Advice for new Interns?

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Anonymous (not verified)
Advice for new Interns?

So as many of us are now filling out applications, signing contracts and looking for new places to live I thought maybe some of the current residents could share some advice on preparing for intern year. Obviously the best advice will come once we start and come from the upper years. But until then I think some general recommendations could be helpful to keep in mind as we get ready. Thanks in advance for your replies.

Edited by: nicky on 05/11/2015 - 19:50 Reason: Updated by FeedsNodeProcessor
Anonymous (not verified)
Some things

1. Dont lie, ever, cause you will be found out! If you dont know an answer, say youll find it 2. Showing up in in time for rounds without prerounding while your PGY2,3 was forced to see your patients that moring while also seeing theirs, this dosent help you 3. Dont ever say your first name is doctor, realize who you are and how far out of medical school you are 4. Dont ever write in a daily progress note: "bowel and omentum look good, will continue to observe" if you can see bowel and omentum on a patient who is not supposed that have an open abdomen, thats probably not something you want to observe or have your senior discover 5. Dont go to the ER and admit a disaster patient whithout talking to ANYONE!! An interns job is not to think, it is to do, most of the time the thinking is wrong, you will learn alot by observing for your first year 6. COMPLAIN, complain, ComPLaiN . .. dont do it You will get a rep very bad very fast, just put your head down for a year and do as told 7. Dont ever tell a senior/chief that you dont want to see a consult, go to the ER, go do a hernia, drain butt puss, followup on a lab, stay the last 2 hours of your 30 because you are tired ... blah, blah, blah (not the keisha song) Surgery has lost some of it heirarchy in the last decade with the advent of the 80 hr work week, no more pyramids. As an intern you should be happy to go do or see whatever is asked of you. 8. Dont yell and meds students, make them cry, then tell them there is no crying in surgery, it is for sure going to get you called into the PDs office for a discussion

Anonymous (not verified)
Hi, I'm Dr. Buzzkill

Would any of you more glass-half-full residents like to share some constructive suggestions, rather than a list of rules that we are not to violate.  Please try and take it from the approach of how to be a strong intern rather than how to NOT look bad.  Thank you kindly. P.S.  I heard its bad form to call an upper level out for being a condescending jerk. 

Anonymous (not verified)
Here's some advice for you

dont eat the yellow snow.

Anonymous (not verified)
It would be nice... to have

It would be nice... to have someone actually help and answer this for us. Im sure many of you were in our shoes not too long ago. I pray I always help and give back.Sorry to hear you have such a bad history with interns. 

Anonymous (not verified)
disagree

Call every upper level, attendings, nurses who is a jerk an a$$ho@%. The key is to set the tone from day 1. But seriously that first post was ridiciously lame, and sounds like some abused general surgery resident typing in the wrong forum.

Anonymous (not verified)
I'll give it a try.  I'm a

I'll give it a try.  I'm a 3rd year resident...  I am sure that the intern experience varies greatly from one program to the next, so I'll just give some general feedback...1. Realize you are new at this.  There is always someone above you (attending, chief, 3rd year resident) who you can/should ask if you are not sure what to do with a patient.  The easiest way to get in trouble as an intern is if you try take care of something yourself and it goes wrong, or you blow off some detail that someone above you thinks is important.  So "bump it up."  If you are unsure or uneasy, ask your upper levels for input- its how you learn and ensure you're not the only one going down (or to fix the problem) if something turns south. Listen to your gut- if something seems not right with a patient that you can't pinpoint or you feel uneasy there is a reason, and thats when you should bump it up...2.  The "Rule of 2" for floor calls:  1st page about a symptom/sign you can handle over the phone if its benign (pain not well controlled, hypertensive, low UOP).  If you get a second page (your primary treatment did not help i.e. increased pain meds, antihypertensive, fluid bolus) go see the patient.  Of course calls for substernal chest pain, mental status changes, unstable, etc you need to see right away.3.  Know your patients.  Ultimately, you will be the one running the tasks on the floor. Upper levels will be in the OR and will likely be disinterested about floor details.  If you take a genuine interest in knowing your patients, details are less likely to drop through the cracks.4.  Communicate with your patients.  It still amazes me how little MDs talk to the patients and let them know the plan- patients going downstairs for post-op CTs, getting transfused, etc and nobody ever tells them.  Let them know.  If the patient knows the plan, its makes things much easier.  You will be amazed how much faster a patient can be discharged if everyone is on the same team.  Tell them "once you pass gas, can eat regular food, and your pain is controlled, you can go home..."  on rounds they will literally tell you the status without you asking...4.  Get to the OR as often as you can.  You want to operate, right?  Even closing fascia will help you develop your skills.5.  Be likeable.  Work hard. Be a team player.  Probably easier said than done.  If you work hard and aren't annoying, upper levels will take notice, and you'll get to do more in the OR.6.  Read.  Its hard to read gen surg when you're only doing it for a year, but at least know about your patients and there operation/disease, and be sure to know the anatomy/steps of the operation you are doing.7.  Find time to relax.  Time will become much more valuable.  Use it to relax, exercise, hang out with friends.  You still need your sanity.8.  In terms of preparing between now and July... I'd just relax.  You are about to get much busier and come August you will likely regret spending April/May reading surgery texts instead of hanging out with friends if thats how you ended up spending your Spring.  Your intern year is designed to teach you how to manage all this stuff, and a week as intern is more valuable than reading for the next two months..  So don't overdo it.  Just relax for now and realize that med school and residency is the time for learning... this strange, leisurely, sometimes "boring" two months in between the two is for you to relax, recharge, and take pride in coming as far as you have...

Anonymous (not verified)
and...

 I agree with points 4 (the second 4) through 8.Overall, just relax. Urology interns typically far outperform the general surgery categoricals and prelims with half the effort, its what got you into Urology. You will be absolutely amazed at how much of internship is just doing what you are told with almost no thinking and no real responsibility.  

Anonymous (not verified)
Thanks for the well-informed

Thanks for the well-informed words of wisdom...much appreciated!

Anonymous (not verified)
THANK YOU!!!

THANK YOU so much for an awesome, honest, response! You couldn't be more valid about the "talk to your patients" point. I actually didnt rank a program this year (that I did a SUB-I with!!) bc their residents and some attendings even, barely touched, much less talked to patients on rounds and in between and I felt if thats the training Id be doing for the next 5 years Id rather not match at all! Such an important, and often not performed skill/task/necessity!I'll try to take to heart #8 as well. :)Thanks again for the great advice! Best to you!

Anonymous (not verified)
great thread

PGY-2 here reminscing about my first days as an intern...its definitely a crazy experienceI whole-heartedly agree with the above posts, I will add some of my own $0.02 while trying to not repeat whats been already said so well1.) Strive to learn good technique. Your intern year should be a pivotal experience in your surgical training and this is a year were you should start getting familiar with the feel and physics of the needle driver, suture, bovie and basic knot tying. While this may sound easy and straight forward, developing bad techiques now will make it much harder to break later on down the line. Ask for critique when people are watching you, or if in an appropriate situation say "I'm struggling here what am I doing wrong?"...i remember would ask for tips doing minor room procedures with my senior residents and surprised at how I was sometimes making things too difficult for myself....fellow residents can be great for this as you may feel more comfortable asking them for tips.  Put your pride aside as EVERYBODY struggles and really take and ask for advise on how to improve2.) Be attentive, learn the ropes and begin to anticipate. Do you have a strict protocol for your post-op chole's, hemi colectomes, etc etc? Learn it well, anticipate and take care of things before you get asked to. If something doesn't seem right, then ask. The best feeling I had as an intern was that of being trusted and it was all from being honest and attentive to details3.) Don't brush off critical care experience. Although our field is one where we do not have to (luckily) have to deal with the most critical of pts, its important to have a knowledge basic critical care things when crap hits the fan. Your attendings will expect this of you, especially when you advance through the ranks. 4.) Start getting familiar with reading your own radiology exams. Ours is a field that uses CTs and ultrasounds frequently and getting familiar with these studies and how disease processes appear can only help you in the long run. Fight the temptation to just read the report, especially late at night when you are tired as crap or when you're slammed.5.) Take Step 3 during your intern year. The more you stray away from medical school and focus your education on a specialized field, the harder and more of a pain in the butt this test will be. Get that crap out of the way6.) In this time before residency starts, have fun, relax and spend time with loved ones as much as possible. Even if you ready the entire Sabistons text prior to starting residency, you will still feel overwhelmed, so why stress yourself out now? You will be glad you did. Thats it for now peeps, best of luck and congrats on beginning your journey in the best field in medicine  

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