To be completely honest with you, not much will be expected from you at the start of your internship - definitely not this much - but I'll tag
@ThoracicGuy and
@Winged Scapula who can probably provide better help since they've been seniors on surgical services.
But I'll answer from how things were a few years ago when I was an intern on surgical services:
1) No need to really prepare by reading, just be well-rested heading into the year because it could be tough depending on your program. Read about your patients and know the more exotic ones cold, similar to a medical student but take it a step farther and understand why certain treatment options are being pursued, goals of care and, perhaps most importantly, how you are going to move the patient along for discharge (this includes possibility of rehab/SNF placement, PT/OT evaluation, social worker evaluations - these people are your lifelines!).
2) If you have done well enough in medical school to match IR, then you probably have a solid base of medical knowledge to draw upon. Honestly I doubt you'll come up with initial surgical plans - your job is to get the information, do a focused physical exam and laboratory/imaging review and communicate the pertinent positive and negatives to your seniors/attendings so they can make the decision about what to do.
- The decision to consult Medicine will largely be institutional and service-dependent, but best to run that idea by your seniors. Basically if they need close titrations (meaning changing doses several times a day) of medications - whether for CHF/diabetes/COPD/etc - a medicine consult might be useful. But in some places (like my shop), the consult service isn't very helpful because they are super overloaded with patients.
3) If you attempted any procedure alone as a new intern with the possible exception of IVs you'll probably get a stern talking-to by your senior. Let them instruct you on basic things like wound dressing/VAC changes, ultrasound. Suprapublic catheter placement probably shouldn't be attempted by a general surgery intern.
- As a general rule of thumb, you should NEVER be afraid to call a senior resident or more experienced personnel if you are uncomfortable doing something. Doing otherwise will get you quickly labeled as a cavalier, or worse, dangerous resident. It might be annoying to a senior but be honest with yourself about your skill set - you don't want to cause harm to a patient just to avoid calling a senior resident at night.
4) Again, institutional and service-dependent. At my shop, I seldom went into the OR as the floor was extremely busy and I was the only provider to help. There are other services with PA/NPs on the floor to help and the intern is often needed in the OR to help (i.e. drive the camera during laparoscopic procedures). Surgeons love initiative, so if you want to get involved then head down to the OR if you are done with your floor work.
5) It's OK to look up doses, have a handy reference site on your phone or computer. Many EMRs have common dosing regimens built-in which is very helpful.
6) If you want to go to this conference you need to request the time off from your program ASAP/NOW/YESTERDAY. The sooner you let them know about these sorts of things the better. Depending on your program they might let you go or they might not based on their rules (especially if it isn't a conference related to the field of surgery). Waiting until the week before the conference is a guaranteed no.
7) At my shop, nurses are great and do all of this unless it's very difficult. At other shops (especially where RNs have a more contentious relationship with the docs) this isn't as common. I'd like to believe that the days of the intern running around the hospital drawing his or her own AM labs are largely over, but who knows?
- Be friendly with the nurses on the ward, especially if they've been there a while. They can make some pretty solid suggestions on common issues ("severe constipation after surgery? We usually try X, Y and then if that doesn't work Z"). I started residency on one of the busiest services in the hospital and the nurses absolutely saved my bacon many times because I was friendly and took their concerns seriously.
8) I didn't, but you'd have to ask your program. Will be covered in orientation.
9) I think so, but you'd have to ask your program. I can't imagine that the score would really be worth much since you have a full residency to follow.
10) Basic suturing is fine, I am proficient with instrument and one-handed knots which is all I really needed. If you need more I'd hope the senior would show you.
I didn't intend to make this long of a post! Basically, be positive/interested and be sure to hit every "to do" box or have a reason why it isn't done at the end of the day. Be an active member of the team and take ownership of the patients - that means understanding their surgical and medical issues and the current therapy being employed. This can be a valuable year which can give you more respect for your surgical colleagues and teach you very applicable time-management skills. It can also be stressful with long hours, so come ready to work and don't ask if you can go home early if your work is done. It's only a year, you can do it! Good luck.
