ICU clerkship necessary to make it through internship ICU rotation?

[cbest]

MS4 here going into PM&R, but will have to do a TY or Prelim Med year, which will pretty much guarantee that I spend at least 1 month in the ICU. I'm currently scheduled to do an ICU rotation, but not because I'm really that interested in it. I set it up so that I wouldn't be completely clueless when internship rolls around. However, there are some other clerkships I thought would be cooler (Stroke/Neurocritical Care) that I'd like to do. Is it possible to get through the internship ICU rotation okay without having done an ICU clerkship during medical school? Thanks in advance for your help!

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[gutonc]

MS4 here going into PM&R, but will have to do a TY or Prelim Med year, which will pretty much guarantee that I spend at least 1 month in the ICU. I'm currently scheduled to do an ICU rotation, but not because I'm really that interested in it. I set it up so that I wouldn't be completely clueless when internship rolls around. However, there are some other clerkships I thought would be cooler (Stroke/Neurocritical Care) that I'd like to do. Is it possible to get through the internship ICU rotation okay without having done an ICU clerkship during medical school? Thanks in advance for your help!

While an ICU elective is extremely high yield, you can certainly muddle through a unit month as an intern without having done one as a student. I did...it was my favorite month of internship.

 

[Law2Doc]

While an ICU elective is extremely high yield, you can certainly muddle through a unit month as an intern without having done one as a student. I did...it was my favorite month of internship.

Agreed. Many of us has no ICU electives in med school and did fine during internship. You may need to spend a bit more time reading up on what the heck the respiratory settings all mean, but I wouldn't really sweat not having the experience. Regardless of the experience you have had, you are going to be clueless as an intern. That's just the way it is. The learning curve is extremely steep and whether you come in knowing nothing or next to nothing is not going to make or break you.

 

[WaveEquation]

Agreed. Many of us has no ICU electives in med school and did fine during internship. You may need to spend a bit more time reading up on what the heck the respiratory settings all mean, but I wouldn't really sweat not having the experience. Regardless of the experience you have had, you are going to be clueless as an intern. That's just the way it is. The learning curve is extremely steep and whether you come in knowing nothing or next to nothing is not going to make or break you.

Do the majority (95%?) make it through ok though, or is there a substantial cut in the number of interns that progress beyond internship? Just kind of concerned...if it's so steep, I would be concerned that a lot cannot cope.

 

[Law2Doc]

[/B]
Do the majority (95%?) make it through ok though, or is there a substantial cut in the number of interns that progress beyond internship? Just kind of concerned...if it's so steep, I would be concerned that a lot cannot cope.

It's rare for someone to not progress beyond internship, once accepted to a categorical or advanced path, although there are always a small handful of folks on SDN who seem to have been "fired" after intern year. Intern year is hard, but the vast majority survive it. But yes it's a very steep learning curve, and you will work very hard to learn a lot of medicine in a very short period of time so as not to kill too many people, as well as not to get abused by your attendings/seniors too badly. It's a job with very high expectations, and you really don't learn much of what you need in med school. There's simply no good way to teach some of what you are going to get hit with in intern year without throwing you into intern year. You learn to make decent decisions in the middle of the night despite incomplete or unavailable information.

You will likely be a very different person at the end of that year, perhaps a bit jaded, definitely a bit tired, and fairly unflappable. But you will very likely still be employed.

 

[gutonc]

[/B]
Do the majority (95%?) make it through ok though, or is there a substantial cut in the number of interns that progress beyond internship? Just kind of concerned...if it's so steep, I would be concerned that a lot cannot cope.

Outside of surgery prelims, no, the vast majority of people who enter internship complete not just internship but their entire residency.

This isn't Orgo, internship is not there to weed people out. A steep learning curve does not necessarily equate to failure, it usually equates to working your butt off, reading/learning a ton and coming out the other side a better physician. That's the whole purpose of residency. Well, that and nearly free labor but that's another discussion.

This is not to say that people don't flame out in internship and decide to become goat farmers. And the training process is somewhat designed to catch people who have no business being physicians and redirect them (although I would venture that >98% of the people who have no business being physicians still manage to make it through residency). But the odds of completing a residency are greatly in your favor if you secure a spot.

 

[WaveEquation]

Thanks for the advice, guys! Yeah, internship and residency are going to be grueling. I realize that nothing is guaranteed...just got to hang in there and do my best.

So, although it sounds like you're big-time advocates of learn-it-when-you-get-there...are there any tips for maybe getting ready for some of the tip of the iceberg of intern year? Pocket Medicine, the ICU book, Washington Manual of Therapeutics for prelim-IM? Bates for PD?

 

[Buzz Me]

I did a SICU rotation as an MS-IV but besides learning about how to interpret Swan numbers, I still had to relearn everything else (e.g. vents and drips) anyway.

 

[yohimbine1]

MS4 here going into PM&R, but will have to do a TY or Prelim Med year, which will pretty much guarantee that I spend at least 1 month in the ICU. I'm currently scheduled to do an ICU rotation, but not because I'm really that interested in it. I set it up so that I wouldn't be completely clueless when internship rolls around. However, there are some other clerkships I thought would be cooler (Stroke/Neurocritical Care) that I'd like to do. Is it possible to get through the internship ICU rotation okay without having done an ICU clerkship during medical school? Thanks in advance for your help!

i didnt do any ICU during med school and I was fine. do an easy fourth year.

everyones stably ill in the ICU. the fact that they were all already on the brink of death and everyone know this was strangely comforting to me.

 

[werd]

yeah i didn't do an ICU rotation in med school and i was fine as an intern. (i hated the ICU, but performance-wise wasn't at a disadvantage). probably pocket medicine is good prep if you're going to read something.

 

[oreosandsake]

I'm going into PM&R next year, and in the ICU this month.

I remember when I had the option of choosing between doing a month of ICU, vs PCCU vs ER vs OB vs medicine floor vs surgery

and I knew for a fact that the ER would give me the best hours over all...

I picked ICU because I thought i would be a better physician for it, and I would feel more prepared for my residency at a stand alone rehab hospital.

well, i'm half way through the ICU month, and I dread it everyday. some other interns where I am at are also going to PM&R, and although many of us are doing the ICU month, most of us regret the decision.


hopefully your experience will be better.

 

[FenderHM]

i just finished my ICU month, now on ICU night float! I had not worked in an ICU setting before... while an ICU rotation might have helped me know more about blood gases and CVVHD, I figured it out eventually... its not that much different than the regular floors, the more competent nurses with less patients make up for the sickness of the patients. You'll be fine, esp as a prelim.. go do your cool electives