Six Clinical Pearls from Intern Year

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Author: Casey Grover, MD
Stanford/Kaiser Emergency Medicine
Originally Published: Modern Resident October/November 2011

Looking back after finishing a year as an emergency medicine intern, the lessons that I remember the most come from the mistakes that I have made. I had one particularly rough month late in my internship that was filled with bounce backs and mismanaged cases. I learned six important lessons that will hopefully help to avoid another such month in the future.

1. Review every study that you order. While you may have ordered a chemistry panel just to check the creatinine, it's embarrassing to miss a sodium of 121.
   
2. Document your discharge decision process. If a patient has a problem or bounces back, it is extremely helpful to have documented everything (i.e., normal vitals, well appearance, consultant recommendations) that you considered when sending that patient home.
   
3. Review discharge vital signs. Vital signs are actually important – they reflect the patient's underlying physiology. Document normal vital signs when sending patients home; and when discharging someone with abnormal vitals, document your rationale and plan.
   
4. Document your discussions with consultants. Record at what time and to whom you spoke, as well as what they recommended. This allows others to see the basis of your decisions, which is essential if an adverse outcome occurs.
   
5. Be suspicious of patients signed out to you. Review the labs and vital signs of the patient you will be taking care of, and address all of their medical issues. Approach the case with fresh eyes and be willing to consider other diagnoses than those billed to you in sign out.
   
6. Approach procedures carefully. While it's fun to do procedures, be aware that complications may arise – particularly in a patient who is high risk for bleeding. Review labs and history, particularly for things like coagulopathy, that may make procedures difficult.

Making the Most of Third Year

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Author: Mary Calderone, MS3
AAEM/RSA Medical Student Council President '13-'14

Originally published: Common Sense January/February 2013

Aside from intern year, the third year of medical school is traditionally considered one of the most formative experiences in a physician’s life. Suddenly, we’re propelled from passively sitting in a lecture hall to thinking on our feet. Our thought process now has the potential to impact how we care for a patient, rather than just how we answer an exam question. Just as we impact the lives of patients, patients also impact us in powerful ways. We begin to make decisions about the future of our medical careers, ruling out certain specialties and exploring others further. As we navigate these new challenges, we gain an increasingly keen sense of self-awareness. Our strengths and weaknesses stare us straight in the eyes, whether we realize them through self-reflection, hear about them from one of our senior colleagues, or experience some combination of the two. We start to contemplate our life goals and our requirements for happiness and well-being. By the time we’re fourth years, we’re expected to have decided upon an area of medicine after a whirlwind of speed-dating with different specialties.

While many students enter medical school with some idea as to their future specialty, studies have shown that the majority of students change their minds. I entered my M1 year with a passion for emergency medicine that has only continued to grow as I’ve gained more clinical experience. Entering medical school with relative confidence in the area of medicine you wish to practice has its advantages and disadvantages. On one hand, you can direct your efforts toward a concrete goal. You can lay the foundation for pursuing a career in a given area of medicine early in your training. You can participate in activities and opportunities that prepare you well. You can find the right mentors. On the other hand, you may fail to consider all of the exciting possibilities for your career, thereby prematurely closing your mind to an area of medicine that you might otherwise have loved. Your bias toward one specialty may cloud your judgment of whether or not you actually fit well into its culture. You may even disregard the importance of a clerkship because you think it won’t ultimately be relevant to the type of medicine you plan to practice, thereby cheating yourself of a fulfilling and valuable experience.

Be a Non-Terrible Intern in Ten Easy Steps

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Author: Gregory Wanner, DO PA-C

Thomas Jefferson University Hospital

Welcome to residency! Now that you’ve had some time to learn the hospital computer system, find the coffee maker, and begin to settle into your new role as an intern, it’s time for a few tips. Intern year is tough. You have a whole new set of responsibilities, and for some this is your first “real” job. There are many ways to be a terrible intern, but you can avoid terribleness and become a wonderful intern.

Over my ten years in medicine, initially as a physician assistant and now as a senior resident, I’ve had quite a bit of exposure to interns. Plus, I was one not so long ago. As interns we all have times — often brief — when we feel brilliant, as well as times we feel completely incompetent. We have moments of enlightenment and moments when we need to be bailed out by nurses or attendings. This is to be expected. The goal is to learn from your mistakes and eventually become a great physician. To learn what you can do to further your own education, keep your attendings relatively happy, and avoid terribleness: read on.