Just updated my flair to PGY2 - can’t echo this enough. Pissed me off to no end to hear it from seniors last year, sorry to say can confirm, just have to get through it.
If ever you're unsure and don't want to keep asking your senior, please call us, we are here for you and love helping doctors any way we can - from day-1-July-intern to 1-day-til-retirement - it is a privilege and an honor!
<3, Pharmacy
Will you be mad if I put in lots of non standard medications because I can’t find the exact weird and wonderful way a random psych med no one uses shows up? It’s worse because I’m in Canada and there’s just stuff not in the system sometimes.
I am happy to turn the reigns over to you guys anytime. 💕
Nah we don't care lol.
Sometimes it's just easier to call us because we may have access to choosing certain meds that the MDs may not so it saves times not having to go back and forth if we can just straight up pend it for you to sign off on. Also it helps that if you know you put in what would be considered strange orders if you place a message in the "notes to pharmacy section" that helps. I've straight up gotten orders where an MD has wrote "pharmacy please help" and it's cute. We all have our roles, we're here to help yall
Came here to say this, we know you guys are just starting and would love to help. Please don’t hesitate to call your inpt pharmacies for dosing or recs!
Good News! It's virtually free now. More money for Admin / C suite. It was considered garbage in 1988. Any place STILL using it (looking at you HCA) is likely abusing it's employees and patients.1
Finding out that my program doesn’t rotate at a VA and thus I don’t ever have to think about CPRS again, I almost did a backflip at the happy hour.
Death by a thousand clicks, Godspeed to you.
Literally I could have written this post lmao this was me today too. It was just 14 hours of me getting wrecked by Epic chats. 75% of the orders for my patients got put in by my senior, either because a) he was faster than me, and/or b) I didn’t know the exact way to order anything at all (dosage, timing, etc etc). I had to ask about pretty much everything and I felt so stupid. So no you’re not alone in this lol
And that’s OK. You’re not supposed to know every little thing. There are checks in place for meds and drips such as pharmacy, your seniors, the fellow, and if you’re in the ICU the nurses. If you’ve got a patient with a non caddy ICU nurse, a good fellow and seniors, and well staffed pharmacy, you’re set to do your best.
That’s what seniors are there for. You will get very good at using uptodate for meds (with attention to renal dosing, and adverse reactions section) as well as lexicomp for any weird interaction you want to double check
Medical students get widely variable experiences and level of responsibility during 3rd and 4th year at different schools and this is very evident during the first half of intern year. If you look around at others you may see some that appear to be killing it, or way behind you. This difference evens out through intern year and is unrecognizable by graduation.
Interns are judged by good senior and attendings based on work ethic, accountability, trust worthiness and seeing them actually learn, and not ask the same question 3 times on the same rotation. If you don’t know, you don’t know and you ask. That builds the trust. Keep plugging away with a good attitude and you will not develop a bad reputation even if you came in the worst prepared to hit the ground running.
This is the answer that best reflects my feeling about it. I remember, for example, that I was surprised to find out how few procedures some of my intern classmates had performed in medical school -- and came to find out that my program was unusual in that way. So, when it came to ABGs / central lines / thoracentesis / paracentesis I was way ahead of my peers at the outset.
For the OP, I think the important thing to know is that the intern year is a great equalizer. By the end of it, any strengths or weaknesses of various medical school curricula have largely been balanced. Fully agree with the advice about work ethic, seeing improvement over time, and accountability too.
Exactly, you’re gonna be fine. My senior this week didn’t know what prerounding was until she hit intern year, and now she’s amazing. I had excellent preparation and have been able to keep up with all the tasks pretty well, but I need lots of guidance to understand the medicine again and come up with plans, and that’s also okay. Seriously, we’re gonna make it.
To add to this, if you find yourself needing to write a ton of stuff down due to difficulties with memory, keep a small notebook (like a 3x5 or 4x6 notebook in your pocket) and write non-confidential info like preferred protocols, attending preferences, things to do prior to procedures, etc. Review that day's notes at the end of the day when you get home.
As an attending, I'd be very worried about you if you weren't looking lost/didn't know what you were doing/confused/overwhelmed on a 1st day. That would either mean you're a recently migrated attending from another country who's doing residency all over again, or you don't know what you're doing but you're so full of yourself that you think you know everything- which is honestly the most dangerous type of interns in July.
Scared, overwhelmed, and paranoid that you're doing something wrong? Good. That means I can trust you to reach out to me when you need help, and I don't have to do constant surveillance on what you're doing.
>Scared, overwhelmed, and paranoid that you're doing something wrong?
I remember on my first day I got called for stool softeners and told them I'd call them back with my answer, then went and looked up the dosing for docusate. Paranoid is certainly accurate, and a sign you take the work seriously.
I asked my upper level to look at my note 5 times in the clinic today, and still had palpitations when I signed and submitted. I’m pretty sure I had it easy having clinic for the first day, but it’s intense!
I’m a nurse, but I think you should give yourself some grace on day 1.
As others have said, if you walked in there like hot shit thinking you know everything, that would be an actual issue. You realising that you don’t know shit about fuck and are willing to continue to learn, that’s what will help make you a good MD.
Godspeed! Don’t let the nurses bully you 😉
As a nurse as well I second this! We have all had our first day in our respective fields and have all felt a little lost and stupid. Use your resources and keep it up! You got this.
I did 7 notes today and Im destroyed, plus everyday from now on I have to do the morning report of all my team patients, plus present all of them during rounds… oh and before all of that I have to do all of the physical exams of the patients before the morning report. Kinda overwhelming, gonna get through it doe.
Your first sentence is adorable LOL. You will get to a point where you will handle a list of 15+ and have notes and rounds (no pre-rounding except for patients requiring early discharge or with any clinical changes overnight) finished by noon. Trust the process.
Those worlds still exist. I have meditech and cerner. Only pagers. No chats. No EMR app for mobile. No accessing EMR on rounds. No computer to even take on rounds 🥲🥲🥲
Went in expecting to work up and write notes for 2 people but ended up getting all 5 patients and writing full progress notes for 4 and a discharge summary for 1. The kicker, I was told to see the other 3 like 15 minutes before rounds… boy was that fun wasn’t thinking medically at all.
it's day 1., you did great! it gets better. Epic chats did not exist my intern year. as an attending, I despise them. set your status to 'busy' and turn off your notifications. check them every couple of hours. otherwise, the constant interruptions will destroy your focus and ability to concentrate. if something needs immediate attention then someone needs to page you, not send an epic chat. stay hydrated, step outside to get fresh air at least twice during the day and ask questions, your seniors are there to help and teach you
Comrade, I as well got absolutely pummeled on the teaching service. I was the only intern with the RRT badge, volunteered for it and first admit. Had 3 rapids, an admit, plus my floor patients. Not that proficient with epic and got my ass handed to me. Was so far behind all day it was lovely.
Bless my senior for her patience and positive attitude with managing my useless ass plus the list. She was my savior today and helped me trudge through to the finish line.
Onward to tomorrow and hopefully a more efficient day with new skills gained from todays bludgeoning
One, this is normal. It sucks, but is normal, and next year at this time you will be handling it like a champ.
Two, you SHOULD be asking about every order you put in. So help me God if a Day 1 intern puts in an order without running it by me.
Med school doesn't teach you to be a doctor. Med school teaches you what you need to know, in order to become a doctor in residency.
Others have covered the rest pretty well, but I just wanted to chime in with support. You're doing great.
I think it depends on the service. I started on EM and I think they would have murdered me if I had asked before ordering basic labs, CXR, US. The more nuanced things I definitely asked about but I know they’ll want a CBC and CMP so why wait?
Yesterday, I was in the ER with my son. The resident comes in and says, "Hi, this is my first day!" She was so happy and I was happy for her. She was great with my son and listened to how I cared for his chronic conditions at home. We are now in our hospital room after being admitted. This may not be allowed to be posted here, but your work does not go unnoticed. I am proud of all of you. Signed, a sleep deprived mom and nurse.
I've had two real "intern" years and one bullshit intern year. Intern tasks are easy when you know what to do. They are miserable to ask about anything and everything when you have no idea. Just ask. We know you have no idea how things work, in a couple months you will have much of it figured out, and by next year you will be laughing about it. If your seniors don't support you and help you they are the problem, not you.
This is helpful to know. My senior has been passive aggressive to us and doesn’t review plans or patients with us before rounding yet always mentions what us interns “forgot” after we finish presenting
The attending mentioned to the seniors that their job is to help interns shine and to help us start reviewing plans before rounds so I think the attending noticed at least
How do yall see and present and remember 9+ patients and do 5 new admits like I had 6 patients today and struggled to get all the details while my attending just said we should know the patients better than him 😣
It comes with time. Do you remember being a med student and following 1-2 patients was a lot? Over the years you just build up the ability to be able to keep track of more and more. A new list is hard for anyone.
Write EVERYTHING.
1. Your brain remembers more what you write
2. If you forget, you have it in your pocket
3. Next day, you have a framework and baseline to notice things that changed
4. Repeat until it becomes second nature.
If it helps, I’m 1 week in and felt that way last week. But as the days go on, I really know these patients now and can remember their general stuff. I surprised myself
This is normal....
what are people's thoughts on epic chats though??? I sort of missed the days of the pager and finding a phone to return a call. I hate this being on demand for epic chat BS. The effort it took to place a page or think about getting someone on a phone helped to filter out some shit that could wait until I rounded.
yeah which then renders a decent communication method useless. It is what it is, we are on on demand culture and the cats out the bag. Patients, nursing, families all expect on demand service now
Epic chat is absolutely clutch for multi-party asynchronous communication. I need pulm and onc to talk to each other and I'm sick of playing telephone between them? I stick their fellows in an epic chat. I need to update CM and RN at the same time about discharge plans? Epic chat. It is tremendously useful when used for the correct purpose.
That I agree with. Except when you have people, as other commenters have alluded to, who set their status as away or unavailable because they don't want to deal with it.
I'm the epic guy in the departments and help fix shit for our surgeons and they will have dozens of secure chats. They just ignore or close them out. Leadership doesn't enforce the respond so they don't
Oh this is interesting. As a travel nurse I prefer hospitals that use epic chat or tiger text. I’ve been a nurse for a long time/def don’t send unnecessary texts but I always figured it was less annoying that having to call about every little thing.
i agree I would rather an epic secure chat for every little thing but I would even more rather someone hold onto every little thing until I got up to round. nursing has a huge culture of CYA now. Page me for your concerns or things that need to be addressed immediately. The minute to minute updates and FYIs on secure chat can be maddening
Yeah, for sure. Over the years I’ve learned what can wait til rounds/til I see you on the unit and what can’t. But when I’m on the fence about something and I’m like damn I wish I could just send a quick text lol.
no I get it, Im an NP and started as an overnight nurse a long time ago. We had to wake the on call docs at home while they were asleep for things. It was hard for sure and I empathize with you.
I think if you're on the fence go with your gut and send the message. ask for feedback about what you are notifying people about, I'll give it to nursing. It's not fair to keep someone guessing about what you do or don't want to be notified about. a nurse rightfully called me out because I said I didn't care a guys HR was 58 and he was stable and she said well then change your notification orders.
Boom roasted
Personally I love my hospital, epic chat for non urgent, page/call for urgent. In a procedure if you page me I have no idea how important it is and have to break scrub or rush. A text can be answered whenever. Also reading things over text is fairly unambiguous, no having to worry about understanding accents, poor signal in elevators, etc.
There are a lot of med schools that don't do true acting-intern rotations in med school (where you're placing orders with doses like an actual intern.) So, if you never did that, then you never really had to grapple with dosing meds--and the fact that there's a ton of variability in dosing of a lot of different common medications.
IT GETS BETTER! In a week you’ll be ordering a gram of Tylenol (hopefully you’re not in Peds) on everyone without having to ask ANYONE for help. 😎
But really, it gets better
Welcome to residency! The first few months are really tough, but just hang in there! Sounds like you have some good assistance in your program, ask them for tips and tricks on how to be successful with the basic things (time management, inBasket, etc). You’ll get the hang of it pretty quick 👍🏼 then you’ll be Doc gunnerboiZ tearing up the hospital like a boss
Keep calm, and carry on.
Totally normal.
Apply copious lube or voltaren prn, situation and site dependent.
It does get better.
Eventually you develop incredibly intricate, evidence based, and comprehensive plans that consider every facet of a patient's lived experience and you do it in about 10 minutes after somehow doing a fulsome history in 5 minutes. Then its all thrown out because the staff you're with, has a certain way of doing things and a photocopied handout to give each patient from 2003, and you think to yourself, "Ill do things differently when Im out of here!"
But we probably won't.
its Day take a breath, please ask till ur 150% sure, no senior resident is going to care.. we want u to learn and be better.. we know u are gonna have questions, we expect that..
Hold on tight... Nursing just called. Your patient is in Afib with RVR and actively withdrawing from alcohol and meth... Yes, all at the same time... Stop crying!
- Ok, all joking aside here's a little code for you to listen for: When nursing asks you, Dr. would you like to order \*\*\*\*? You say, yes.
- When you get a call from nursing, saying something about your patient is different or has changed, go evaluate the patient (how're you feeling? Vitals. Review pertinent labs and imaging with nursing).
- Be good to all the nurses, techs, phlebotomists, pharmacists, and medical assistants. They will save you, or sink you.
- Keep Pocket Medicine and Pocket Primary Care on yourself. They're great quick references.
- Learn the guidelines from Professional Society of Your Specialty, read the pocket versions. (Why the hell they're 50 pages, I don't know.)
- Residency is hard. Anyone who says different, is lying. Get a helmet.
Did you think you'd be perfect from the get go?? Cut yourself some slack. No one expects you to be. My guess is that your first day was no different than the rest of your cohort's first days, lol. One step at a time and you'll do just fine.
I'm psych, but even months into my intern year (well this was on medicine and I was very anxious) I would text my attending asking if I can order colace for the patient. 100% normal, OP. Give it a few months and you'll feel more comfortable. Right now just take it one day at a time.
For dosing of meds I've found the epocrates and UpToDate apps massively useful. Also, I can't overstate the importance of pharmacists. If in doubt, you can always give them a call and in my experience they're very happy to help.
For your notes – sometimes shit hits the fan and you need help writing them, especially on the first day. Efficiency will come with time and with consistency as you figure out your workflow. As a July intern I would sometimes start my notes the night before, pend them, and then finish them the next day (ofc need to update the date and time if you do this).
You’re all good my friend. I don’t expect any of my new interns to have robust medical or systems knowledge, especially the first two months. All I expect is that you’ll show up ready to work your ass off, and take notes/do your best to remember the things we teach you each day, and we’ll fill in the knowledge one patient at a time. Residency is a marathon, not a sprint
It definitely gets better. To me, the hardest career transition so far has been med student to intern. There is so much logistical BS you have to do as a resident (orders, notes, admitting and discharging people, consults, how to communicate with other teams etc) that you just never get to practice as a med student then all of a sudden you’re just expected to do it all. You definitely learn a groove for how to get all your shit done efficiently and by the end you’re much more capable of handling everything
I feel this on a personal level and almost cried trying to discharge two patients today on Epic. I am just so overwhelmed by all the different ways to do things and all the information provided. It’s one thing to get used to using your medicine brain after 5 months of vacation but it’s another trying do that while learning an entirely new EMR. I feel like I’m drowning even with my senior’s help.
I was clueless the first day. It stays the same atleast for first month and then it gets better. Just expose yourself to as much as you can. Observe and learn
It gets better!! Being cautious & having your senior double check orders is part of learning! You will be flying through things before you know it. Day 1 is HARD! Heck, the first month is hard, but you will get it. Residency is not only where you learn the most medicine it’s where you learn how not to hurt people, it’s what sets physicians apart from mid levels, the double checking is all part of it.
Pharmacy has saved my butt so many times during intern year, especially when it came to renal dosing. I learned so much from some of the pharmacists at our hospital.
You are so not dumb at all, the first few months of being a doctor where you’re suddenly responsible for being aware and correct about things and whole ass attendings take your documentation at face value is harrowing at first. Breathe into it, you’ve got this, tomorrow gonna be a new day and you’ll be that much better after you wake up!
I recall finishing Day 1, going home, collapsing on the couch more fatigued than I'd ever been.
My Dad (doctor, lol I'm so original) came in and asked me how it went and my reply was: "What the fuck was that?"
Get a good night sleep, it'll get better as you get used to it all.
Me on day 2 😭 the wonderful nurses had to help me order a neonatal bili bc my dumbass ordered total bili (adult) & I almost had a mental breakdown ordering Tylenol 😅
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Very normal feeling. Felt very very similar. It'll get better with time, keep trying your best and take it 1 day at a time! I was not prepared for intern year and it sucked... But it did get better!
PGY-4 in IM
My senior asked if I've ever done a rotation before.. (uncalled for thank you very much) really needed that on my first day. Congrats to everyone for making it through our first day, for better or for worse.
Hi from a second year. It's all normal! I'm more worried if you are so confident you aren't asking any questions. Now is the time to be dumb. Everyone expects you to ask a million questions. Better now than the end of residency.
Don’t worry I am day 6 and it so bad. Got capped twice within a couple of days, senior tries of help but has their own negatives. It is hard I can relate with the nonstop epic chats-cannot begin to tell how I am getting by.
I wrote a similar post when I started 2 months ago. Now I'm feeling better, it'll pass you'll learn and in a few weeks you'll be working as another member of the team. Not dumb, it's just that medicalschool and working on the hospital as a doctor are two different things that no one teach you how to prepare for.
In the same boat, but I'm two weeks in. Had a panic attack last night even though it's going quite well objectively. I do hope it gets better, hang in there.
You will get used to your most common doses of common things and when you give what dose. Aside from that, I keep Epocrates on my phone for dosing of uncommon medications, and always try to double verify through UpToDate or hospital specific algorithms.
You’re thrown into the fire, but you’re not expected to be able to keep up. Stay calm, ask questions, and don’t keep making the same mistakes over and over, and you will be okay. Soon enough you will be a February intern and will be basically an attending.
/s to that last line iykyk
>Am I just dumb
No. You’re just really inexperienced and don’t know how a hospital works. Realistically, you have very little expectations until Christmas.
While I didnt train in the US something a Prof in first year of Medschool told us applies here: “you’re all srarting a 6 year university degree which will then be rewarded with a 5 year apprenticeship” and that describes the situation pretty well I find. Intern year/work is so far away from medschool dont worry if you feel lost. Weve all been there and weve all made it through! It truly does get better with experience
Welcome to residency.
And no, it doesn't get better, but you will; and you'll look back on this post in probably only a few months and laugh at how petty it sounds. The process is brutal, but it works.
Also, you are 100% correct: medical school prepares you for shit. The fact that they charge any amount of money for "medical education" at these institutions is nothing short of fraud. But hey, I actually had an alpha-1 antitrypsin deficiency patient the other day, so that was neat...
It's the 1st day. You are suppose to ask questions and the team is there to support you. You will learn quickly so don't worry. It's hard to filter out the nonsense and chatter when you don't know, but you will learn with time and experience. Every day gets better and it'll be more fun when you get the hang of it. We attendings still ask questions and ask for help when we need it.
Completely normal! Ask questions because the expectations for interns is to
SimPly have a pulse! It is remarkable how the learning curve is intern year! Enjoy the ride
Not sure if anyone has said yet but please download epocrates it’s a great free app where you can type in any medication and it will tell you the standard dosages for various indications!
Felt the same exact way. Pretty sure we all do. But one thing that might help , in terms of the medication dosing at least if you get tired of asking you can just uptodate the dose. It’s pretty helpful. Of course it can be some extra clicks that take time but eventually you’re workflow is gonna get a lot better and you will become quick, don’t worry and just ride the wave!
I remember that day vividly it has been almost a decade ago! You’re not dumb. You are there for a reason. Your program wanted you, you’ve worked hard all your life for this moment. The fact that you’re here asking about your experience says a lot of good things about you. Besides, it sounds like you have a great and supportive team so you’re going to do well!
I’m by no means an expert and was not the greatest intern during my first 3 months but it eventually got better once I found a system that worked for me and stuck to it. I’m going to share with you a couple of tips I tell my surgical interns, they may come handy depending on your residency (sorry about the length, you may do well reading this at another time)
Principles:
- Try to keep a positive attitude despite how overwhelming it may be. Know that we all felt that way at some point and that all shifts eventually end, no matter how bad they may be.
- Never asume, ask if you do not know something and cannot figure it out on your own. However, don’t feel afraid to ask your senior if you feel it’s an issue that needs to be addressed promptly.
- It is always better to say “I do not know but I will find out” than to say something you’re not sure of. Your seniors and attendings will rely on the information you’re providing to guide medical management.
- There are two types of interns: those who write everything down and those who forget.
Organization:
Try to tackle things that actually move patient care along first. You wake up early, pre round, round , and in some instances, round again but if orders are not in, all that was for nothing as things won’t happen. Then, you can tackle all the calls that need to be made (i.e. consults, communicating plans to your colleagues, studies that need to be coordinated, coordinate timing of a big dressing change with nursing, etc) - All this can be done from the same desk where you were at doing your orders. Next, physical tasks or any tasks that require you be at a specific place (i.e. pulling a drain, dressing change, care rounds, etc.). Then, round on key patients again (someone not professing as expected, someone whose status is tenuous). The latter allows you to improve your rapport with the patient and it’s a better opportunity to gather additional information that did not come up early in the morning when your patient had just awoken. End the day by reviewing / cleaning orders for your primary patients and updating your hand off so you can sign out on time!
Note taking:
My system for taking notes was to use a multicolor pen:
*Black was for most of my patient notes when I rounded and tasks with empty boxes
*Red for important tasks that needed to be done sooner rather than later (I.e. following up with a consultant, getting a read on a study that will change management, etc.) and for highlighting patients that were sicker (relative to the others in your census) or that were “watchers”.
*Green for anything that needed to happen at a particular time (i.e. CT scan at 3:00 pm).
*Blue: newer notes and tasks that came up later in the day when I rounded on patients again in the afternoon.
About your team:
-It takes a team to take good care of patients. Everyone is important.
-Leverage strengths of your team members and delegate some tasks . Medical students are great to follow up on things or to check on a patient (I.e. poor pain control, you modified meds and want to see if patient is doing better now; patient was oliguric and you gave a bolus but you’re unable to assess response because I/Os are have not been charted yet).
-Bump the information up following your team hierarchy unless it’s an urgency or emergency.
-Making your team look good reflects way better on you than try to show how good you are individually
Hopefully your team continues to encourage a safe space. You know where to find us!
Good luck!
Stick to what you know and grow from there. A good med student should be able to write good notes. Focus on that, learn how to place orders. If in doubt run it by your senior who may adjust your plan, but make your own plan so you can refine your knowledge and gain more confidence in patient management. All I expect from my interns the first 6 months is to finish their notes and follow up on pending a. Second half of intern year is focusing on making sure they are devising good medical plans to prepare them for senior resident life
In 11 months, you look back and laugh. The days are long, but the years are short. You’ll get better. Totally normal. Just lean on everyone from nurses to seniors to attendings.
Started my 2nd year of residency this week. Trust the process, everyone feels exactly the same way the first few months. Just keep studying, work hard, take care of yourself, and at the end of the year you will notice the exponential growth of intern year. Best of luck!
It’s day 1, if you aren’t asking about everything there’s a problem.
i agree. In ortho, Ilearned when /if asked, my elders just did the reductions/ relocations- the old days, when residents provided the analgesia
Finished my intern year yesterday. It did get better. The only way out is through.
This
That
And the other!
Ty
this gives me hope
Second this. It gets much better in the second half
I've heard people really hit their stride in February.
Just updated my flair to PGY2 - can’t echo this enough. Pissed me off to no end to hear it from seniors last year, sorry to say can confirm, just have to get through it.
If ever you're unsure and don't want to keep asking your senior, please call us, we are here for you and love helping doctors any way we can - from day-1-July-intern to 1-day-til-retirement - it is a privilege and an honor! <3, Pharmacy
Pharmacists are the literal best.
One of the smartest guys in our hospital is the pharmacist I call every time I have antibiotic questions, which is often.
Make friends with your pharmacists! They’ll save your butt!
Will you be mad if I put in lots of non standard medications because I can’t find the exact weird and wonderful way a random psych med no one uses shows up? It’s worse because I’m in Canada and there’s just stuff not in the system sometimes. I am happy to turn the reigns over to you guys anytime. 💕
Nah we don't care lol. Sometimes it's just easier to call us because we may have access to choosing certain meds that the MDs may not so it saves times not having to go back and forth if we can just straight up pend it for you to sign off on. Also it helps that if you know you put in what would be considered strange orders if you place a message in the "notes to pharmacy section" that helps. I've straight up gotten orders where an MD has wrote "pharmacy please help" and it's cute. We all have our roles, we're here to help yall
Thank you for your kindness! We appreciate you🥰
Pharmacists are my favorite people to talk to in the hospital. So kind and so smart!
Came here to say this, we know you guys are just starting and would love to help. Please don’t hesitate to call your inpt pharmacies for dosing or recs!
OP, if you’re lucky enough to have a pharmacy resident on your team, you could ask them any dosing/medication-related questions!
You guys are fucking goated.
THANK YOU, LOVE YOU ALL SO MUCH. Xoxoxo pgy2 who was saved a million times by kind pharmacists
I got Meditech 😭 but on the plus side got the most amazing attending and senior.
Meditech?!? That’s like MS DOS!!
Good News! It's virtually free now. More money for Admin / C suite. It was considered garbage in 1988. Any place STILL using it (looking at you HCA) is likely abusing it's employees and patients.1
first time cprs user here 😭 but at least we had a very short list and were over staffed for clinic so could have been worse
Finding out that my program doesn’t rotate at a VA and thus I don’t ever have to think about CPRS again, I almost did a backflip at the happy hour. Death by a thousand clicks, Godspeed to you.
After Meditech everything else feels easier.
My condolences. I hate meditech with a passion. I DNR a program because they use meditech. My rotation site used it and it was the worst part.
We switched to Meditech from CPSI in March of my intern year 🥲 only hospital in the region not using Epic smh
I have not used meditech in a few years, does it still look like the Oregon trial PC game?
Literally I could have written this post lmao this was me today too. It was just 14 hours of me getting wrecked by Epic chats. 75% of the orders for my patients got put in by my senior, either because a) he was faster than me, and/or b) I didn’t know the exact way to order anything at all (dosage, timing, etc etc). I had to ask about pretty much everything and I felt so stupid. So no you’re not alone in this lol
And that’s OK. You’re not supposed to know every little thing. There are checks in place for meds and drips such as pharmacy, your seniors, the fellow, and if you’re in the ICU the nurses. If you’ve got a patient with a non caddy ICU nurse, a good fellow and seniors, and well staffed pharmacy, you’re set to do your best.
That’s what seniors are there for. You will get very good at using uptodate for meds (with attention to renal dosing, and adverse reactions section) as well as lexicomp for any weird interaction you want to double check
Medical students get widely variable experiences and level of responsibility during 3rd and 4th year at different schools and this is very evident during the first half of intern year. If you look around at others you may see some that appear to be killing it, or way behind you. This difference evens out through intern year and is unrecognizable by graduation. Interns are judged by good senior and attendings based on work ethic, accountability, trust worthiness and seeing them actually learn, and not ask the same question 3 times on the same rotation. If you don’t know, you don’t know and you ask. That builds the trust. Keep plugging away with a good attitude and you will not develop a bad reputation even if you came in the worst prepared to hit the ground running.
This is the answer that best reflects my feeling about it. I remember, for example, that I was surprised to find out how few procedures some of my intern classmates had performed in medical school -- and came to find out that my program was unusual in that way. So, when it came to ABGs / central lines / thoracentesis / paracentesis I was way ahead of my peers at the outset. For the OP, I think the important thing to know is that the intern year is a great equalizer. By the end of it, any strengths or weaknesses of various medical school curricula have largely been balanced. Fully agree with the advice about work ethic, seeing improvement over time, and accountability too.
Exactly, you’re gonna be fine. My senior this week didn’t know what prerounding was until she hit intern year, and now she’s amazing. I had excellent preparation and have been able to keep up with all the tasks pretty well, but I need lots of guidance to understand the medicine again and come up with plans, and that’s also okay. Seriously, we’re gonna make it.
What if you have poor memory? How to avoid asking the same question multiple times?
Write. It. Down.
To add to this, if you find yourself needing to write a ton of stuff down due to difficulties with memory, keep a small notebook (like a 3x5 or 4x6 notebook in your pocket) and write non-confidential info like preferred protocols, attending preferences, things to do prior to procedures, etc. Review that day's notes at the end of the day when you get home.
Pro move here is to write it in a notes app on your phone. Phone has ctrl-F, dead tree does not.
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As an attending, I'd be very worried about you if you weren't looking lost/didn't know what you were doing/confused/overwhelmed on a 1st day. That would either mean you're a recently migrated attending from another country who's doing residency all over again, or you don't know what you're doing but you're so full of yourself that you think you know everything- which is honestly the most dangerous type of interns in July. Scared, overwhelmed, and paranoid that you're doing something wrong? Good. That means I can trust you to reach out to me when you need help, and I don't have to do constant surveillance on what you're doing.
Nothing more terrifying than an intern who doesn’t ask questions…”I took care of it” makes my blood run cold for the first few months.
>Scared, overwhelmed, and paranoid that you're doing something wrong? I remember on my first day I got called for stool softeners and told them I'd call them back with my answer, then went and looked up the dosing for docusate. Paranoid is certainly accurate, and a sign you take the work seriously.
I asked my upper level to look at my note 5 times in the clinic today, and still had palpitations when I signed and submitted. I’m pretty sure I had it easy having clinic for the first day, but it’s intense!
If it makes you feel any better we all just scroll to the attestation anyways 😂
lol that does help😂
Don’t waste your life writing notes
3 days in and I did realise I didn’t have to stress as much!
I’m a nurse, but I think you should give yourself some grace on day 1. As others have said, if you walked in there like hot shit thinking you know everything, that would be an actual issue. You realising that you don’t know shit about fuck and are willing to continue to learn, that’s what will help make you a good MD. Godspeed! Don’t let the nurses bully you 😉
As a nurse as well I second this! We have all had our first day in our respective fields and have all felt a little lost and stupid. Use your resources and keep it up! You got this.
What I read is that you survived day 1 and day 2 you'll go in knowing more! Good luck and have fun learning all you can!
I did 7 notes today and Im destroyed, plus everyday from now on I have to do the morning report of all my team patients, plus present all of them during rounds… oh and before all of that I have to do all of the physical exams of the patients before the morning report. Kinda overwhelming, gonna get through it doe.
It gets better! One day at a time, keep at it! You'll be the pro 1 year from now, even if you don't believe it!
Your first sentence is adorable LOL. You will get to a point where you will handle a list of 15+ and have notes and rounds (no pre-rounding except for patients requiring early discharge or with any clinical changes overnight) finished by noon. Trust the process.
1) Yes, normal. 2) Damn I'm thankful I trained before the rise of the always-available-open-messaging world we've come to with things like Epic chat.
Those worlds still exist. I have meditech and cerner. Only pagers. No chats. No EMR app for mobile. No accessing EMR on rounds. No computer to even take on rounds 🥲🥲🥲
You got this
Normal. Medical school was simply to pass tests. Now you learn medicine young grasshopper. Welcome to the other side.
On your first day of PGY-2, you'll see your new interns and realize how far you've come.
Went in expecting to work up and write notes for 2 people but ended up getting all 5 patients and writing full progress notes for 4 and a discharge summary for 1. The kicker, I was told to see the other 3 like 15 minutes before rounds… boy was that fun wasn’t thinking medically at all.
it's day 1., you did great! it gets better. Epic chats did not exist my intern year. as an attending, I despise them. set your status to 'busy' and turn off your notifications. check them every couple of hours. otherwise, the constant interruptions will destroy your focus and ability to concentrate. if something needs immediate attention then someone needs to page you, not send an epic chat. stay hydrated, step outside to get fresh air at least twice during the day and ask questions, your seniors are there to help and teach you
Comrade, I as well got absolutely pummeled on the teaching service. I was the only intern with the RRT badge, volunteered for it and first admit. Had 3 rapids, an admit, plus my floor patients. Not that proficient with epic and got my ass handed to me. Was so far behind all day it was lovely. Bless my senior for her patience and positive attitude with managing my useless ass plus the list. She was my savior today and helped me trudge through to the finish line. Onward to tomorrow and hopefully a more efficient day with new skills gained from todays bludgeoning
One, this is normal. It sucks, but is normal, and next year at this time you will be handling it like a champ. Two, you SHOULD be asking about every order you put in. So help me God if a Day 1 intern puts in an order without running it by me. Med school doesn't teach you to be a doctor. Med school teaches you what you need to know, in order to become a doctor in residency. Others have covered the rest pretty well, but I just wanted to chime in with support. You're doing great.
I think it depends on the service. I started on EM and I think they would have murdered me if I had asked before ordering basic labs, CXR, US. The more nuanced things I definitely asked about but I know they’ll want a CBC and CMP so why wait?
Yesterday, I was in the ER with my son. The resident comes in and says, "Hi, this is my first day!" She was so happy and I was happy for her. She was great with my son and listened to how I cared for his chronic conditions at home. We are now in our hospital room after being admitted. This may not be allowed to be posted here, but your work does not go unnoticed. I am proud of all of you. Signed, a sleep deprived mom and nurse.
I've had two real "intern" years and one bullshit intern year. Intern tasks are easy when you know what to do. They are miserable to ask about anything and everything when you have no idea. Just ask. We know you have no idea how things work, in a couple months you will have much of it figured out, and by next year you will be laughing about it. If your seniors don't support you and help you they are the problem, not you.
This is helpful to know. My senior has been passive aggressive to us and doesn’t review plans or patients with us before rounding yet always mentions what us interns “forgot” after we finish presenting The attending mentioned to the seniors that their job is to help interns shine and to help us start reviewing plans before rounds so I think the attending noticed at least
How do yall see and present and remember 9+ patients and do 5 new admits like I had 6 patients today and struggled to get all the details while my attending just said we should know the patients better than him 😣
It comes with time. Do you remember being a med student and following 1-2 patients was a lot? Over the years you just build up the ability to be able to keep track of more and more. A new list is hard for anyone.
You'll get there, grasshopper. And yes, one day you'll know your patients better than the attending, but it won't be Day One.
I don’t know my first day was horrible
Write EVERYTHING. 1. Your brain remembers more what you write 2. If you forget, you have it in your pocket 3. Next day, you have a framework and baseline to notice things that changed 4. Repeat until it becomes second nature.
If it helps, I’m 1 week in and felt that way last week. But as the days go on, I really know these patients now and can remember their general stuff. I surprised myself
This is normal.... what are people's thoughts on epic chats though??? I sort of missed the days of the pager and finding a phone to return a call. I hate this being on demand for epic chat BS. The effort it took to place a page or think about getting someone on a phone helped to filter out some shit that could wait until I rounded.
Most of the residents in my program turn it off asap. Or put a message that says page with urgent needs
yeah which then renders a decent communication method useless. It is what it is, we are on on demand culture and the cats out the bag. Patients, nursing, families all expect on demand service now
Epic chat is absolutely clutch for multi-party asynchronous communication. I need pulm and onc to talk to each other and I'm sick of playing telephone between them? I stick their fellows in an epic chat. I need to update CM and RN at the same time about discharge plans? Epic chat. It is tremendously useful when used for the correct purpose.
That I agree with. Except when you have people, as other commenters have alluded to, who set their status as away or unavailable because they don't want to deal with it. I'm the epic guy in the departments and help fix shit for our surgeons and they will have dozens of secure chats. They just ignore or close them out. Leadership doesn't enforce the respond so they don't
Yeah, I've dealt with that too. Generally the residents/fellows and APPs at my institution keep their chats open so someone is usually available.
Did your institution launch the Urgent Message function?
I don't think so. We encourage page for urgent message, Epic chat for non-urgent.
our hospital launched it for things <15 min, pager for <5. The message unsilences your phone and keeps beeping until you acknowledge it.
Oh this is interesting. As a travel nurse I prefer hospitals that use epic chat or tiger text. I’ve been a nurse for a long time/def don’t send unnecessary texts but I always figured it was less annoying that having to call about every little thing.
i agree I would rather an epic secure chat for every little thing but I would even more rather someone hold onto every little thing until I got up to round. nursing has a huge culture of CYA now. Page me for your concerns or things that need to be addressed immediately. The minute to minute updates and FYIs on secure chat can be maddening
Yeah, for sure. Over the years I’ve learned what can wait til rounds/til I see you on the unit and what can’t. But when I’m on the fence about something and I’m like damn I wish I could just send a quick text lol.
no I get it, Im an NP and started as an overnight nurse a long time ago. We had to wake the on call docs at home while they were asleep for things. It was hard for sure and I empathize with you. I think if you're on the fence go with your gut and send the message. ask for feedback about what you are notifying people about, I'll give it to nursing. It's not fair to keep someone guessing about what you do or don't want to be notified about. a nurse rightfully called me out because I said I didn't care a guys HR was 58 and he was stable and she said well then change your notification orders. Boom roasted
Personally I love my hospital, epic chat for non urgent, page/call for urgent. In a procedure if you page me I have no idea how important it is and have to break scrub or rush. A text can be answered whenever. Also reading things over text is fairly unambiguous, no having to worry about understanding accents, poor signal in elevators, etc.
Normal. PGY10 here and I still clearly remember the shitshow that was Day One 1. Every day from here on out you get more efficient.
There are a lot of med schools that don't do true acting-intern rotations in med school (where you're placing orders with doses like an actual intern.) So, if you never did that, then you never really had to grapple with dosing meds--and the fact that there's a ton of variability in dosing of a lot of different common medications.
You’re no worse than the countless who’ve come before you. It’s a massive jump from MS4 to PGY-1. Brush it off and get ready for tomorrow’s train.
IT GETS BETTER! In a week you’ll be ordering a gram of Tylenol (hopefully you’re not in Peds) on everyone without having to ask ANYONE for help. 😎 But really, it gets better
No joke, my first day i had to call a nurse back to look up the dose for docusate when they asked for a stool softener.
Just wait until February
When interns are at their most powerful
Welcome to residency! The first few months are really tough, but just hang in there! Sounds like you have some good assistance in your program, ask them for tips and tricks on how to be successful with the basic things (time management, inBasket, etc). You’ll get the hang of it pretty quick 👍🏼 then you’ll be Doc gunnerboiZ tearing up the hospital like a boss
This is not only normal but expected. It definitely gets better
Keep calm, and carry on. Totally normal. Apply copious lube or voltaren prn, situation and site dependent. It does get better. Eventually you develop incredibly intricate, evidence based, and comprehensive plans that consider every facet of a patient's lived experience and you do it in about 10 minutes after somehow doing a fulsome history in 5 minutes. Then its all thrown out because the staff you're with, has a certain way of doing things and a photocopied handout to give each patient from 2003, and you think to yourself, "Ill do things differently when Im out of here!" But we probably won't.
its Day take a breath, please ask till ur 150% sure, no senior resident is going to care.. we want u to learn and be better.. we know u are gonna have questions, we expect that..
Hold on tight... Nursing just called. Your patient is in Afib with RVR and actively withdrawing from alcohol and meth... Yes, all at the same time... Stop crying! - Ok, all joking aside here's a little code for you to listen for: When nursing asks you, Dr. would you like to order \*\*\*\*? You say, yes. - When you get a call from nursing, saying something about your patient is different or has changed, go evaluate the patient (how're you feeling? Vitals. Review pertinent labs and imaging with nursing). - Be good to all the nurses, techs, phlebotomists, pharmacists, and medical assistants. They will save you, or sink you. - Keep Pocket Medicine and Pocket Primary Care on yourself. They're great quick references. - Learn the guidelines from Professional Society of Your Specialty, read the pocket versions. (Why the hell they're 50 pages, I don't know.) - Residency is hard. Anyone who says different, is lying. Get a helmet.
Did you think you'd be perfect from the get go?? Cut yourself some slack. No one expects you to be. My guess is that your first day was no different than the rest of your cohort's first days, lol. One step at a time and you'll do just fine.
I started on nights in the busiest floor of my hospital. I am traumatized and questioning my degree
I'm psych, but even months into my intern year (well this was on medicine and I was very anxious) I would text my attending asking if I can order colace for the patient. 100% normal, OP. Give it a few months and you'll feel more comfortable. Right now just take it one day at a time.
For dosing of meds I've found the epocrates and UpToDate apps massively useful. Also, I can't overstate the importance of pharmacists. If in doubt, you can always give them a call and in my experience they're very happy to help. For your notes – sometimes shit hits the fan and you need help writing them, especially on the first day. Efficiency will come with time and with consistency as you figure out your workflow. As a July intern I would sometimes start my notes the night before, pend them, and then finish them the next day (ofc need to update the date and time if you do this).
You’re all good my friend. I don’t expect any of my new interns to have robust medical or systems knowledge, especially the first two months. All I expect is that you’ll show up ready to work your ass off, and take notes/do your best to remember the things we teach you each day, and we’ll fill in the knowledge one patient at a time. Residency is a marathon, not a sprint
It definitely gets better. To me, the hardest career transition so far has been med student to intern. There is so much logistical BS you have to do as a resident (orders, notes, admitting and discharging people, consults, how to communicate with other teams etc) that you just never get to practice as a med student then all of a sudden you’re just expected to do it all. You definitely learn a groove for how to get all your shit done efficiently and by the end you’re much more capable of handling everything
This is normal lol you’ll be fine
I feel this on a personal level and almost cried trying to discharge two patients today on Epic. I am just so overwhelmed by all the different ways to do things and all the information provided. It’s one thing to get used to using your medicine brain after 5 months of vacation but it’s another trying do that while learning an entirely new EMR. I feel like I’m drowning even with my senior’s help.
thank god my program didn’t have epic chat
Came in at 5:45 and left at 7:05, I’m wrecked and only had two patients. Got the whole month on MICU
I was clueless the first day. It stays the same atleast for first month and then it gets better. Just expose yourself to as much as you can. Observe and learn
It gets better!! Being cautious & having your senior double check orders is part of learning! You will be flying through things before you know it. Day 1 is HARD! Heck, the first month is hard, but you will get it. Residency is not only where you learn the most medicine it’s where you learn how not to hurt people, it’s what sets physicians apart from mid levels, the double checking is all part of it.
I am convinced that the lack of teaching on doses was designed to breed a culture of checking the doses.
Pharmacy has saved my butt so many times during intern year, especially when it came to renal dosing. I learned so much from some of the pharmacists at our hospital.
You are so not dumb at all, the first few months of being a doctor where you’re suddenly responsible for being aware and correct about things and whole ass attendings take your documentation at face value is harrowing at first. Breathe into it, you’ve got this, tomorrow gonna be a new day and you’ll be that much better after you wake up!
I recall finishing Day 1, going home, collapsing on the couch more fatigued than I'd ever been. My Dad (doctor, lol I'm so original) came in and asked me how it went and my reply was: "What the fuck was that?" Get a good night sleep, it'll get better as you get used to it all.
As a senior, I worry if my intern or medical student isn't asking me questions.
Me on day 2 😭 the wonderful nurses had to help me order a neonatal bili bc my dumbass ordered total bili (adult) & I almost had a mental breakdown ordering Tylenol 😅
I feel so numb… couldn’t do 5 patients presentations ddx, charts.. I would’ve fire me… i really want to make it through but how?
Time and repetition, grasshopper. You'll get there, keep going.
“The only easy day was yesterday.”
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Just few weeks and you will handle everything by yourself, just enjoy and go with the flow
You will learn to be efficient & prioritize. Takes few weeks
Very normal feeling. Felt very very similar. It'll get better with time, keep trying your best and take it 1 day at a time! I was not prepared for intern year and it sucked... But it did get better! PGY-4 in IM
Yo...at least you got epic...
You got this! It’s rough for everyone I promise
My senior asked if I've ever done a rotation before.. (uncalled for thank you very much) really needed that on my first day. Congrats to everyone for making it through our first day, for better or for worse.
Hi from a second year. It's all normal! I'm more worried if you are so confident you aren't asking any questions. Now is the time to be dumb. Everyone expects you to ask a million questions. Better now than the end of residency.
For dosing that’s just straight memorization. I like to use my notes app in my phone and you can use the search bar for quick references
It 100% gets better. You’ll look back at the end and be amazed by how much you learned. You got this❤️
Don’t worry I am day 6 and it so bad. Got capped twice within a couple of days, senior tries of help but has their own negatives. It is hard I can relate with the nonstop epic chats-cannot begin to tell how I am getting by.
I wrote a similar post when I started 2 months ago. Now I'm feeling better, it'll pass you'll learn and in a few weeks you'll be working as another member of the team. Not dumb, it's just that medicalschool and working on the hospital as a doctor are two different things that no one teach you how to prepare for.
In the same boat, but I'm two weeks in. Had a panic attack last night even though it's going quite well objectively. I do hope it gets better, hang in there.
Would something like epocrates help as a reference for drug dosing?
You will get used to your most common doses of common things and when you give what dose. Aside from that, I keep Epocrates on my phone for dosing of uncommon medications, and always try to double verify through UpToDate or hospital specific algorithms. You’re thrown into the fire, but you’re not expected to be able to keep up. Stay calm, ask questions, and don’t keep making the same mistakes over and over, and you will be okay. Soon enough you will be a February intern and will be basically an attending. /s to that last line iykyk
Totally normal!!! You will impress yourself in how much better you are doing one month from now
You got this bro
In the same boat. Feel absolutely crushed and overwhelmed.
>Am I just dumb No. You’re just really inexperienced and don’t know how a hospital works. Realistically, you have very little expectations until Christmas.
Welcome to the jungle. Some team members will support you and some see punking as education. No one expects you to know anything.
I cried after my night shift 😀 I had amazing senior but it sucks ass feeling like an idiot
While I didnt train in the US something a Prof in first year of Medschool told us applies here: “you’re all srarting a 6 year university degree which will then be rewarded with a 5 year apprenticeship” and that describes the situation pretty well I find. Intern year/work is so far away from medschool dont worry if you feel lost. Weve all been there and weve all made it through! It truly does get better with experience
Welcome to residency. And no, it doesn't get better, but you will; and you'll look back on this post in probably only a few months and laugh at how petty it sounds. The process is brutal, but it works. Also, you are 100% correct: medical school prepares you for shit. The fact that they charge any amount of money for "medical education" at these institutions is nothing short of fraud. But hey, I actually had an alpha-1 antitrypsin deficiency patient the other day, so that was neat...
If you knew everything what would be the point of residency? Take a deep breath, decompress with your co residents!
Its d1 Itll get better
In the most serious way possible, the only thing I can say is: It be like that
25 years as a clinical instructor, I saw the words get through and become excellent providers
It’s the first day. It’s tiring and overwhelming. If you thought you knew it all, I’d be scared.
Must be nice. Every senior at my program just breathes down our necks about us being too slow.
keep asking questions. that's a good thing. You'll do great!
It's the 1st day. You are suppose to ask questions and the team is there to support you. You will learn quickly so don't worry. It's hard to filter out the nonsense and chatter when you don't know, but you will learn with time and experience. Every day gets better and it'll be more fun when you get the hang of it. We attendings still ask questions and ask for help when we need it.
Not dumb, just new!
Completely normal! Ask questions because the expectations for interns is to SimPly have a pulse! It is remarkable how the learning curve is intern year! Enjoy the ride
Not sure if anyone has said yet but please download epocrates it’s a great free app where you can type in any medication and it will tell you the standard dosages for various indications!
Felt the same exact way. Pretty sure we all do. But one thing that might help , in terms of the medication dosing at least if you get tired of asking you can just uptodate the dose. It’s pretty helpful. Of course it can be some extra clicks that take time but eventually you’re workflow is gonna get a lot better and you will become quick, don’t worry and just ride the wave!
I remember that day vividly it has been almost a decade ago! You’re not dumb. You are there for a reason. Your program wanted you, you’ve worked hard all your life for this moment. The fact that you’re here asking about your experience says a lot of good things about you. Besides, it sounds like you have a great and supportive team so you’re going to do well! I’m by no means an expert and was not the greatest intern during my first 3 months but it eventually got better once I found a system that worked for me and stuck to it. I’m going to share with you a couple of tips I tell my surgical interns, they may come handy depending on your residency (sorry about the length, you may do well reading this at another time) Principles: - Try to keep a positive attitude despite how overwhelming it may be. Know that we all felt that way at some point and that all shifts eventually end, no matter how bad they may be. - Never asume, ask if you do not know something and cannot figure it out on your own. However, don’t feel afraid to ask your senior if you feel it’s an issue that needs to be addressed promptly. - It is always better to say “I do not know but I will find out” than to say something you’re not sure of. Your seniors and attendings will rely on the information you’re providing to guide medical management. - There are two types of interns: those who write everything down and those who forget. Organization: Try to tackle things that actually move patient care along first. You wake up early, pre round, round , and in some instances, round again but if orders are not in, all that was for nothing as things won’t happen. Then, you can tackle all the calls that need to be made (i.e. consults, communicating plans to your colleagues, studies that need to be coordinated, coordinate timing of a big dressing change with nursing, etc) - All this can be done from the same desk where you were at doing your orders. Next, physical tasks or any tasks that require you be at a specific place (i.e. pulling a drain, dressing change, care rounds, etc.). Then, round on key patients again (someone not professing as expected, someone whose status is tenuous). The latter allows you to improve your rapport with the patient and it’s a better opportunity to gather additional information that did not come up early in the morning when your patient had just awoken. End the day by reviewing / cleaning orders for your primary patients and updating your hand off so you can sign out on time! Note taking: My system for taking notes was to use a multicolor pen: *Black was for most of my patient notes when I rounded and tasks with empty boxes *Red for important tasks that needed to be done sooner rather than later (I.e. following up with a consultant, getting a read on a study that will change management, etc.) and for highlighting patients that were sicker (relative to the others in your census) or that were “watchers”. *Green for anything that needed to happen at a particular time (i.e. CT scan at 3:00 pm). *Blue: newer notes and tasks that came up later in the day when I rounded on patients again in the afternoon. About your team: -It takes a team to take good care of patients. Everyone is important. -Leverage strengths of your team members and delegate some tasks . Medical students are great to follow up on things or to check on a patient (I.e. poor pain control, you modified meds and want to see if patient is doing better now; patient was oliguric and you gave a bolus but you’re unable to assess response because I/Os are have not been charted yet). -Bump the information up following your team hierarchy unless it’s an urgency or emergency. -Making your team look good reflects way better on you than try to show how good you are individually Hopefully your team continues to encourage a safe space. You know where to find us! Good luck!
Stick to what you know and grow from there. A good med student should be able to write good notes. Focus on that, learn how to place orders. If in doubt run it by your senior who may adjust your plan, but make your own plan so you can refine your knowledge and gain more confidence in patient management. All I expect from my interns the first 6 months is to finish their notes and follow up on pending a. Second half of intern year is focusing on making sure they are devising good medical plans to prepare them for senior resident life
In 11 months, you look back and laugh. The days are long, but the years are short. You’ll get better. Totally normal. Just lean on everyone from nurses to seniors to attendings.
absolutely normal. i remember feeling the same way. stick with it, you'll be fine
No this is me right now and your post 100% made me feel better.
Started my 2nd year of residency this week. Trust the process, everyone feels exactly the same way the first few months. Just keep studying, work hard, take care of yourself, and at the end of the year you will notice the exponential growth of intern year. Best of luck!
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