Most important/useful tidbits to know when starting Peds internship...

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thank you ..today is first day ..i am quite nervous ..but still excited ...
nice thread ..please continue more !

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Wow what a great thread - wish I would've found it before residency! Here's a few more now that I've been through it:

-Don't be afraid to question things. Attendings and fellows make mistakes too. If your gut tells you something is off, ask questions (appropriately) about the plan, new orders, medications - until you're satisfied. Believe it or not, as a 2nd year resident you may be more experienced dealing with "gen peds" issues than many subspecialty attendings.

-Acknowledge that you will cause harm to a patient at some point. It's just a fact of life. You can't go through a high-volume stressful experience like residency and not do something like misdose antibiotics or cause an adverse reaction of some sort. Learn from it (!), but move on and don't beat yourself up about it.

-Exercise regularly. I can't emphasize this enough. It's easy after a 12 hour day on the wards to just plop on the couch with some cheesecake (believe me I did this multiple times), but you have no idea how refreshing that 20 minute jog around the block can be too. Nothing works better to actually relieve some stress and get your mind away from the hospital for a bit other than some light exercise. You'll sleep better too.

-UptoDate isn't always. RedBook and other sources are often more frequently updated, so check there too when deciding about antibiotics choice/duration for unusual (or even normal) diseases.

-Don't feel bad about treating yourself. A fellow resident on her golden weekend went all by herself to the Turks and Caicos just to get away. Not joking. You don't have to be that extreme but sometimes you just have to go indulge in some retail therapy or take that impromptu weekend trip. You've earned it!

-Read every chance you get while you're at work. It's easy on long night shifts to surf the web or watch tv if things are slow, but I found that I did a much better job of reading while at the hospital, and that way I would've feel as bad if I didn't read all the time at home. I'd rather go play golf anyway.

-Don't stress about boards until after residency. If you work hard and keep up with things during residency (which is busy enough), you'll have a solid foundation of knowledge to prepare for boards afterwards. Keep in mind you get a solid 3-4 months after residency to study. That's plenty of time (assuming you use it wisely).

-And lastly - keep in mind that while residency is no doubt one of the most stressful times, it's also ultimately incredibly rewarding. You'll make lifelong friends and have experiences you'll never forget. Enjoy it!
 
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Nurses place bets on which intern will be the first one to write an order for IV Tylenol, so don't be that guy. More to come later...

What a difference a few years makes. We use IV tylenol like water on some services (fever and neutropenia kids with vomiting or who are NPO, in particular).
 
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Probably repeating some things here but....

Bolus the patient. Just do it. If their heart rate is up, if they look a little dry, even if they have a fever and that "explains" the tachycardia, just bolus them. I was scared for some reason to bolus patients as an intern-it was as if it meant they were extra sick and I would try to hold off, and I've noticed the same hesitancy in interns watching them as an upper level. (20mL/kg, unless they are a cardiac patient, a renal patient, or have a fluid overloaded status at baseline. Then as someone for more advice).

Never put anything into an orifice of a neutropenic patient. That means no rectal meds, no enemas. And always check a febrile neutropenic patient for rectal fissures.

Talk to all the nurses at start of your shift. Make mini-rounds, ask if they have anyone they are worried about, ask in advance if you can clean up any orders for them. You will save yourself several calls overnight, they will put a face on the name they are calling, and you will know who to worry about.

Call your upper level. Don't be a hero. If you have a question we want to know about it. If you are worried about someone we want to know about it. If you need help with an order we want to know about. You are our reason for being there overnight. Take advantage. And don't apologize when you call, that always feels silly.

Check on patients in person. I cannot stress enough how important this is, especially as an intern. It's very easy to just put in the order the nurse wants, or the easy answer, but if you are giving a new drug for the first time, if it's a new complaint, a new fever, pain, go get a story yourself and do an exam. In time you will learn when it's okay just to do something over the phone, but even now I almost always go see the patient.

Refusing vitals is a big deal. One of the main reasons patients are in the hospital and not at home is so we can follow their vital signs. We all want our patients to sleep overnight, but if you get called that a parent is refusing vitals, it's essential to talk to the parent and find out why and if there is a way we can better schedule vitals for them. Kids can get very sick (especially non or pre-verbal kids) without anyone knowing and they can even die, and no one would notice that their vitals are changing drastically if they aren't being taken.

Make sure every parent gets an update every day. This is especially easy to forget in places like the NICU where parents may visit infrequently. Make it your priority to call them and tell them the plan for the day. If a parent missed rounds, have the nurses call you when they get back to the room. This will save you calls and confusion, will save the night resident covering your patient the awkward conversation about a plan they don't really know, and would be what you would want if your kid was in the hospital.

Write cross cover notes. If you order a new med, if you go to the bedside to evaluate a patient, if you have a conversation with a parent, if you change a plan, write a note. No one will know about it unless you document it. It takes 5 seconds. it doesn't need to be exciting or formal. Just write it down.
 
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Congrats to everyone who is going to be starting in pediatrics this July! I'm just finishing up my intern year and agree with the great advice offered above, especially the very thorough lists by pediperson and No1Cub17. Just wanted to share a blog I've started that chronicles my experiences, especially the anxieties and frustrations of being a new resident. I hope some people might find it useful to read about others' experiences as I think we all go through some similar things when we are starting out.
 
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I'm a fellow. Please call me with questions especially your first month. We expect you to calI. I would much rather you call me than find out the next day when something went wrong. But do have the information ready esp at 2 am and try to have a plan even if you are not sure about it. It shows me that you have at least thought through the problem. Good luck all.
 
I recommend working through some study materials as you go through internsip (and even a bit before you start!) I use the questions on the boardvitals pediatric question bank
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Wow, what a thread. It seemed to be revived every so often - but a 6 year hiatus is strong

Coming off my second to last night shift of residency - there is nothing quite like nights at the hospital. They can be so scary. One of the best ways to build autonomy is facing your fears. That's why, in the end, nights can be as meaningful as they were once scary.

Just because they had a normal CT abdomen from an OSH hospital before transfer. How do they look to you now? If you see an acute abdomen, if you feel an acute abdomen, get a STAT KUB

Pharmacists can save your patients life. They catch things. Always be kind to pharmacists (any staff, for that matter). If you get some annoying pages, don't forget to recall all the helpful ones they've sent.

Speaking of catching things - just like the pharmacists, if you're careful, if you pay close attention, why is she having a headache? What's really in that IV fluid bag? Medication safety is boring, but it's absolutely not overrated
 
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