1 Scared Intern

[danielmd06]

My med school dismissed the medstudents before overnight call as there weren't rooms for the students, so I haven't had alot of experience with problems that arise on night call.
But how much is the intern expected to know about calls that aren't "pedistrian?"

Good heavens!! Which medical schools force medical students to go home and not take call? You mean you haven't taken call overnight...ever?!?

I would suggest that you at least stay overnight once or twice so the concept isn't quite so scary when you have to do it for real as an intern - when a heavy responsibility suddenly gets placed on your shoulders. Maybe others will disagree and say that you shouldn't take my advice, but I couldn't conceive of starting as a fresh intern in July without having seen how things pan out on overnight call.

To answer your question, I can say that both the hospital where I went to medical school and the one I currently work at fully expect interns to have at least some semblance of an idea of what to do in the situations that you mentioned. Are you expected to make mistakes? Sure. Are you expected to always know exactly what to do? Of course not. But you should always be present in a bad situation or have made initial efforts on your own to research a problem prior to calling an upper level. Unless it's a true emergency...in which case a nurse might just call the senior first anyway.

What I kept telling myself this year was to work as hard as I possibly could whenever I could. It sounds trite and cliche, but it's true. If you are putting maximum effort into your job...things just have a way of working out. This includes overnight call. No one is going to yell at you if you are unsure of what to do and ask for help, and this goes double for the person putting in a strong effort each month. Upper levels will definitely respect you for how hard you work.

You'll be fine. Enjoy these last few golden months.

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[dynx]

Good heavens!! Which medical schools force medical students to go home and not take call? You mean you haven't taken call overnight...ever?!?

Stanford, for one. All show no go. Where else can you wear a long coat and have the cushiest schedule ever and still fool people into thinking you go to a real school?

 

[OR 1]

No dude, I've had overnight call for surgery, obgyn, and night shift on ER but no overnight call for Internal Medicine.

 

[8744]

I don't think pulling call as medical student prepares you for call as an intern. The difference is all in the level of responsibility. I can tell you what to do in a code, for instance, but at the first one I had the bad luck to arrive at first I drew a blank.

We had call at my medical school but it was pretty light. On most rotations you pretty much had to really skyline yourself to get called for anything, as in going to the senior resident and saying, "Hey, I'm a medical student and if you need any scut done tonight here is my pager number." I never did this, of course, preferring as I do to sleep at 3AM. I don't see how doing an admit at 9PM is fundamentally different from doing one at 2AM except for the former you are probably more alert. I don't think you can get used to going without sleep and even if you could, fourth year would rapidly decondition you to sleep deprivation.

It is school, after all. I thought residency was supposed to be the on-the-job training. I hate how they always justified making one lose sleep for no reason (because medical students have no authority or responsibility) for the sake of "teamwork."

**** teamwork. When someone starts talking about the team he is usually looking for the angle to get you to do his work.

 

[8744]

No dude, I've had overnight call for surgery, obgyn, and night shift on ER but no overnight call for Internal Medicine.

The only "real" call we did was for OB and surgery. Medicine, peds, and the like were hit or miss.

 

[Winged Scapula]

I do take umbrage with your argument that "we make less than a taco bell worker", because its misleading and fallacious. We are salaried employees and we work until our works done, because thats the way it is. I know that my hospital has plenty of money, I also know that I get things that most midlevel salaried trainee-level workers dont get (great insurance, dental plan, free parking, moving stipend, computer, book fund) that adds up to a nice chunk. ...Resident salaries have gone up markedly in the last ten years and work hours have gone down substantially as well.

While the last thing I want to do is to get into this argument, I did want to point out that you cannot count the benefits as perks of the job that mid-levels don't get because these are not standard.

I did not get moving expenses, CME money or a computer during residency. Our meal allowance was cut to $50 a month, the lowest in the hospital which barely covered a week of in house call meals; we also got 1 week of vacation less than all other residencies. Our health benefits weren't all that great and the book fund was $300 a year which while did buy one major book and a handbook or two, was no where near what the other residents got.

The "extras" are departmentally decided and funded by the department, so should not be calculated as a cost of teaching. While we do make more than we used to, and the hours are less, for some programs, in the habit of violating the work hours, it ain't that much less, especially at the senior level.

(stepping off my soap box)

 

[Mayhem]

Good heavens!! Which medical schools force medical students to go home and not take call? You mean you haven't taken call overnight...ever?!?

It's not that rare. The only overnight duty we have to do is OBGYN. All other rotations dismiss us at 10 pm the latest.

 

[Tired]

I don't see how doing an admit at 9PM is fundamentally different from doing one at 2AM except for the former you are probably more alert.

The difference, at least at my school, is that during the day, we often don't get to do the complete admits until the residents/attendings have gone home. Staying overnight allows the students to do more H&Ps, which they might not get to do otherwise if they were only present during the day or early evening. In my opinion, this is the advantage of night call to the student.

In addition, for those more surgically-oriented, the opportunity to be 1st assist on cases occurs almost exclusively during night call. After spending all day doing nothing but watching or holding retrators, the chance to actually cut out the appendix or play with the laparascope is pretty exciting, even if it is at 3am.

 

[Tired]

It's not that rare. The only overnight duty we have to do is OBGYN. All other rotations dismiss us at 10 pm the latest.

Wow.

I had q4 call on Medicine, Surgery, Peds, and Ob. I even had call on FP three nights. Only psych had no call.

 

[dynx]

Wow.

I had q4 call on Medicine, Surgery, Peds, and Ob. I even had call on FP three nights. Only psych had no call.

Jesus. Call on family practice? I thought my school was reasonably hard core...but I have to admit we got nothing on folks who take FP call.

 

[deleted87716]

Jesus. Call on family practice? I thought my school was reasonably hard core...but I have to admit we got nothing on folks who take FP call.

It's been a few years since I was a med student, but I had call on every rotation during 3rd year, including FM and psych. I thought that was pretty much the norm.

 

[Tired]

Jesus. Call on family practice? I thought my school was reasonably hard core...but I have to admit we got nothing on folks who take FP call.

To be completely honest: there are multiple sites for FP at my school, and I landed in the one place where they managed inpatients; thus I was "given the choice" of whether or not to do call, which of course I said I would be "excited" to do. Whatever, it got me Honors, so it was worth it.

 

[Entei]

The difference, at least at my school, is that during the day, we often don't get to do the complete admits until the residents/attendings have gone home. Staying overnight allows the students to do more H&Ps, which they might not get to do otherwise if they were only present during the day or early evening. In my opinion, this is the advantage of night call to the student.

In addition, for those more surgically-oriented, the opportunity to be 1st assist on cases occurs almost exclusively during night call. After spending all day doing nothing but watching or holding retrators, the chance to actually cut out the appendix or play with the laparascope is pretty exciting, even if it is at 3am.

Completely different experience from my school. My school is the polar opposite. Here, at the main teaching hospital, all of the services have a night float system, so your only call as a student is on L&D. Things are busy enough during the day, though, that you still get to do your H&Ps alone. For rotations done at the affiliate hospitals, call varies. I did my surgery rotation at an affiliate where I took q3 call, but even with being there overnight that often, I never had the chance to first assist on anything because even at 3AM there was never "no one else around." I think this part varies geographically, though.

I'm not claiming one way of doing things is better than another, btw. Just pointing out differences. I'm just as surprised that there are students out there first assisting on appys as some people are surprised that some schools don't require overnight call.

 

[Mayhem]

Wow.

I had q4 call on Medicine, Surgery, Peds, and Ob. I even had call on FP three nights. Only psych had no call.

I guess we're living the life. Most days on Psych and FM we were out by lunch.

My worst schedule was Surgery, where they had assigned duty days instead of a rotating schedule. My firm was Tuesday and Friday which is the dumbest thing I've ever heard. Imagine never having a Friday night off for as long as you were assigned to that firm. Anyway, it was only 4 weeks and I loved surgery so it wasn't too bad. Plus, we got a lot of cool stuff because people seem to turn into bloody idiots on a Friday night.

 

[8744]

The difference, at least at my school, is that during the day, we often don't get to do the complete admits until the residents/attendings have gone home. Staying overnight allows the students to do more H&Ps, which they might not get to do otherwise if they were only present during the day or early evening. In my opinion, this is the advantage of night call to the student.

In addition, for those more surgically-oriented, the opportunity to be 1st assist on cases occurs almost exclusively during night call. After spending all day doing nothing but watching or holding retrators, the chance to actually cut out the appendix or play with the laparascope is pretty exciting, even if it is at 3am.

I never got to do a complete admit as a medical student no matter when I was at call which was past annoying and so much like pulling teeth, being supervised and criticised continuously you understand, that I dreaded it and kept a very low profile indeed. The only good thing about this particular medicine rotation I am on now is that nobody really supervises me except for the phone call to the attending when everything is done.

I have found that everybody has a different way of doing things and what passes without comment for one person results in a ten minute diatribe from another. This is particularly true for procedures where, within certain limits, there is a good deal of variabilty between different people's techniques. I had a resident this year, for example, who insisted I use an "Arrow" arterial catheter set when I prefer the "Cook" kit.

I try to let my medical students do their thing without too much criticism unless they are doing something completely wrong. My medical student on this rotation likes to use the Arrow kit and he's pretty good with it so I keep my mouth shut.

 

[8744]

The difference, at least at my school, is that during the day, we often don't get to do the complete admits until the residents/attendings have gone home. Staying overnight allows the students to do more H&Ps, which they might not get to do otherwise if they were only present during the day or early evening. In my opinion, this is the advantage of night call to the student.

In addition, for those more surgically-oriented, the opportunity to be 1st assist on cases occurs almost exclusively during night call. After spending all day doing nothing but watching or holding retrators, the chance to actually cut out the appendix or play with the laparascope is pretty exciting, even if it is at 3am.

I certainly see your point but I confess I would rather sleep than learn. What I hated about medical student call was that we were never post-call and, on my surgery rotation, had to spend most of the next day performing our usual pretend duties.

It just wiped me out. I hated it. Maybe I'm different than most of you but I need sleep. Another good thing about the medicine rotation I am on is that there are so mant patients on the service (130 or so covered by one senior and one junior resident) that we don't even have to make a pretense of rounding on patients when post-call and usually get to go home before 8AM (After admittting almost non-stop for 24 hours. I kid you not. There is, apparently, no cap.) In fact, there's not even much sign out. Talking to the attending during the night is about it. The attendings round on the patients and the resident, if he is not post call, makes an effort to help.

I follow my ICU patients closely but that's about it.

When I was at Duke, the medicine service was not such a patient mill and we formally rounded on all of our patients. Of course, our census was rarely more than 15 so it was possible.

 

[sunlioness]

One thing I remember from starting my IM internship was that no one expected us to know a darn thing. They've been there before too and remember what it's like. I know I do! And while every place has jerks, most residents are very understanding, supportive, and helpful. You ARE ready for this. And you'll learn what you need to know by doing it, which is after all the point.

 

[sunlioness]

Hey- I'm the original OP. I think I'm more scared after reading all of these posts!

What do you advise for an intern if you get a resident that doesn't want to be bothered with their new 'tern?"

I guess I'm most worried about night calls and what is expected at the intern level. My med school dismissed the medstudents before overnight call as there weren't rooms for the students, so I haven't had alot of experience with problems that arise on night call.
I get that if it's pain, agitation, nausea that I handle these myself. But how much is the intern expected to know about calls that aren't "pedistrian?" Like night calls for GI bleeds, Flash Pull Edema, PE whatever?

Don't be scared. Not yet. My first rotation as an intern was in the MICU. I had a resident whose philosophy was that if he helped me get my work done I wouldn't learn anything. So he sat there and played on the internet while I struggled through my sign-out post-call. But the point is, he was a jerk and most weren't like him and I still got through it. Would I do it again? Hell, no. But I know that I could and I did learn a lot.

I guess all I can say is that if you get a resident who "can't be bothered", you just have to make them bother. You are their responsibility. Your screw-ups are their screw-ups and it's their job to supervise you. So even if they're being jerks about it, remember that that's THEIR problem, not yours. And make sure you ask for what you need. There is no shame in that.

 

[Tater]

Incredibly, the thing that will get you is not necessarily knowing how to recognize and handle a GI bleed. It is the ability to prioritize and multi-task. You will feel very overwhelmed at times when nurses are paging you every five minutes, your chief is paging you every 3 and the patients are hanging outside their doors demanding pain medications.

I repeat, you will feel very overwhelmed.

But if you keep a tight list, utilize your time effectively, and address issues in the order they need to be addressed, you will at least maintain a feeling of control. It certainly is hard, but you will get better with time.

I have had technically worse calls these past couple of months than when I first started, but they still pale in comparison to July. Heh

 

[jon62781]

You are alone. You have a senior, but if you call him asking for pain med orders, he/she will hate you. Just ask the nurse if the patient is allergic/sensitive to any meds. Then pull out your pharmacopeia. After a few times of this, you'll get the hand of MSO4 1mg IV q4hrs PRN pain. You'll likely become more familiar with Zofran 4mg IV q6hrs PRN N/V.

Dude, you are stingy with the morphine!

 

[Tired]

Dude, you are stingy with the morphine!

Seriously, I'm praying the 1mg q4h dosing is for a 10kg one-year old.

 

[deleted109597]

Seriously, I'm praying the 1mg q4h dosing is for a 10kg one-year old.

Eh, I usually give more, and I think I may have been thinking something else at that point.

Although, for some reason, the service I am on thinks that 1mg qhour is sufficient, and since it is medicine, I just go along rather than listen to the 3 hour explanation should I question it. Rarely do I give less than 5 in the ED.

 

[Tired]

Although, for some reason, the service I am on thinks that 1mg qhour is sufficient, and since it is medicine, I just go along rather than listen to the 3 hour explanation should I question it. Rarely do I give less than 5 in the ED.

From my last Ortho chief:

"The one thing I want you guys to take away from this rotation, even if you end up in another specialty, is this. If you're in the ER, or an urgent care clinic, or whatever, and you have a guy who just broke his arm, man-up and give him 10mg of morphine. Don't d!ck around with 2mg at a time, just relieve their pain. That's number one."

 

[fang]

Eh, I usually give more, and I think I may have been thinking something else at that point.

If I'm not mistaken, McNinja is an MS4. Personally I'd rather hear intern prescribing advice from people with some experience past my own. I know he mentioned here somewhere that while "technically illegal" he would write for medications for nausea, pain, etc without a cosignature... I did 2 sub-I's and never had to do that. It's really not that hard to track down someone else on the team for a cosignature.

Anyway McNinja, I apoplogize if you're an intern or resident, but if you're an MS4 maybe you should back up a step and listen to advice before dispensing it-- Sub-I does not equal intern, no matter how autonomous you were!

 

[deleted109597]

Fang, I can give advice about everything and anything I want. Nobody has to listen to it.

All I am saying is that after MY sub-I, I felt comfortable giving orders for pain and nausea. I didn't say I felt comfortable giving orders for ACLS. That being said, there are ACLS instructors who happen to be in the same graduating class as me. They probably feel more comfortable doing that. There are people who feel more comfortable intubating people after an anesthesia rotation, they can probably give advice based on that. Nothing about the title MS4 means you have to always take advice and never give it.

Sub-I's are also different at every school. Hell, they are different within the same school. I don't report to a resident. I report to the attending on mine. I can't call him at night for simple things like pain and nausea. I can call him for other things.

Also, there is only 1 intern on call at our entire hospital at night, so tracking them down for a cosignature really is hard sometimes. Plus, hospital policy is orders must be cosigned with 24 hours, not cosigned before being done. I figure that this is still skirting the law, but like I said, I don't write orders for things I don't feel comfortable for. BMP, CBC, CXR in AM is not a particularly hard order. You page your senior for every one of those you write, instead of waiting for rounds, and you will eventually be told to just not write them.

Something else pisses me off about my current SubI, and that is that I am carrying 6 patients, while the medicine intern only has 5 today. However, that is a different thread.

So, in summary, just like anyone else who asks for advice on an internet board, they don't have to listen to it. Feel free to ignore any posts I make in the future.

 

[lucky_deadman]

If I'm not mistaken, McNinja is an MS4. Personally I'd rather hear intern prescribing advice from people with some experience past my own. I know he mentioned here somewhere that while "technically illegal" he would write for medications for nausea, pain, etc without a cosignature... I did 2 sub-I's and never had to do that. It's really not that hard to track down someone else on the team for a cosignature.

Anyway McNinja, I apoplogize if you're an intern or resident, but if you're an MS4 maybe you should back up a step and listen to advice before dispensing it-- Sub-I does not equal intern, no matter how autonomous you were!

Let's keep things civil here. Everyone back to their neutral corners and try to keep the punches above the belt. If you two insist on keeping this up, well at least let me be the promoter and sell some tickets.

BTW: If his advice offends you, as being a possible med student, then how fragile your ego must be when the nurses have to bail you out and tell you what you should really give the patient. But oh wait, you're the all mighty doctor to be and would never hear to that.

 

[fang]

So, in summary, just like anyone else who asks for advice on an internet board, they don't have to listen to it. Feel free to ignore any posts I make in the future.

You're right, that's why I take what you're saying with a grain of salt-- no offense, I'm sure you're a bright person, but you can't equate a few months on a sub-I with 8 months of internship. Plus, you didn't exactly say "on my sub-I I got used to giving XXX"... instead it was "oh, I usually give 1mg morphine unless I'm in the ED... "

I never had to page anyone to cosign an order-- we all worked in the same general area, and it was not an issue. I think you mean that verbal orders need to be signed in 24 hours, but med students can't give verbal orders. It's illegal, and there would be consequences if someone had an adverse reaction (which can happen even if you "feel comfortable").

I'm glad you're confident about the morphine, but in MY limited experience 1mg is probably good for a 90 year old woman who weighs 75# with a bad hangnail, not a typical dose.

I think there's a fine line between having confidence and overstepping your role-- imo, routinely giving verbal orders as though you're the intern is overstepping the role of MS4.

 

[fang]

Let's keep things civil here. Everyone back to their neutral corners and try to keep the punches above the belt. If you two insist on keeping this up, well at least let me be the promoter and sell some tickets.

BTW: If his advice offends you, as being a possible med student, then how fragile your ego must be when the nurses have to bail you out and tell you what you should really give the patient. But oh wait, you're the all mighty doctor to be and would never hear to that.

OK, I'll be civil. I would love to hear advice and suggestions from a nurse, especially one who seems to know his/her stuff-- it definitely wouldn't offend me. I'm not offended by mcninja's claims, just questioning his/her authority.

 

[deleted109597]

You're right, that's why I take what you're saying with a grain of salt-- no offense, I'm sure you're a bright person, but you can't equate a few months on a sub-I with 8 months of internship. Plus, you didn't exactly say "on my sub-I I got used to giving XXX"... instead it was "oh, I usually give 1mg morphine unless I'm in the ED... "

I wasn't equating them. I was equating it with the 2 weeks it takes for a normal person to get used to not having to ask for help with every little thing. YMMV

I never had to page anyone to cosign an order-- we all worked in the same general area, and it was not an issue.

Read as "I never leave sight of the residents." Seriously, the only time we are all together is during rounds, and even then we are told to go off and do things on our own. Maybe at the VA, where we all sat around and typed into computers instead of actually doing work, but I haven't been there since third year, and won't ever return.

I think you mean that verbal orders need to be signed in 24 hours, but med students can't give verbal orders. It's illegal, and there would be consequences if someone had an adverse reaction (which can happen even if you "feel comfortable").

Tell me how my hospital works once you start working here. Also, tell that to my residents who tell me to call floors and give orders.

I'm glad you're confident about the morphine, but in MY limited experience 1mg is probably good for a 90 year old woman who weighs 75# with a bad hangnail, not a typical dose.

You wouldn't believe how many 90 year old women are on our service right now. Also, if you read the original post, I also misspelled hang. If you would like to also correct my spelling/grammar, please feel free to do so at this time.

I think there's a fine line between having confidence and overstepping your role-- imo, routinely giving verbal orders as though you're the intern is overstepping the role of MS4.

Once again, if your team expects you to do it, you are not overstepping your role.

 

[Tired]

but you can't equate a few months on a sub-I with 8 months of internship.

Although it is necessary in our modern medical system, if I were a patient, the thought of either a sub-i or an intern writing my med orders would make me want to crap my pants.

 

[fang]

I wasn't equating them. I was equating it with the 2 weeks it takes for a normal person to get used to not having to ask for help with every little thing. YMMV

Read as "I never leave sight of the residents." Seriously, the only time we are all together is during rounds, and even then we are told to go off and do things on our own. Maybe at the VA, where we all sat around and typed into computers instead of actually doing work, but I haven't been there since third year, and won't ever return.

Tell me how my hospital works once you start working here. Also, tell that to my residents who tell me to call floors and give orders.

You wouldn't believe how many 90 year old women are on our service right now. Also, if you read the original post, I also misspelled hang. If you would like to also correct my spelling/grammar, please feel free to do so at this time.

Once again, if your team expects you to do it, you are not overstepping your role.

Despite the vitriol and show of confidence here, I STILL would rather hear from an intern/resident than a fellow MS4 about common intern calls. I don't need to defend my autonomy as a sub-I-- when the medicine service is 2 floors of one hospital it's just not hard to find people. Finally, it doesn't matter which hospital you work at, MS4's can't write orders because we don't have a provisional license.

 

[SLUser11]

Despite the vitriol and show of confidence here, I STILL would rather hear from an intern/resident than a fellow MS4 about common intern calls. I don't need to defend my autonomy as a sub-I-- when the medicine service is 2 floors of one hospital it's just not hard to find people. Finally, it doesn't matter which hospital you work at, MS4's can't write orders because we don't have a provisional license.

I can chime in here....I have eight months of surgical internship behind me.

I find what works the best for pain is to clap your hands together really loud, and then move them up and down against eachother, creating alot of friction, until their, like, really warm....then you apply both your hands firmly to the patient's arm/chest/whatever's injured. Works every time.

Sometimes they'll question what you're doing, to which you should reply "AAAAIIIIIIIIIGH!!" Afterwards, they may be surprised, and say something like "how'd you do that?" Don't tell them.

Regardless of their injury, if you use that technique, they should be able to finish the tournament.

Learned that one from Mr. Miyagi.

 

[somedude98317]

From my last Ortho chief:

"The one thing I want you guys to take away from this rotation, even if you end up in another specialty, is this. If you're in the ER, or an urgent care clinic, or whatever, and you have a guy who just broke his arm, man-up and give him 10mg of morphine. Don't d!ck around with 2mg at a time, just relieve their pain. That's number one."

I like the way your chief thinks

 

[Tired]

I find what works the best for pain is to clap your hands together really loud, and then move them up and down against eachother, creating alot of friction, until their, like, really warm....then you apply both your hands firmly to the patient's . . .

When I read this I kind of got turned on. Anyone else? Anyone? Anyone?

 

[fang]

I can chime in here....I have eight months of surgical internship behind me.

I find what works the best for pain is to clap your hands together really loud, and then move them up and down against eachother, creating alot of friction, until their, like, really warm....then you apply both your hands firmly to the patient's arm/chest/whatever's injured. Works every time.

Sometimes they'll question what you're doing, to which you should reply "AAAAIIIIIIIIIGH!!" Afterwards, they may be surprised, and say something like "how'd you do that?" Don't tell them.

Regardless of their injury, if you use that technique, they should be able to finish the tournament.

Learned that one from Mr. Miyagi.

I prefer accidentally letting my scrubs come untied just as I enter the room, sending the pants and the attached pager crashing to the floor with the case and battery then flying in opposite directions. The mutual embarassement distracts the patient from their pain. The wonderful thing is that there are rarely any side effects, and I don't need to get a cosignature. But I suppose it's a question of style; maybe in 5 months I'll switch to the Miyagi method.

 

[mallard79]

As far as late night orders, most people develop their own preferences...the important things to know are the correct dose, contraindications, etc. Most pharmacopeias have a equal analgesic doses for pain meds, I know I check mine often. Morphine is notoriously underdosed, ie the person who feels comfortable giving 1-2 mg IV dilaudid will turn around and give 2mg morphine on a similar patient (or even homeopathic 1mg q4 ). Also, always ask for the patients allergies---there is a current lawsuit at my institution where at 3 am a nurse called and requested a rather benign medication which the resident immediately ordered, one bout of angioedema later, he got the pleasure of speaking with risk management. Another point I think is helpful, disclosure--intern speaking, control pain quickly then de escalate just as quickly. I will generally start with iv meds, then quickly go to po meds or a patch, short acting to long acting, etc.

 

[deleted109597]

Despite the vitriol and show of confidence here, I STILL would rather hear from an intern/resident than a fellow MS4 about common intern calls.

That's fine, but you still don't have to tell me not to talk. Since you didn't ask the question, I don't feel I need to respect your wishes, just the OPs. Since his post asked if we were scared too, I assume he meant MS4s and not interns in February (although there are some that are still scared out there).
Also, consider the fact that for most of us MS4s, there will be no more formal education until intern year starts. Our year is over at my school, and is the same at many others. So it's not like I am going to absorb nonexistant experience before my first call. So if you aren't comfortable now (at least slightly), you won't be at all then, which is why the OP originally asked the question. You'll note that I didn't tell him to do it my way, just that he would get the hang of it, and gave a few common (with typos) calls. Some people give Reglan/Phenergan instead. Some people give PO pain meds. Whatever they do, they will get comfortable, and very quickly. If they don't, their senior will make sure they get comfortable quickly just so they stop bugging them.

I don't need to defend my autonomy as a sub-I-- when the medicine service is 2 floors of one hospital it's just not hard to find people.

Whenever you feel like it, you can stop making assumptions about my hospital . Simply put, I can't find the people on medicine service without paging them, and even then they are often on one of the other 7 floors. Either I have them walk down to where the order is (and get told not to do that by them), or I take the chart off the floor (and get told not to do that by the nurse). Since it has been told to us at our hospital that we can write orders, I do. You act like I am writing amiodarone orders or something here.

Finally, it doesn't matter which hospital you work at, MS4's can't write orders because we don't have a provisional license.

Ok. Tell our clerkship director that. And my attendings. And my residents. PM me and I will give you each and every one of their pagers. I bet you could put a poll up and ask the other MS4s if they write orders. I would guess it is 50/50. However, since I have worked at 6 hospitals in 4 states during my 4th year, and written orders at all of them, I assure you this isn't a universal policy that my school is breaking. YMMV though.

 

[Faebinder]

That's fine, but you still don't have to tell me not to talk. Since you didn't ask the question, I don't feel I need to respect your wishes, just the OPs. Since his post asked if we were scared too, I assume he meant MS4s and not interns in February (although there are some that are still scared out there).
Also, consider the fact that for most of us MS4s, there will be no more formal education until intern year starts. Our year is over at my school, and is the same at many others. So it's not like I am going to absorb nonexistant experience before my first call. So if you aren't comfortable now (at least slightly), you won't be at all then, which is why the OP originally asked the question. You'll note that I didn't tell him to do it my way, just that he would get the hang of it, and gave a few common (with typos) calls. Some people give Reglan/Phenergan instead. Some people give PO pain meds. Whatever they do, they will get comfortable, and very quickly. If they don't, their senior will make sure they get comfortable quickly just so they stop bugging them.

Whenever you feel like it, you can stop making assumptions about my hospital . Simply put, I can't find the people on medicine service without paging them, and even then they are often on one of the other 7 floors. Either I have them walk down to where the order is (and get told not to do that by them), or I take the chart off the floor (and get told not to do that by the nurse). Since it has been told to us at our hospital that we can write orders, I do. You act like I am writing amiodarone orders or something here.

Ok. Tell our clerkship director that. And my attendings. And my residents. PM me and I will give you each and every one of their pagers. I bet you could put a poll up and ask the other MS4s if they write orders. I would guess it is 50/50. However, since I have worked at 6 hospitals in 4 states during my 4th year, and written orders at all of them, I assure you this isn't a universal policy that my school is breaking. YMMV though.

PLUS some 4th years are acting interns as well so they write orders as well.

 

[fang]

That's fine, but you still don't have to tell me not to talk. Since you didn't ask the question, I don't feel I need to respect your wishes, just the OPs. Since his post asked if we were scared too, I assume he meant MS4s and not interns in February (although there are some that are still scared out there).
Also, consider the fact that for most of us MS4s, there will be no more formal education until intern year starts. Our year is over at my school, and is the same at many others. So it's not like I am going to absorb nonexistant experience before my first call. So if you aren't comfortable now (at least slightly), you won't be at all then, which is why the OP originally asked the question. You'll note that I didn't tell him to do it my way, just that he would get the hang of it, and gave a few common (with typos) calls. Some people give Reglan/Phenergan instead. Some people give PO pain meds. Whatever they do, they will get comfortable, and very quickly. If they don't, their senior will make sure they get comfortable quickly just so they stop bugging them.

Whenever you feel like it, you can stop making assumptions about my hospital . Simply put, I can't find the people on medicine service without paging them, and even then they are often on one of the other 7 floors. Either I have them walk down to where the order is (and get told not to do that by them), or I take the chart off the floor (and get told not to do that by the nurse). Since it has been told to us at our hospital that we can write orders, I do. You act like I am writing amiodarone orders or something here.

Ok. Tell our clerkship director that. And my attendings. And my residents. PM me and I will give you each and every one of their pagers. I bet you could put a poll up and ask the other MS4s if they write orders. I would guess it is 50/50. However, since I have worked at 6 hospitals in 4 states during my 4th year, and written orders at all of them, I assure you this isn't a universal policy that my school is breaking. YMMV though.

Look dude, I'm not taking issue with your ability, I'm sure you're an excellent med student. I'm also not objecting to simply stating, "Hey, I'm an MS4 with some experience and here's what I do". Instead, I read through your advice, wondered about the 1mg MSO4 thing, and then saw your signature which says "16 days to match" and thought, "aha!! This is no savvy intern here, it's someone just like me!!" Just state who you are, especially when you're giving advice to people with the same level of experience as you.

 

[VentdependenT]

From my last Ortho chief:

"The one thing I want you guys to take away from this rotation, even if you end up in another specialty, is this. If you're in the ER, or an urgent care clinic, or whatever, and you have a guy who just broke his arm, man-up and give him 10mg of morphine. Don't d!ck around with 2mg at a time, just relieve their pain. That's number one."

Until some phattie with sleep apnea crumps from hypoventilation from that slug o' morphine you gave him. Point is, your chief was right about obliterating pain but ya gotta judge your patient. Pain wont kill a person as fast as apnea will.

Fentanyl is the way to go for acute pain. 10ucg of fentanyl = 1mg of morphine = 0.125 mg dilauded (powerful stuff). Fentanyl onset&peak is 3-5 min while morphine onset/peak is 10min & 20-30min respectively.

On the floors don't fear the PCA. Just dont put a continuous dose on it.

 

[deleted109597]

Look dude, I'm not taking issue with your ability, I'm sure you're an excellent med student. I'm also not objecting to simply stating, "Hey, I'm an MS4 with some experience and here's what I do". Instead, I read through your advice, wondered about the 1mg MSO4 thing, and then saw your signature which says "16 days to match" and thought, "aha!! This is no savvy intern here, it's someone just like me!!" Just state who you are, especially when you're giving advice to people with the same level of experience as you.

So, you're saying the signature isn't enough for someone to gather that I am a medical student?

 

[lucky_deadman]

Look dude, I'm not taking issue with your ability, I'm sure you're an excellent med student. I'm also not objecting to simply stating, "Hey, I'm an MS4 with some experience and here's what I do". Instead, I read through your advice, wondered about the 1mg MSO4 thing, and then saw your signature which says "16 days to match" and thought, "aha!! This is no savvy intern here, it's someone just like me!!" Just state who you are, especially when you're giving advice to people with the same level of experience as you.

This whole pissing contest to see who pisses on the post last to mark it as their territory is a bit old. It was fun to read at first, now just lame.

If you two insist on keeping this battle of wills up, it's gonna be a non-issue as we'll all be residents and probably even attendings and some of us retired by the time you two kiss and make up or at least part ways amicably.

 

[OR 1]

My word those are alot of opinions! Thanks.

Not to offend anyone, I think I was mostly interested in the opinions of the current interns and residents. Although, I'm interested in ideas from MS4's.

Dr McNija's comments were of interest however, because I think it is what he is saying that scares me most. As a ms4 I have done the usual, replacing eletrolytes, ording AM labs,Chest x rays etc without a resident's input. But honestly, I don't have a good sense of pain med management drugs. I don't have a good sense at this level of my training of how strong morphine is compared to fentynl or other drugs- how strong the vasopressors are compairing one drug to another. Dr McNija seems to be writing independent orders, that I don't feel comfortable doing.

I'm not trying to blast Dr. McNija as I don't know him/her. But there has been alot of concern in the news about the overblown ego's of the Gen Y population from years of being told they're "special, unique and brillant" which isn't supported by talent or knowledge. I have been at a UC school where ms3's and 4's were giving orders to OBGYN nurses with no resident input. I don't want to be writing orders because others are doing it. I won't do something I don't feel comfortable doing. Some of these students were like ready to "hang with Debakey" and I'm like what happened at my school, we were good students but not doing that kind thing.

In Dr.McNija's defense, I've had residents who told me to go ahead and treat my patient and would sign orders before I had even seen the patient, that made me nervous, as I wasn't sure if the dosage was correct so I'd call the pharmacy.

On the other hand , I can certainly do somethings and I am motivated and egar & don't want to be a wennie. I guess it varries from student to student but I just want to get a sense of what level is an incoming intern supposed to be?

 

[lucky_deadman]

My word those are alot of opinions! Thanks.

Not to offend anyone, I think I was mostly interested in the opinions of the current interns and residents. Although, I'm interested in ideas from MS4's.

Dr McNija's comments were of interest however, because I think it is what he is saying that scares me most. As a ms4 I have done the usual, replacing eletrolytes, ording AM labs,Chest x rays etc without a resident's input. But honestly, I don't have a good sense of pain med management drugs. I don't have a good sense at this level of my training of how strong morphine is compared to fentynl or other drugs- how strong the vasopressors are compairing one drug to another. Dr McNija seems to be writing independent orders, that I don't feel comfortable doing.

I'm not trying to blast Dr. McNija as I don't know him/her. But there has been alot of concern in the news about the overblown ego's of the Gen Y population from years of being told they're "special, unique and brillant" which isn't supported by talent or knowledge. I have been at a UC school where ms3's and 4's were giving orders to OBGYN nurses with no resident input. I don't want to be writing orders because others are doing it. I won't do something I don't feel comfortable doing. Some of these students were like ready to "hang with Debakey" and I'm like what happened at my school, we were good students but not doing that kind thing.

In Dr.McNija's defense, I've had residents who told me to go ahead and treat my patient and would sign orders before I had even seen the patient, that made me nervous, as I wasn't sure if the dosage was correct so I'd call the pharmacy.

On the other hand , I can certainly do somethings and I am motivated and egar & don't want to be a wennie. I guess it varries from student to student but I just want to get a sense of what level is an incoming intern supposed to be?

You'll be fine. Sounds like you are able to recognize your limitations. One of the best pieces of advice I've received and can pass along is this: If stumped just ask the nurse(s); "What do we normally do for this?". They want to ensure you don't kill the patient as it reflects poorly on them and it's their license on the line as well.

Otherwise, find a couple drugs from each class that you like and feel comfortable with. Learn them well (such as common dosages) and then build on them as you progress.

 

[Tired]

In Dr.McNija's defense, I've had residents who told me to go ahead and treat my patient and would sign orders before I had even seen the patient, that made me nervous, as I wasn't sure if the dosage was correct so I'd call the pharmacy.

Wow.

Most of us just carry a pharmacopeia.

 

[fang]

I'm not trying to blast Dr. McNija as I don't know him/her. But there has been alot of concern in the news about the overblown ego's of the Gen Y population from years of being told they're "special, unique and brillant" which isn't supported by talent or knowledge. I have been at a UC school where ms3's and 4's were giving orders to OBGYN nurses with no resident input. I don't want to be writing orders because others are doing it. I won't do something I don't feel comfortable doing. Some of these students were like ready to "hang with Debakey" and I'm like what happened at my school, we were good students but not doing that kind thing.

I tend to agree, which is why I reacted. I see over-inflated egos as a personality flaw, not a positive sign of confidence, and in people with no obvious accomplishments to support their grandiosity it implies to me they are overcompensating for a lack of knowledge or talent. On the other hand, in medicine sometimes you have to act more confident that you are toward the patient or you'll risk losing their trust... you can't be wishy-washy when you tell someone you'll be removing their appendix in 2 hours. I think the difference is whether you really "believe your own rap". I have to admt it's a pet peeve of mine, and never thought of it as a generation Y thing before.

To OR1, as a fellow MS4 I think most of us feel some uncertainty about the questions you're asking-- I posted a similar thread about 2 months ago. If we're honest, I think at this level we have a lot to learn about prescribing pain meds, treating nausea effectively, etc. You're asking what level an incoming intern is supposed to be-- I bet most of us will have done 1 or 2 sub I's and will know how to replete K+ and Mg pretty well, but will need to investigate a bit to determine what to do with mental status changes or new breakthrough pain. I also have a feeling that after a few months of internship we'll all be at the same level with regard to the common stuff reguardless of our experience coming in.

 

[Wahoos]

To the OP, Here is what I Rec:

1.) If you get called for something during the first few months of residency, always go see the patient, no matter how big or small, unless timing or circumstances does not permit you.

2.) After seeing the patient, if you are comfortable with the situation deal with it, if not, then always call your senior to ask for advice, they would be more appreciative if you call to tell them something is up with the patient than to find out on round that one of the patients had an MI overnight or clotted off their new graft but you forgot to mention it because it was 3am. The attending will have your senior and you for breakfast. Plus it is just good patient care to ask for help when you need it, don't assume anything..... I am sure you heard the saying "Assumption is the mother of all F#$% ups".

3.) As time passes you will learn through experience what is serious and what is not and you will be able to triage your time better and also able to take care alot of the problems over the phone.

4.) As one of my Spine Attending tells it " TRUST NO ONE. THERE IS ASSASSINS EVERYWHERE!" You will learn the meaning of that sentence as you go through residency. And if you ever want to make sure something is done, do it your self.

Here is a book that I would highly recommend, "On Call, Principles and Protocals"

http://www.amazon.com/Call-Principles-Protocols-Shane-Marshall/dp/0721650791

http://www.harcourt-international.com/catalogue/title.cfm?ISBN=072163902X

Both are the same book except one is the 4th edition. It teaches you how to deal with the most common problems overnight as a Intern. Even though I am in Ortho, I read this book front to back and it has taugh me a ton on medical management, which will last me a long time. If you want a book for surgery, there is an on call surgery book that is very good as well.

Hope this helps.

 

[Tired]

To OR1, as a fellow MS4 I think most of us feel some uncertainty about the questions you're asking-- I posted a similar thread about 2 months ago. If we're honest, I think at this level we have a lot to learn about prescribing pain meds, treating nausea effectively, etc. You're asking what level an incoming intern is supposed to be-- I bet most of us will have done 1 or 2 sub I's and will know how to replete K+ and Mg pretty well, but will need to investigate a bit to determine what to do with mental status changes or new breakthrough pain. I also have a feeling that after a few months of internship we'll all be at the same level with regard to the common stuff reguardless of our experience coming in.

Weren't you listening? He doesn't care about your advice because you're just a med student. Why are you giving advice? What do you know about it?

 

[deleted109597]

Weren't you listening? He doesn't care about your advice because you're just a med student. Why are you giving advice? What do you know about it?

Am I the only one that thinks one troll account is responding to another with that part there?

 

[sophiejane]

To the OP, Here is what I Rec:

1.) If you get called for something during the first few months of residency, always go see the patient, no matter how big or small, unless timing or circumstances does not permit you.

2.) After seeing the patient, if you are comfortable with the situation deal with it, if not, then always call your senior to ask for advice, they would be more appreciative if you call to tell them something is up with the patient than to find out on round that one of the patients had an MI overnight or clotted off their new graft but you forgot to mention it because it was 3am. The attending will have your senior and you for breakfast. Plus it is just good patient care to ask for help when you need it, don't assume anything..... I am sure you heard the saying "Assumption is the mother of all F#$% ups".

3.) As time passes you will learn through experience what is serious and what is not and you will be able to triage your time better and also able to take care alot of the problems over the phone.

4.) As one of my Spine Attending tells it " TRUST NO ONE. THERE IS ASSASSINS EVERYWHERE!" You will learn the meaning of that sentence as you go through residency. And if you ever want to make sure something is done, do it your self.

Here is a book that I would highly recommend, "On Call, Principles and Protocals"

http://www.amazon.com/Call-Principles-Protocols-Shane-Marshall/dp/0721650791

http://www.harcourt-international.com/catalogue/title.cfm?ISBN=072163902X

Both are the same book except one is the 4th edition. It teaches you how to deal with the most common problems overnight as a Intern. Even though I am in Ortho, I read this book front to back and it has taugh me a ton on medical management, which will last me a long time. If you want a book for surgery, there is an on call surgery book that is very good as well.

Hope this helps.

Thank you. This is the most valuable post in the entire thread and actually made it worth it to slog through the pi$$ing contest that this thread had become.