your car on the way home on a regular basis. I've been Q3 for the last month and the difference between Q3 (essentially not in compliance) and Q4 (essentially in compliance) is night and day.
And sometimes, if you're lucky and good, you get to go to the operating room. And operate. And that rocks, and reminds you why you're putting yourself through this, and that intern year is a year, not a lifetime.
The hardest aspects in the beginning is that you literally feel as though you know nothing about anything. Everything is foreign, especially if you didn't got to med school where you are now training. From writing TPN orders to dictating, to trying to find the ORs, you don't know how to do. That's stressful. Also, you often are given a ton of work to do in a day, and racing to keep track of the results of all the studies, replete lytes, write TPN, check up on post-ops, dictate discharges, write notes, write admit notes, check on the patient who might have wound infection, open the wound on the patient that does have a wound infection, order the X-ray on the guy who sounds wet, check the Xray on the guy who sounds wet, run over to clinic because patients are stacked up and they need an extra hand, re-write insulin drips because the glucose control is uncontrolled, and on and on and on can be be overwhelming. I find the 80hr work week climate to be difficult, because on top of all the work you have to do, there is pressure to get it done by 6pm so you can check out to night float and stay under your hours.
That being said, there are also some positives to intern year. As long as you communicate with the residents above you, very few things are your fault -- the buck rarely stops with you. A co-intern and I were changing a wound-vac on a skin graft and it wasn't going well. Our solution? Call the R2 on the team. The wrong answer would have been to keep going and not tell anyone. Also, you're in the same boat with a bunch of other surgical interns, and if you picked a program that matches your personality, you love your class. With the 80 hour work week, you are often tired, but not so exhausted that you want to cry in your car on the way home on a regular basis. I've been Q3 for the last month and the difference between Q3 (essentially not in compliance) and Q4 (essentially in compliance) is night and day.
And sometimes, if you're lucky and good, you get to go to the operating room. And operate. And that rocks, and reminds you why you're putting yourself through this, and that intern year is a year, not a lifetime.
] start)
