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- Mar 25, 2015
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I'm trying not to be overdramatic here, but I'm dying. AMG, did fine in medical school, dead average on STEP 1-3. Just finisheda few months of psych and performed pretty solidly as an intern. But now? I'm on medicine and it's more difficult than I had imagined. A large contributing factor to this is that I was never able to take my medicine subinternship/acting internship during 4th year because a bunch of my rotations were cancelled due to COVID, back in March.
So...I kind of graduated with incomplete credentials. The last time I took internal medicine was in December, 2-years ago, as a third year medical student. Yep. And I have only done psychiatry as an intern thus far. Because of COVID, and this being a big city, the patient census is extremely high. I have about the same responsibilities as other IM interns but I don't know jack **** (even if my passing scores on USMLE say otherwise). I am performing poorly on the rotation thus far. I'm just a few days in, and I'm asking my resident for help on everything.
Does anyone have any advice for me? I am feeling very overwhelmed with the patient load and the expectations, even though I am technically an "extra intern" on the medicine team. Good thing is I have a week of vacation soon and maybe I can do something to change my downward trajectory? I do not want to be dismissed as an intern for failing internal medicine. My main problems are as below:
1) It is very hard to present for me. My presentations are garbled garbage. When the attending asks for a specific history or lab value of the patient I can't pull it off my paper off hand. On psych, I get in a little early, write out a little blurb, check the labs, etc. On medicine, there is TOO much to check on and I find it extremely hard to present new patients since there is not enough time. Is there a specific flow to the morning/day you recommend following? For me, I need some time to synthesize and put together what I'm doing before I can present, but I am just overwhelmed with the number of patients that I don't have time to do a thorough chart review/pick out history.
2) When I do a physical exam, I have no idea what I'm looking for. It's been almost 2 years since I've done a legit physical lol. Help.
3) How do I stay organized? Consults come and go throughout the day and the nurses constantly message me for small thing (re-order lab please, patient had a bowel movement, etc.) and I can't seem to keep on top of it. For example, if I'm running an antibiotic on someone and then ID comes in the middle of the day and recommends a change, all the while I'm doing 10x other things, how do I reflect that change throughout the day? In my note?
4) Are there any places where I can look up basic "to-dos" or basic algorithms when on call? For example, what do I do if a patient has low O2 sats? What if they have low glucose? I know the simple answers on a test (give oxygen, give glucose/dextrose/etc.) but I find it really difficult in real life with real patients. I feel like a medical student again.
5) All that said, I did learn a hell of a lot in just a few days as a medicine intern. If the hours weren't garbage and the responsibility wasn't real, it would ALMOST be kind of fun. I'm trying to keep up a good attitude but I feel really useless and stupid and I'm positive that the attending thinks I'm intellectually challenged.
So...I kind of graduated with incomplete credentials. The last time I took internal medicine was in December, 2-years ago, as a third year medical student. Yep. And I have only done psychiatry as an intern thus far. Because of COVID, and this being a big city, the patient census is extremely high. I have about the same responsibilities as other IM interns but I don't know jack **** (even if my passing scores on USMLE say otherwise). I am performing poorly on the rotation thus far. I'm just a few days in, and I'm asking my resident for help on everything.
Does anyone have any advice for me? I am feeling very overwhelmed with the patient load and the expectations, even though I am technically an "extra intern" on the medicine team. Good thing is I have a week of vacation soon and maybe I can do something to change my downward trajectory? I do not want to be dismissed as an intern for failing internal medicine. My main problems are as below:
1) It is very hard to present for me. My presentations are garbled garbage. When the attending asks for a specific history or lab value of the patient I can't pull it off my paper off hand. On psych, I get in a little early, write out a little blurb, check the labs, etc. On medicine, there is TOO much to check on and I find it extremely hard to present new patients since there is not enough time. Is there a specific flow to the morning/day you recommend following? For me, I need some time to synthesize and put together what I'm doing before I can present, but I am just overwhelmed with the number of patients that I don't have time to do a thorough chart review/pick out history.
2) When I do a physical exam, I have no idea what I'm looking for. It's been almost 2 years since I've done a legit physical lol. Help.
3) How do I stay organized? Consults come and go throughout the day and the nurses constantly message me for small thing (re-order lab please, patient had a bowel movement, etc.) and I can't seem to keep on top of it. For example, if I'm running an antibiotic on someone and then ID comes in the middle of the day and recommends a change, all the while I'm doing 10x other things, how do I reflect that change throughout the day? In my note?
4) Are there any places where I can look up basic "to-dos" or basic algorithms when on call? For example, what do I do if a patient has low O2 sats? What if they have low glucose? I know the simple answers on a test (give oxygen, give glucose/dextrose/etc.) but I find it really difficult in real life with real patients. I feel like a medical student again.
5) All that said, I did learn a hell of a lot in just a few days as a medicine intern. If the hours weren't garbage and the responsibility wasn't real, it would ALMOST be kind of fun. I'm trying to keep up a good attitude but I feel really useless and stupid and I'm positive that the attending thinks I'm intellectually challenged.
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