All about 2010 Interns!

[smq123]

I thought the same thing. Even if you CAN request a consult with a simple computer order, I think it would be pretty rude to call a consult without actually CALLING the consultant (or service-specific resident).

Not quite.

In the world of private practice (especially in a hospital like mine, where there are few residents), consult requests get sent to your office secretary. She relays it to whichever partner happens to be on call that day, and the physician sees the patient between office hours or after office hours are over. The attendings would actually be quite peeved if I called the office and asked to speak with them directly, since most of them are either seeing patients in the office or finishing charts or paperwork.

The only time I have ever called an office and asked to speak to a consulting physician directly was for a cancer patient who was starting to crump. Obviously, that was an emergency, though.

Your view is colored (as mine was) by being in the university setting, where most consults get called in to a service pager (being held by a resident) or to a consultant who is seeing patients in the hospital all day long. This is not how it frequently works in a community hospital, though.

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[MattD]

Not quite.

In the world of private practice (especially in a hospital like mine, where there are few residents), consult requests get sent to your office secretary. She relays it to whichever partner happens to be on call that day, and the physician sees the patient between office hours or after office hours are over. The attendings would actually be quite peeved if I called the office and asked to speak with them directly, since most of them are either seeing patients in the office or finishing charts or paperwork.

The only time I have ever called an office and asked to speak to a consulting physician directly was for a cancer patient who was starting to crump. Obviously, that was an emergency, though.

Your view is colored (as mine was) by being in the university setting, where most consults get called in to a service pager (being held by a resident) or to a consultant who is seeing patients in the hospital all day long. This is not how it frequently works in a community hospital, though.

Sure, makes sense in that setting

 

[seahawk188]

Bump! Any more 2010 interns here?

A lot of ppl talk about prerounding. What is exactly prerounding?

 

[smq123]

A lot of ppl talk about prerounding. What is exactly prerounding?

Prerounding is seeing your patients in the morning before formal rounds with the attending (pre-rounds). You write notes, see how the patient did overnight, etc.

You're not familiar with night float, cross-cover, or prerounding....do you have ANY clinical experience in the US?

 

[seahawk188]

...

You're not familiar with night float, cross-cover, or prerounding....do you have ANY clinical experience in the US?

No, I came from a very different system - that's why I am here!

 

[seahawk188]

Prerounding is seeing your patients in the morning before formal rounds with the attending (pre-rounds). You write notes, see how the patient did overnight, etc.

.

So prerounding is just a fancy word for anything you do before the rounding, what else can you do besides prerounding during those hours?

 

[gutonc]

You're not familiar with night float, cross-cover, or prerounding....do you have ANY clinical experience in the US?

I was just thinking the same thing.

To all Foreign Grads out there, this is why USCE is really important.

I'm sure seahawk188 is a smart person, but I am super excited to not have to deal with you/him/her next month.

 

[smq123]

So prerounding is just a fancy word for anything you do before the rounding, what else can you do besides prerounding during those hours?

I'm confused by the question. What else would you want to do? Prerounding is always such a chaotic time (the septic patient's CBC didn't get drawn, the patient with a PE didn't get his coags done and you have to hunt down the nurse ASAP, another patient is now complaining of chest pain, etc.), that what else would you do besides seeing patients, writing notes, changing dressings, getting vitals, checking labs, and reading consults that were done after you went home?

I'm sure seahawk188 is a smart person, but I am super excited to not have to deal with you/him/her next month.

Maybe the orientation should include a week of shadowing an intern or something.

 

[seahawk188]

I was just thinking the same thing.

To all Foreign Grads out there, this is why USCE is really important.

I'm sure seahawk188 is a smart person, but I am super excited to not have to deal with you/him/her next month.

Just took a long hiatus from medicine, had a family and kids, had some life, no zip student loans, now back to my love - what's wrong with that?

I prefer to work alone if my co-intern is a condescending or think-they-know-it-all AMG, or FMG in that matter.

 

[seahawk188]

So prerounding is just a fancy word for anything you do before the rounding, what else can you do besides prerounding during those hours?

I thought I was a bit sarcastic here.

 

[smq123]

Just took a long hiatus from medicine, had a family and kids, had some life, no zip student loans, now back to my love - what's wrong with that?

I prefer to work alone if my co-intern is a condescending or think-they-know-it-all AMG, or FMG in that matter.

This is the point gutonc is trying to make. You can't just "work alone." The fact that you think that you can is very concerning!

If you don't know how the system works, you'll end up slowing EVERYONE down, since rounds cannot start until everyone (including you) is ready. If you're not familiar with what needs to be done, either the other interns will be forced to do your work for you, or rounds will start 1-2 hours late....which means that you all leave the hospital 1-2 hours late.

There's nothing wrong with taking time away from medicine, but the more able you are to "hit the ground running" as an intern, the easier it will be for you and for your fellow residents.

 

[SouthernSurgeon]

but I am super excited to not have to deal with you/him/her next month.

Agree.

 

[seahawk188]

This is the point gutonc is trying to make. You can't just "work alone." The fact that you think that you can is very concerning!

..

Yeah, right! if gutonc can work alone, why can't I? Where is the spirit of teamwork? where is that warm hand extending to you if you need help? Don't b******t me here!

Maybe I don't have substential USCE, but I have non-USCE elsewhere. You think I cannot pick it up quickly?

 

[seahawk188]

Agree.

Yet another selfish b*******t!

 

[smq123]

Yeah, right! if gutonc can work alone, why can't I? Where is the spirit of teamwork? where is that warm hand extending to you if you need help? Don't b******t me here!

Maybe I don't have substential USCE, but I have non-USCE elsewhere. You think I cannot pick it up quickly?

- gutonc is a fellow, not an incoming intern - i.e., he already DID his internship 4-5 years ago. What he meant was that he is glad that he doesn't have to supervise you while you struggle to learn on the job. He never said that he was able to "work alone" as an intern.

- The "spirit of teamwork" only extends so far. I'm happy to help my fellow teammates, but I have never been asked to carry their load for them. That's the difference.

- I hope, for your sake, that you DO pick it up quickly.

- Insults and profanity is not necessary when responding to other people's posts. Please keep it civil.

 

[SouthernSurgeon]

Yet another selfish b*******t!

So following smq's request I'll try for civility here. But seriously, you should be freaking TERRIFIED right now. Your posts here have made it clear that you have NO understanding of how a US clinical service works, and in fact have some dangerous misconceptions. Yet in a few short weeks you are going to be in a position of actual responsibility. You should spend less time insulting me, and more time LEARNING.

 

[Winged Scapula]

I'd also suggest that you try and accept the advice being offered with the grace that it is intended.

No one doubts that you personally can learn quickly: no one here knows anything about you.

But we ALL have worked with FMGs without an ounce of USCE and believe me, there is no time to learn the basic things such as how rounds work, how to present patients, write notes, etc. I went to medical school outside of the US and even though I did a lot of USCE, I can tell you that every hospital works a little differently and that it was overwhelming trying to figure out where the call room was, let alone trying to figure out how "American medicine" works.

Interns without USCE are often seen as a liability because they don't pull their weight in work because they're too busy figuring out how the hospital works...things the other interns learned as a student. This is not meant as a reflection on how smart or capable you are, but the fact remains that if I were to do an internship in say, Croatia, I wouldn't have the foggiest about how their rounds are run, what is expected, what the NORMAL behavior was.

By way of personal anecdote: I ended up doing an extra month of Trauma as an intern because one of the off service interns (with no USCE) was so slow, so befuddled, so hesitant that the work was piling up and the attendings were worried something was being missed (and we all ended staying late to get the work done - this was before the days of 80 hr workweeks). Believe me, he was a nice guy but I was not pleased to be doing an extra month of that rotation.

If you get off on the wrong foot, or simply work at a much slower pace than your fellow interns, it will create a lot of bad feelings and perhaps negative evaluations.

Feel free to ask questions as they occur to you, but leave the insults unspoken/written.

 

[seahawk188]

Sorry, I maybe went a little bit too far...but I represent a majority of FMGs and we all are frustrated by the fact that we cann't get decent USCEs because most of programs and hospitals here will not sponsor you externship opportunities. And most of us ended doing some observeships in private clinics. What do you expect if you don't give us opportunities?

But, hey, I survived all the USMLE tests, all the interviews, and the dreadful MATCH as a FMG, I doubt I will not survive the internship. Learning is never too late for me, and that's why I am here...

If you stuck with me, you are in bad luck - not entirely my fault though.

 

[Winged Scapula]

Sorry, I maybe went a little bit too far...but I represent a majority of FMGs and we all are frustrated by the fact that we cann't get decent USCEs because most of programs and hospitals here will not sponsor you externship opportunities. And most of us ended doing some observeships in private clinics. What do you expect if you don't give us opportunities?

It is difficult, but what is expected is that you have some foresight and forethought, as a student, that you may wish to come to the US, and see what that might entail. There is no reason why the majority of FMGs you represent could not have thought about seeing what US program directors want and arranging USCE. Many many do it every year (including myself). USCE as a student is much easier to get and worth much more than an observership.

Obviously there are those whose lives or circumstances made it impossible to arrange in advance, but the majority that I see on SDN (which is admittedly a subpopulation of very motivated and savvy FMGs) are able to make this work for them.

But, hey, I survived all the USMLE tests, all the interviews, and the dreadful MATCH as a FMG, I doubt I will not survive the internship. Learning is never too late for me, and that's why I am here...

The match may be hellish, but internship? Depending on the program, you may wish you were back in the match.

 

[seahawk188]

It is difficult, but what is expected is that you have some foresight and forethought, as a student, that you may wish to come to the US, and see what that might entail. There is no reason why the majority of FMGs you represent could not have thought about seeing what US program directors want and arranging USCE. Many many do it every year (including myself). USCE as a student is much easier to get and worth much more than an observership.

The match may be hellish, but internship? Depending on the program, you may wish you were back in the match.

I thought FMGs by definition are graduates, not students. Of course USCE as a student is much easier to get, but for a FMG, that is not the case. Many ppl came here for research opportunities initially and didn't even know they could do this. I don't blame them for lack of foresight. Pursuit of happyness and fullfillment is entitled to everyone, at least in this country.

I heard FM is relatively easy residency, that's one reason I chose it. Anyway, I am old school and nothing can bother me too much.

 

[Winged Scapula]

I thought FMGs by definition are graduates, not students.

Perhaps technically (given what the letter "G" stands for" but practically many FMGs are students who are given to coming to the US after they graduate.

Of course USCE as a student is much easier to get, but for a FMG, that is not the case.

I understand that, but am unsure, as to why you are lecturing me on the topic. As I have mentioned, I am a foreign graduate as well.

Many ppl came here for research opportunities initially and didn't even know they could do this. I don't blame them for lack of foresight. Pursuit of happyness and fullfillment is entitled to everyone, at least in this country.

Again, I'm not sure what your point is. NO ONE here is denying you the pursuing of happiness or fulfillment.

And yes, there are graduates here who came after completing medical school, but if one came to the US to do research, then they should be skilled enough to understand the nuances of US medical education and what the options for training are. No one is denying that if you have already graduated then you don't have any options but to do observerships or research. However, you presented your experience as the norm; I would beg to differ that many foreign students do come to the US every year and obtain USCE as they have educated themselves on what is required and what is available. For you, the point is moot - you have graduated, cannot get USCE and will have to learn on the job. We just want you to realize that you will be starting residency at a distinct disadvantage.

I heard FM is relatively easy residency, that's one reason I chose it. Anyway, I am old school and nothing can bother me too much.

Fair enough. I wish you the best of luck.

 

[seahawk188]

I am not lecturing nobody here, just wanted to state some facts: every year there are less than 50% FMGs got matched, and the task to get matched is as easy as you stated. If you can not grab the point, I don't know what to say.

As you said, the point is perhaps moot once one is in the system so let's just give the topic a rest. I know I may have a distinct disadvantage now but in three years I may be as good as anyone.

 

[seahawk188]

... Your posts here have made it clear that you have NO understanding of h You should spend less time insulting me, and more time LEARNING.

I was LEARNING not untill you distracted me.

 

[smq123]

I heard FM is relatively easy residency, that's one reason I chose it. Anyway, I am old school and nothing can bother me too much.

FM is "relatively" easy compared to, say, surgery, but it is not easy.

Since much of it is outpatient (i.e. a chance to generate revenue), you must be fast and efficient.

Inpatient FM is structured very much like inpatient IM, EXCEPT many inpatient FM services do not have a limit as to how many patients they can have, as most IM programs do.

Finally, as an FM intern, you will be off-service for 80% of the year. As an off-service resident, no one will be lenient when you are slow or make bad mistakes. If you think that the OB residents will be patient with you when you don't show up early enough to preround....well, you're in for a rude surprise.

 

[Winged Scapula]

I am not lecturing nobody here, just wanted to state some facts: every year there are less than 50% FMGs got matched, and the task to get matched is as easy as you stated. If you can not grab the point, I don't know what to say.

I think perhaps you have misunderstood me.

Nowhere did I say it was easy to match, for anyone, let alone an FMG.

My point was, and remains, that the match is much easier if you have USCE. When you responded that it was impossible, I corrected you and said that every year, many FMGs, are able to secure USCE, so it is not as difficult as you make it for those who have not yet graduated (which was a nuance you did not include in your analysis).

Furthermore, when we tried to help you by pointing out that while you may be very bright and hardworking, you seem to have neglected the reason why programs want USCE: because it makes your job and the job of everyone around you easier if you understand the medical system. It is clear from your posts here you don't.

That is not to say that you won't be able to pick it up - you seem determined to find criticism where none exists. I have no doubts that you will do well but IMHO we are being honest when we tell you that you may face some difficulties with staff and your peers when you come in on the first day of internship and have no idea how American hospitals or residencies work. As smq points out, that there is little time to get you up to speed; you WILL be compared to your colleagues who have USCE or are US grads. First impressions count and if you fail to show up early to pre-round, or early enough to get the work done, can't write a note, or...or...or...well, there will not be much leniency because you haven't any USCE. Many of us have worked with FMGs who did little more than shadow physicians during medical school and never once wrote a note, removed a drain, sutured, etc. My own school told me that would be learned during internship. It was a rude awakening - thankfully, I spent many months in the US as a final year student doing all of those things and accepting the criticism which was much more lenient than it would have been as an intern.

I hope I am wrong and that your program treats you with the silken gloves you seem to think they will. But bear in mind that you will be off service much of the year and even FM programs have standards and expectations.

I don't know if the First Aid for the Wards is useful anymore, but you might read the Clinical Rotations forum and see what US students are reading to prepare themselves for the wards.

 

[seahawk188]

WC, thanks for your post. Actually my program has already sent me a lot of formal training materials for me to get started, so I will not spend a lot of time here debating some moot points. I have learned a lot from SDN though and will continue to do so from time to time. No grudes ever hold!

 

[Law2Doc]

... What I mean is do you treat your own pts and cross-cover pts absolutely the same? ...

Yes. They are your patients. If something happens, like a code, it is not a defense to say -- "well gee, I was only cross-covering, I don't know much about this guy", although a few lousy interns at each program will try to get away with saying this each year. It's your ***** on the line for every patient you are covering, and you had better get a good enough sign out such that you can manage each of these folks as if they were your primary. Also when the attendings call in the middle of the night to see how X is doing, you again can't say "I have no idea, he's not my primary so I'm only going to give him attention if I get paged. Doesn't work that way. Once you know how each attending/chief operates, and which patients are sicker than others, you will find ways to give each patient the appropriate level of attention. Before that, it's going to be hard, and you will have to over-manage a few cross cover patients to make sure you're doing enough. The crappy interns don't, and a lot of those who don't have their contracts renewed fall into this category, I suspect. So we've all heard the "I don't know, I'm just cross covering" defense, and it never ever flies. Don't be that guy.

 

[Law2Doc]

I know I may have a distinct disadvantage now but in three years I may be as good as anyone.

I think everyone's point is that you are going to have a much much harder time simply because most US grads can focus on being a good intern but already basically know the system, while you have to focus on first learning the system. A lot of foreign grads as a result end up being the weak link in the chain, folks for whom some have to pick up the slack to protect the team from the wrath of attendings. While US grads can struggle as well, coming in with basic notions of what it means to preround, cross cover, and what q4 call is are things all US students tend to know well from med school. There are probably another thousand things you don't know that haven't yet been asked on this thread but are presumed to be basic knowledge for US grads. This doesn't mean that you cannot be a fast learner and end up being a solid resident. But honestly, internship is not the most nurturing environment in which to learn the basics -- they throw you into the pool and expect you to know how to swim. You will learn to swim, but at first, you may be pulling your team under the water for a while. Whether you emerge with better team mates or people who try to avoid rotations with you will depend on how you conduct yourself and how quickly you pick up things. I think everyone can tolerate a month or so of a struggling teammate. But after that if there's a co-intern who needs so much help that it affects your ability to get out early on post-call days, or that you don't feel comfortable signing off certain tasks to at the end of your shift, or that you have to run and double check things on so the chief doesn't go balistic, that gets old fast. Again, this doesn't always have to be the FMG who is the weak link in the chain. But if you are coming in without knowing the basics, that puts you in the lead for being "that guy". At least you have the good sense to ask some of these questions before you start. Learn fast. You have no choice.

 

[seahawk188]

LawToDoc, thanks for the detailed advice! The concepts of NF, CC, qCall, post-call are easy to grasp, I guess the hard part will be to act efficiently and confidently during every shift, and to know every nitty gritty of the system. As you said, there are maybe still one thousand of things I don't know, I think in that case I can only learn each by doing. Once I get the hang of it, I can speed things up.

Any other good tips, pls elaborate.