HOW TO SUCCEED IN
INTERNSHIP
What They Neglected to Teach You in Medical School
Khanjan Shah
Fall 2013
MOST IMPORTANT INTERN TRAITS
 Attractive
 Brilliant
 Studious
 Hilarious
Confident
Meticulous
ORGANIZED
THE MANY HATS YOU WILL WEAR THIS
YEAR
 Physician
 Scholar
 Educator
 Researcher
 Communicator
 Secretary
 Phone Operator
 Scribe
 Event Planner
 Spouse
 Parent
 Child
 Applicant
THE SECRET
 Have a system!
 Be prepared to change your system
 Ask your colleagues what’s working for them
 Be introspective
THE EARLY BIRD
 Wake up on time!
 Enjoy your routines
 Potential tips:
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Put your clothes out before sleeping
Make breakfast while you pack your things
Pack a lunch the night before
Have a timer on your coffee maker
Keep your keys/phone in a designated place
Estimate commute time with different traffic patterns
Read patient updates while eating
PRE-ROUNDS
 The most critical 1 -2 hours of your day
 Pay attention during night float handof f
 if you’re last in line, go see a patient!
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Do not backtrack – your feet will thank you
Print of f a new handoff – updated vitals/labs!
Minimize unnecessary copying
Check the updated med list
Have a designated work space
Examine your patients well the first time
Be friendly with the nursing staf f
EXAMPLES (H&P)
Today’s Date:
M
Patient Name:
F
Head:
Ears:
Date of Birth:
Age:
Eyes:
Patient Number:
Date of Admission:
Nose:
CC:
Mouth:
Throat:
HPI:
CV:
Resp:
MHx:
GI:
GU:
FHx:
Endo:
Heme:
SHx:
M/S:
Neuro:
Meds: 1.
2.
3.
5.
6.
7.
4.
8.
Psych:
Derm:
EXAMPLES (H&P)
GS:
Skin:
Vitals
Labs
BP:
Tm:
Nodes:
Temp:
Resp:
Pulse:
Head:
Wt:
Eyes:
Ins:
Outs:
DI/O:
Ears:
Nose:
Orophar:
Neck:
Lungs:
Heart:
Breasts:
Abd:
Problem List
Genit:
Rect:
Ext:
Back:
Neuro:
EXAMPLES (DAILY)
Name:
Date:
Events:
ID#:
Date:
Events:
Neuro:
Neuro:
Resp:
RR:
Sat:
Cardio:
P:
BP:
Weight:
FEN/GI:
AST:
ALT:
Renal/
Lytes:
Resp:
RR:
Sat:
Cardio:
P:
BP:
Weight:
FEN/GI:
AST:
ALT:
Renal/
Lytes:
Heme:
CPK (T):
CK-MB:
Trop I:
Amy:
Lip:
Alb:
Ca:
Mg:
PO4:
PTT:
PT:
INR:
MCV:
ESR:
Heme:
ID:
ID:
To do:
To do:
CPK (T):
CK-MB:
Trop I:
Amy:
Lip:
Alb:
Ca:
Mg:
PO4:
PTT:
PT:
INR:
MCV:
ESR:
EXAMPLES (DAILY)
PROBLEM LIST
DOA:
ID:
CC:
MEDS
1
2
3
4
PE Notes:
ROOM:
PMHx/PSurgHx:
5
Home Meds:
6
7
8
ALL:
© www.medfools.com
SHx:
ROS:
FamHx:
PMD/Consults:
EXAMPLES (DAILY)
LABS
/
Tm
HR
TO DO
/
BP
R
O2sat
I/O
BP
R
O2sat
I/O
/
BP
R
O2sat
I/O
/
BP
R
O2sat
I/O
/
BP
R
O2sat
I/O
/
BP
R
O2sat
I/O
/
BP
R
O2sat
I/O
/
Ca
Mg
Ph
P
L
M
/
E
B
Tm
HR
Ca
Mg
Ph
P
L
M
/
E
B
Tm
HR
Ca
Mg
Ph
P
L
M
/
E
B
Tm
HR
Ca
Mg
Ph
P
L
M
E
B
Tm
/
HR
Ca
Mg
Ph
L
M
/
E
B
Tm
HR
Ca
Mg
Ph
P
L
M
/
E
B
Tm
HR
Ca
Mg
Ph
P
L
M
E
B
© www.medfools.com
P
ROUNDS
 Pay attention to all the patients (not just yours)
 Write down everything you need to do
 Box, double box
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Be flexible with the pager
Find the nurse as soon as possible with plans
Involve the social worker for the floor
Have consents readily available
Place orders/review labs on WOW
Keep a list of topics to read about later
IMMEDIATE POST-ROUNDS
 Run the list with your senior
 Work order:
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C = call consults – with specific question!
O = orders
L = labs/imaging
D = discharges
P = paperwork (notes)
 Tips for ef ficiency:
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Call the operator ONCE
Keep all pager numbers for the month
Multitask – place orders while you’re on hold
Work together!
NOON CONFERENCE
 Go to them!
 We are an academic hospital – be academic!
 Ef forts are under way to minimize pages
AFTERNOON
 Follow up on your little boxes
 Write your notes and EDIT them – be concise!
 Add addendums as important results/recommendations
return
 Start working on gold forms early – ask your seniors for help
 Ideally, participate in resident/medical student teaching
session
 Edit sign-out as you go
ON CALL
 Finish up work on established patients (including sign -out)
 Eat/drink when you can
 If no admission until later, catch up on discharge summaries!
 See your patient immediately wherever they are
 Work out efficient schedule with MS3
 Staff with a plan
 Save note as you go
 Some things can wait until tomorrow
WEEKENDS
 Plan for weekend discharged on weekdays
 Find out senior staf fing schedule and call early
 Remember, you can sign-out to sister team
 Meet your friends at Wolfgang!
CLINIC
 Consider looking up patients in advance (but remember high
no-show rate)
 Do not be afraid to place patients back in waiting room
 Staf f with a plan
 Finish work while waiting (ordering labs, consults)
 Write notes while talking to patients
THE “HAPPY” DAY
 Finish your work early
 Do not be afraid to sign -out work – we are part of a team!
 Go home!!
THE REAL “HAPPY” DAYS
 Your days of f!
 Spend your days with the people you love doing the things you
love.
 Do not always feel compelled to study
SANIT Y
 Leave work at work
 Do not excessively check the EMR at home – your colleagues
are good doctors, too!
 Vent when you need to, but learn to forgive
 Do not start “note battles” with other services
 Communication is key – dare to be the listener
 Introspection – did I play a role in staying until midnight?
 Read something edifying daily
WHY I AM EFFICIENT
THANK YOU AND GOOD LUCK
 I look forward to working with you all!