quickfeet

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Just curious what the experience was on your IM sub-internship. I start mine in a couple weeks. What were your responsibilities, how many hrs did you work, when/where did you work (i.e. night float?) etc.
 

blub1212

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I held anywhere from 3-5 patients at a time. The senior resident would see them after I had already seen them and pended orders in EPIC so that I was forced to commit to a plan before I spoke with anyone about the patient. I did all the H&Ps, SOAP notes, and discharge summaries (the senior resident would just copy my note so that it was billable). I held a sub-I pager, so nurses would page me with questions about my patients. Only worked days, but hit about 70-80 hours per week.
 
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quickfeet

quickfeet

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I held anywhere from 3-5 patients at a time. The senior resident would see them after I had already seen them and pended orders in EPIC so that I was forced to commit to a plan before I spoke with anyone about the patient. I did all the H&Ps, SOAP notes, and discharge summaries (the senior resident would just copy my note so that it was billable). I held a sub-I pager, so nurses would page me with questions about my patients. Only worked days, but hit about 70-80 hours per week.
So how much did the experience resemble intern year?
 

Crayola227

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.
 
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quickfeet

quickfeet

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You were very lucky.

My subI, hell even my whole 3rd year, was total and utter crap.
Mine didn't prepare me AT ALL.*
By sub-i, I meant 4th year elective rotation, not M3 clerkship.
 

Crayola227

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By sub-i, I meant 4th year elective rotation, not M3 clerkship.
I know. I meant 3rd year didn't prepare me for the subI, or intern year.

I'm not expecting 4th year to prepare anyone for anything besides residency interviews.

I was listing the aspects of the clinical years I think relate to preparing you for intern year, and saying that mine were crap
 

Crayola227

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luckily I wrote a long thoughtful response plus a repository of wisdom for you, and all you had to say was something critical and didn't make sense.
no thank you like?

maybe I'll just delete it. I put a lot of work into helping you guys. Just feeling salty. I might be convinced to put it back or I'll just wait until someone else asks about subI's and intern year.

Good luck on your subI and intern year.
 

Crayola227

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i'm about to start my sub-i at a hospital that only has paper charts. anyone had to deal with this?
you poor bastard

I did sorta. It was a half/half system. I got nothing for you bro. It sucks.
 

The Anhedonia

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you poor bastard

I did sorta. It was a half/half system. I got nothing for you bro. It sucks.
yeah at my main hospital we've been on epic....i can't even fathom admitting a patient having to pour through paper charts, more or less write an H&P by hand....
i imagine as a sub-i the scut will be all mine :(
 
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Crayola227

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yeah at my main hospital we've been on epic....i can't even fathom admitting a patient having to pour through paper charts, more or less write an H&P by hand....
i imagine as a sub-i the scut will be all mine :(
you'll spend a ridiculous amount of your day just trying to find the charts
 
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Psai

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i'm about to start my sub-i at a hospital that only has paper charts. anyone had to deal with this?
Photocopy machine is the old school copy/paste. Just type out a general note like

Pt offers no complaints, no overnight events
vss nad rrr no mrg ctab sntnd wwp no cce
pt is ___ yo __male with pmh cad dm2 htn presenting with ____ here for ____.

plan



full code regular diet saw and reviewed plan with senior resident and attending
the anhedonia, ms4

Staple it in, use a bowel stapler if you're going into gen surg
 

The Anhedonia

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Photocopy machine is the old school copy/paste. Just type out a general note like

Pt offers no complaints, no overnight events
vss nad rrr no mrg ctab sntnd wwp no cce
pt is ___ yo __male with pmh cad dm2 htn presenting with ____ here for ____.

plan



full code regular diet saw and reviewed plan with senior resident and attending
the anhedonia, ms4

Staple it in, use a bowel stapler if you're going into gen surg
this is straight baller right here.

i'll report back when i see how bad the damage is.
 
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okokok

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I was listing the aspects of the clinical years I think relate to preparing you for intern year, and saying that mine were crap
I would really, really like to read your original comment.
luckily I wrote a long thoughtful response plus a repository of wisdom for you, and all you had to say was something critical and didn't make sense.
no thank you like?

maybe I'll just delete it. I put a lot of work into helping you guys. Just feeling salty. I might be convinced to put it back or I'll just wait until someone else asks about subI's and intern year.

Good luck on your subI and intern year.
 
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Crayola227

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I would really, really like to read your original comment.
ask, and ye shall receive!!



I held anywhere from 3-5 patients at a time. The senior resident would see them after I had already seen them and pended orders in EPIC so that I was forced to commit to a plan before I spoke with anyone about the patient. I did all the H&Ps, SOAP notes, and discharge summaries (the senior resident would just copy my note so that it was billable). I held a sub-I pager, so nurses would page me with questions about my patients. Only worked days, but hit about 70-80 hours per week.
You were very lucky.

My subI, hell even my whole 3rd year, was total and utter crap.
Mine didn't prepare me AT ALL.*

I would say this person as a med student having a chance to pend orders and come up with a plan in a vacuum is very valuable experience - this is what you will often have to do intern year.

Trying to come up with your own problem list at minimum and taking a stab at a plan (not just copying from a resident's note) is the most important thing you can do as a student to prepare. That and getting really efficient with prerounding, notes, presentations, organization.

I would say the above experience from the poster is what you want your subI to be like. It is like what your intern year will be like, except you can have up to 10 patients by yourself as your hard cap in IM.

Some IM programs the intern doesn't get stuck with 7 ICU or 10 wards patients at a time day 1. If you have a subI like this person's, and you end up at a program like this, your workload would be more than twice what it was in the subI.

It is more than twice the amount of work compared to your this ideal subI, because you will have more patient care & residency related admin duties on top of this that a medical student doesn't have. For example, continuity clinic and all the associated work with that (Rx requests, reviewing lab results, calls, etc)

*will not reveal medical school or program so don't ask

check out my intern megapost for intern tips

(some will be useful for a subI)

http://forums.studentdoctor.net/threads/things-to-do-to-shine-in-pgy-1.1188633/#post-17640862

Mastering some of the organizational tips I give will help you very much come intern year.

I assert this as everything I wrote comes from personal experience intern year. From someone who had a poor foundation from an organizatonal and practical skills standpoint (fund of knowledge was fine), and had to hash it all out on the job, as the slowest little intern that couldn't. It is all the stuff I wish I had known to start.

But, you can never develop the skills I talk about if your subI doesn't look like the person I quoted's. That is your goal.
 

blub1212

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So how much did the experience resemble intern year?

It was kinda similar except for the fact that I didn't have nearly as many patients and there was a lot more support from the senior then I get now. I have a lot more actual responsibility now, whereas that was more simulated responsibility.

That being said, that one month prepared me for intern year (I'm still an intern so take it as you like) better than anything else I did all of med school.

Day 1 of intern year I stared on nights in the MICU at our VA. There is no in-house fellow and my senior/attending is a tele attending. I was the only physician on the unit all night (that is how they do nights there), cross covering for 11 patients and I did 3 admits. Nothing can prepare you to do something like that day 1 of intern year, but I think that my sub-i helped a lot.
 
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Crayola227

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It was kinda similar except for the fact that I didn't have nearly as many patients and there was a lot more support from the senior then I get now. I have a lot more actual responsibility now, whereas that was more simulated responsibility.

That being said, that one month prepared me for intern year (I'm still an intern so take it as you like) better than anything else I did all of med school.

Day 1 of intern year I stared on nights in the MICU at our VA. There is no in-house fellow and my senior/attending is a tele attending. I was the only physician on the unit all night (that is how they do nights there), cross covering for 11 patients and I did 3 admits. Nothing can prepare you to do something like that day 1 of intern year, but I think that my sub-i helped a lot.
JFC.
 
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Cyal

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7 AM - 1 PM in the MICU. 2 patients max. No weekends. **** was so cash.
Similar to mine. I avoided my home university and went to the VA. Very chill 6:30 AM to 2 PM (latest) schedule, out by 1 PM most of the time. There were two MS4's with none of us going into IM, so no one really cared. Carried 1 patient 90% of the time, and 2 at the max, but I still learned a lot and did the best I could with the light load.

As an intern, I carry 6 patients on average, and I was prepared to step it up big time prior to residency. So far so good. Can't wait to finish this prelim med yr. It's so strange that 3 patients as a med student was quite a bit of work, but now 3 patients would make for a very very easy day.
 

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For people reading this I might suggest a strategy -

you want the subI you do before ERAS for LORs and grades to not be biting off more than you can chew
I recommend a subI early in the year that is primarily for looking good on paper for the match or is otherwise strategic

after the MSPE comes out, you submit ERAS, it's great to **** off your MS4 year, BUT -
I recommend doing at least one subI in your field or adjacent that is as BRUTAL as possible as long as you can pass,
if you have any concerns about how prepared you are

you don't have to do what one of my co-interns did --> 4 subIs
(but damn from the start they were a machine, looking good running laps around us smoking us, and going home a lot earlier)

mine didn't prepare me

find a balance
 

cbrons

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For people reading this I might suggest a strategy -

you want the subI you do before ERAS for LORs and grades to not be biting off more than you can chew
I recommend a subI early in the year that is primarily for looking good on paper for the match or is otherwise strategic

after the MSPE comes out, you submit ERAS, it's great to **** off your MS4 year, BUT -
I recommend doing at least one subI in your field or adjacent that is as BRUTAL as possible as long as you can pass,
if you have any concerns about how prepared you are

you don't have to do what one of my co-interns did --> 4 subIs
(but damn from the start they were a machine, looking good running laps around us smoking us, and going home a lot earlier)

mine didn't prepare me

find a balance
They were smoking you eh?

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sliceofbread136

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It was kinda similar except for the fact that I didn't have nearly as many patients and there was a lot more support from the senior then I get now. I have a lot more actual responsibility now, whereas that was more simulated responsibility.

That being said, that one month prepared me for intern year (I'm still an intern so take it as you like) better than anything else I did all of med school.

Day 1 of intern year I stared on nights in the MICU at our VA. There is no in-house fellow and my senior/attending is a tele attending. I was the only physician on the unit all night (that is how they do nights there), cross covering for 11 patients and I did 3 admits. Nothing can prepare you to do something like that day 1 of intern year, but I think that my sub-i helped a lot.
Dang I can't imagine being slammed with so much responsibility so soon
 
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cbrons

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MICU. Q4 call. 6am - 3pm on non-call days. 6am-8pm on call days. One day off per week. One week of nights (did about 90 hours that week). Sub-I was a slight step up from being an MS4. (More autonomy with plans, pending orders, getting pages, etc). Overall was a great experience!
Was this at the VA ?
 

blub1212

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Dang I can't imagine being slammed with so much responsibility so soon
Yeah, it was a real kick in the pants to start off.... haha. Now that I am done with it I am really glad it was one of my first rotations though.
 

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Similar to mine. I avoided my home university and went to the VA. Very chill 6:30 AM to 2 PM (latest) schedule, out by 1 PM most of the time. There were two MS4's with none of us going into IM, so no one really cared. Carried 1 patient 90% of the time, and 2 at the max, but I still learned a lot and did the best I could with the light load.

As an intern, I carry 6 patients on average, and I was prepared to step it up big time prior to residency. So far so good. Can't wait to finish this prelim med yr. It's so strange that 3 patients as a med student was quite a bit of work, but now 3 patients would make for a very very easy day.
Lucky bastard. Sorry don't mean to be rude, just couldn't think of a better way of putting it.

At our main hospital, students on their *core* IM rotation (ie equivalent of MS3s) are expected to do most things interns do (prerounding, presenting and discussing on rounds, placing orders - though they have to be approved by superiors, calling consults, communicating with SW, PT and OT, following labs and images, writing notes, doing admissions and admission notes though not adnission orders, taking a stab at plans, writing discharge summaries and doing most of discharge work except meds reconciliation, talking to patients and families, getting pages - true story, fixing daily run of the mill small floor problems - basically the nurses would come and find med students responsible for their patients with any issues, participating in bedside procedures, rapid responses and calls - did I miss anything?) for 3-4 patients. For comparison, our IM interns (regardless of whether categorical or prelim) are capped at 8 patients but are often overcapped at 9 (I'm in NYC, so I guess that explains it). IM was my first core rotation and it was some sort of overwhelming hell. Sub-Is on IM here reportedly carry 4-6 patients doing all of the above + have more responsibility formulating plan. So this place works people hard, but from what I hear from recent graduates from my school, they felt fairly comfortable starting internship.
 

Daodejing

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IM was my first core rotation and it was some sort of overwhelming hell. So this place works people hard, but from what I hear from recent graduates from my school, they felt fairly comfortable starting internship.
Wow...at the very least. I feel for the MS3s over there who have their minds set on path/rads. That's an awful lot of people-interacting.
I wonder how truly efficient systems, such as yours, are with those of the most minimal experience (ie. MS3s) pretty much doing the majority of the foundational groundwork for the IM service.
 

cbrons

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Lucky bastard. Sorry don't mean to be rude, just couldn't think of a better way of putting it.

At our main hospital, students on their *core* IM rotation (ie equivalent of MS3s) are expected to do most things interns do (prerounding, presenting and discussing on rounds, placing orders - though they have to be approved by superiors, calling consults, communicating with SW, PT and OT, following labs and images, writing notes, doing admissions and admission notes though not adnission orders, taking a stab at plans, writing discharge summaries and doing most of discharge work except meds reconciliation, talking to patients and families, getting pages - true story, fixing daily run of the mill small floor problems - basically the nurses would come and find med students responsible for their patients with any issues, participating in bedside procedures, rapid responses and calls - did I miss anything?) for 3-4 patients. For comparison, our IM interns (regardless of whether categorical or prelim) are capped at 8 patients but are often overcapped at 9 (I'm in NYC, so I guess that explains it). IM was my first core rotation and it was some sort of overwhelming hell. Sub-Is on IM here reportedly carry 4-6 patients doing all of the above + have more responsibility formulating plan. So this place works people hard, but from what I hear from recent graduates from my school, they felt fairly comfortable starting internship.
That sounds like an amazing M3 IM clerkship, not sure what you think is "hell" about it.

Compared to sitting a lounge for 8 hours a day forgotten by the attending preceptor who has 3 students shadowing them, that sounds pretty good.
 

Amygdarya

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That sounds like an amazing M3 IM clerkship, not sure what you think is "hell" about it.
That was my *first* clerkship fresh off 1.5 year preclinicals, and I didn't even take Step 1 before that. I didn't know my *ss from my elbow - I'd never done any of the things I listed above before that clerkship. So that was a whole lot of stress, not to mention a ton of assignments to submit and the shelf I had absolutely no time to study for. So yes, I learned a ton (mostly in practical skills rather than book stuff), and I really appreciate being involved in patient care to that degree, but especially as a first clerkship it was hellish, absolutely the most overwhelmed and stressed and exhausted I've ever been in medical school. OBGYN and surgery seemed totally chill after that :D

I agree with you that this is the kind of stuff students should do in clerkships. It's just that as a first clerkship it was really stressful and overwhelming.
 

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That was my *first* clerkship fresh off 1.5 year preclinicals, and I didn't even take Step 1 before that. I didn't know my *ss from my elbow - I'd never done any of the things I listed above before that clerkship. So that was a whole lot of stress, not to mention a ton of assignments to submit and the shelf I had absolutely no time to study for. So yes, I learned a ton (mostly in practical skills rather than book stuff), and I really appreciate being involved in patient care to that degree, but especially as a first clerkship it was hellish, absolutely the most overwhelmed and stressed and exhausted I've ever been in medical school. OBGYN and surgery seemed totally chill after that :D

I agree with you that this is the kind of stuff students should do in clerkships. It's just that as a first clerkship it was really stressful and overwhelming.
You're going to learn how to do it sometime. Better that than waiting around all day doing nothing while the intern takes care of everything.
 

Cyal

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At our main hospital, students on their *core* IM rotation (ie equivalent of MS3s) are expected to do most things interns do (prerounding, presenting and discussing on rounds, placing orders - though they have to be approved by superiors, calling consults, communicating with SW, PT and OT, following labs and images, writing notes, doing admissions and admission notes though not adnission orders, taking a stab at plans, writing discharge summaries and doing most of discharge work except meds reconciliation, talking to patients and families, getting pages - true story, fixing daily run of the mill small floor problems - basically the nurses would come and find med students responsible for their patients with any issues, participating in bedside procedures, rapid responses and calls - did I miss anything?) for 3-4 patients. For comparison, our IM interns (regardless of whether categorical or prelim) are capped at 8 patients but are often overcapped at 9 (I'm in NYC, so I guess that explains it). IM was my first core rotation and it was some sort of overwhelming hell. Sub-Is on IM here reportedly carry 4-6 patients doing all of the above + have more responsibility formulating plan. So this place works people hard, but from what I hear from recent graduates from my school, they felt fairly comfortable starting internship.
This workload is too much and unnecessary for MS3 students who are clearly not ready to handle it, that is why it was an "overwhelming hell". This would be more appropriate for an MS4 medicine sub-I. You can still be a very competent intern with graded responsibility as an MS3 without going through that kind of hell. I really hope you all got a lot of support from the residents.

I hope your medicine shelf went well.
 

Amygdarya

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This workload is too much and unnecessary for MS3 students who are clearly not ready to handle it, that is why it was an "overwhelming hell". This would be more appropriate for an MS4 medicine sub-I. You can still be a very competent intern with graded responsibility as an MS3 without going through that kind of hell. I really hope you all got a lot of support from the residents.

I hope your medicine shelf went well.
Thanks! The shelf was ok - I got around national average, which is basically a failure by SDN standards :D but at least I didn't actually fail, as some of my intelligent and hardworking classmates did :(

The residents - and, in general, people I worked with including attendings and other students on the team - made all the difference. One month I had wonderful supportive residents who answered even the stupidest of my questions without making me feel like a moron and actually taught me something - and I was grateful for that and enjoyed helping them out by doing the work. The other month was awful on so many levels I'm not even going to go into that.

Bottom line is, while I agree that med students should ultimately be learning to do what interns do, at least in the beginning they also need to have time to study, to build foundation. I agree with you that sub-I is a more appropriate time to apply the knowledge you built in your core rotation to do intern-level tasks.
 

The Anhedonia

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this is straight baller right here.

i'll report back when i see how bad the damage is.
Mt Auburn hospital. Paper charts......Meditech computer based on MS DOS...... i'm dying. :eek:
The junior med resident just asked me <while squinting at the illegible attending note in patient chart>: "What do you think this line reads? is it eliquis or therapy?"


upside is everyone is super nice.
 

cbrons

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Mt Auburn hospital. Paper charts......Meditech computer based on MS DOS...... i'm dying. :eek:
The junior med resident just asked me <while squinting at the illegible attending note in patient chart>: "What do you think this line reads? is it eliquis or therapy?"


upside is everyone is super nice.
Lol

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My ICU subi at small community hospital. Shadowed and stood in corner the whole time. Went to pulm clinic, just shadowed. Horrid, worthless experience.

On my transcript it says, "ICU SUB INTERNSHIP" lol my school just completely lies. All it was was shadowing for a ton of $$$, just like a premed would do for free but in an ugly short coat.
 
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The Anhedonia

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i seriously dont know how any medical student after completing their sub-i has any desire to pursue internal medicine.

i'm dying....... if i have to admit another pseudo seizure patient i'm going to start "having seizures" to get the f*** out of my rotation.
 

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Did my medicine subI at the VA. School didn't offer a surgical subI to fill required rotation, just medicine or peds (very annoying).

Was pretty good. I think I carried ~3-4 patients. At the VA, med students can write notes and put in pended orders, so I learned how to replete lytes and order insulin and all that stuff. Overnight call was on a nightfloat system. I did a couple of overnights because it meant not coming in the day before or staying the day after. Worked probably ~60 hours per week.

How did it compare to intern year? I was a surgical intern, so didn't help with that skill set. But I learned the basics of inpatient management (not just M3 stuff, but actually figuring out how to get all that stuff in my A&P done).

I did 3 ICU rotations as an M4 (trauma, SICU, and burn) which were much more valuable for my education.

Being a strong intern is about knowing your limits, working hard, and not being an idiot.
 
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The Anhedonia

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Did my medicine subI at the VA. School didn't offer a surgical subI to fill required rotation, just medicine or peds (very annoying).

Was pretty good. I think I carried ~3-4 patients. At the VA, med students can write notes and put in pended orders, so I learned how to replete lytes and order insulin and all that stuff. Overnight call was on a nightfloat system. I did a couple of overnights because it meant not coming in the day before or staying the day after. Worked probably ~60 hours per week.

How did it compare to intern year? I was a surgical intern, so didn't help with that skill set. But I learned the basics of inpatient management (not just M3 stuff, but actually figuring out how to get all that stuff in my A&P done).

I did 3 ICU rotations as an M4 (trauma, SICU, and burn) which were much more valuable for my education.

Being a strong intern is about knowing your limits, working hard, and not being an idiot.

you really like to punish yourself dont you? ;)
 
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URHere

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I ended up doing 2 sub-Is: general medicine wards and PICU. Both were awesome, and probably the best intern-year preparation I could have hoped for. With respect to the medicine sub-I:

At the beginning, I carried about 3 patients, but by the end I was able to split the patient load 50/50 with the intern on the team (6-7 patients at a time). We would alternate admits, I would pend orders (including admit orders) for all of my patients, call consults, etc. The day started around 6:30, our team took long call together every 4 days (until 8 or 9pm), and we could sign out on most other days as soon as we were done with patient care (anywhere from 2pm-4pm). It was a great way to gradually learn efficiency. It was a community hospital, so I got a bit more freedom than I would have at our major academic center.

Although my ICU sub-I was in pediatrics, I probably learned more that month than during the rest of medical school combined. Try to do both a wards and an ICU sub-I if you can. 100% worth it.

Overall, I think I was about as well-prepared for intern year as I could have been. I won't say I was fully prepared, because I started residency on adult heme onc, which meant rapids/codes multiple times each week and really sick patients outside of an ICU setting. But it could have been much worse if my Sub-Is hadn't been so on point.
 

VisionaryTics

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you really like to punish yourself dont you? ;)
Trauma was rough, burn was intermediate, SICU was cushy.

Then again, I'm an ENT resident applying to head and neck fellowship, so I'm definitely a masochist.
 

The Anhedonia

Winner Winner Chicken Dinner
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Trauma was rough, burn was intermediate, SICU was cushy.

Then again, I'm an ENT resident applying to head and neck fellowship, so I'm definitely a masochist.
what does that say about me as an OMFS resident who will be applying to a head and neck fellowship in a few years :confused:
i'm thinking about doing "advanced radiology" for one of my electives = more time to pwn noobs on xbox

then again there's nothing sexier than a big fibula case w/ bilateral neck dissections where you hold your pee in for 12 + hours
 

Crayola227

The Oncoming Storm
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Oct 22, 2013
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i seriously dont know how any medical student after completing their sub-i has any desire to pursue internal medicine.

i'm dying....... if i have to admit another pseudo seizure patient i'm going to start "having seizures" to get the f*** out of my rotation.
some people love it
gluttons for punishment
love to live in the hospital
don't like surgery