Worried...Need Advice

[NewIntern]

I matched into a very busy IM residency. I did a sub-i at another similarly busy IM residency but I wasn't exactly treated as an intern, more like a 3rd year med student with minimal responsibility of covering 2 or 3 patients. Except for a few days when a couple of the interns were out and they did treat me like an intern out of necessity. Those days where I was the intern I was lost. The patient list was anywhere from 20-30 patients and I was supposed to know everything about them even if they weren't the patients I was specifically covering. Attendings or other residents would page me and ask me questions about any of the patients and I would be fumbling when they expected me to know the answers cold. The questions weren't necessarily medical questions, more like clerical questions (Did this patient get this med today? What did the consult say about that patient? Has this patient gone down for this procedure? Has PT seen that patient today? etc). In a few short months I will be an intern and the residency I'm going to is as busy. The interns where I did my sub-i were on top of it. They knew EVERYTHING about EVERY patient on the census. How do you guys remember and keep track of everything about every patient when you're covering 20-30 of them?

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[smq123]

The interns where I did my sub-i were on top of it. They knew EVERYTHING about EVERY patient on the census. How do you guys remember and keep track of everything about every patient when you're covering 20-30 of them?

Your memory (for medical things, at least) improves significantly during the course of intern year.

That, and you learn to write a LOT of stuff down.

 

[danielmd06]

Your memory (for medical things, at least) improves significantly during the course of intern year.

That, and you learn to write a LOT of stuff down.

Exactly. When you have more responsibility placed upon you, you must rise to the occasion. And necessity is the mother of invention.

I kept a checklist and made lots of notes on it. Constantly, every half hour of every day that I would be on service. Certainly at the beginning and end of each day.

Hang in there. It gets better and easier when you are the one who has previously been following every small detail about a patient. In other words, when you've been taking care of patient A for three days, the fourth and fifth day run much smoother.

Also, you start noticing certain trends that individual situations/medical conditions/or attendings require (lots of what we do is algorithmic and pattern-based) and this makes it much easier to predict what you need to have available. For instance, on a stroke patient in neurology rotation, people are rarely going to ask you about a chloride level, but be prepared to know about a CT scan, whether an echo has been finished, and if the patient is on antiplatelets or anticoagulation.

It gets easier with lots of practice.

 

[Doctor4Life1769]

Agreed.
I'm finishing my 2nd month of medicine sub-i (i know, this late, wtf was I thinking?!) ... anyways, I pretty much breeze through admit H/Ps and associated orders... and discharge paperwork/dictations.. it's almost like 2nd nature... I can have 5 to do and still finish in a reasonable time-frame.
I feel ready for intern year, it's the different system thing and ancillary stuff that'll be my main thing to get a feel for. Also, not forgetting everything b/w now and July 1.

 

[34140]

Agreed.
I'm finishing my 2nd month of medicine sub-i (i know, this late, wtf was I thinking?!) ... anyways, I pretty much breeze through admit H/Ps and associated orders... and discharge paperwork/dictations.. it's almost like 2nd nature... I can have 5 to do and still finish in a reasonable time-frame.
I feel ready for intern year, it's the different system thing and ancillary stuff that'll be my main thing to get a feel for. Also, not forgetting everything b/w now and July 1.

I really really tired scheduling a Sub I or an ICU elective for my last rotation, instead I ended up in a super chill easy rotation. I really wish I had gotten what I initially wanted, I think it would have helped me transition. I feel so unprepared, like I haven't used my brain in months!

 

[Doctor4Life1769]

I really really tired scheduling a Sub I or an ICU elective for my last rotation, instead I ended up in a super chill easy rotation. I really wish I had gotten what I initially wanted, I think it would have helped me transition. I feel so unprepared, like I haven't used my brain in months!

I wouldn't worry about it. You'll get in the swing of things within the 1st week or 2. A lot of it is having the knowledge base, after that, the ancillary/paper work bull**** you can get used to. Just try to do all of your Q/As the 1st few days so it'll save you some headache down the road on that service. My final month is an inpatient palliative medicine month... I only scheduled that so I can get experience with PCA pumps and other types of inpatient pain control (I'm doing anesthesia after I finish my intern year which starts in July). I could care less about palliative medicine in general. I did do 2 SICU months during 4th year, along with an inpatient cards and neuro service. So, my 4th year was inpatient heavy, and rigorous to say the least.

 

[gynogrl]

And as far as knowing what's going on with all the patients - I would take notes during rounds. You should have a sign-out sheet with every patient, so you should write down what the plan is for that day, who needs to be consulted and why, what things to be checked up on. That way, if someone calls you to ask about another intern's patient, at least you know why they got a neuro consult and a bit about the patient's history, so they don't need to keep trying to track down that specific intern. I found as a med student that people were really appreciative if I knew what was going on with everyone, and the best residents I've worked with always write something down for everyone.

 

[Law2Doc]

I matched into a very busy IM residency. I did a sub-i at another similarly busy IM residency but I wasn't exactly treated as an intern, more like a 3rd year med student with minimal responsibility of covering 2 or 3 patients. Except for a few days when a couple of the interns were out and they did treat me like an intern out of necessity. Those days where I was the intern I was lost. The patient list was anywhere from 20-30 patients and I was supposed to know everything about them even if they weren't the patients I was specifically covering. Attendings or other residents would page me and ask me questions about any of the patients and I would be fumbling when they expected me to know the answers cold. The questions weren't necessarily medical questions, more like clerical questions (Did this patient get this med today? What did the consult say about that patient? Has this patient gone down for this procedure? Has PT seen that patient today? etc). In a few short months I will be an intern and the residency I'm going to is as busy. The interns where I did my sub-i were on top of it. They knew EVERYTHING about EVERY patient on the census. How do you guys remember and keep track of everything about every patient when you're covering 20-30 of them?

You get better at it as you go. The first month or so of internship you are pretty useless and don't know enough about anything you are supposed to be on top of. But when your job for 70+ hours a week is prerounding on patients, rounding and presenting patients, writing notes on patients, answering questions to attendings on patients, following up studies on patients, and then signing out your patients to the next shift, every single day, you start to really know those patients, even without your notes. Many of these patients will be in the hospital for several days to weeks, so it's not like you are learning a whole new set of them every shift (except for cross covering purposes), just the changes. On top of that, with experience you will get some skills in terms of how to respond and not come off as totally useless even when you don't know the answer and need to get back to them. Very few people step into the intern role great on day one. Nobody really expects you to, notwithstanding their frustration. If you aren't any better a few months down the pike then is the time to start worrying.

 

[Buzz Me]

You get much faster, more efficient, and your memory improves dramatically during intern year. Checkboxses are your friend.

At times I had to round on up to 50 patients on our trauma service. Brutal. Don't even mention cross-covering at night, when we had to cover 100-150 patients.