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Some Rules to Help You Shine in Your Intern Year

(stuff I wish someone had told me)

Tom Morrissey and David Caro

Dept. Emergency MedicineUFHSC-Jacksonville

1) This is really a job, and an important one!

Professionalism is an absolute must

Show up on time ready to go

Clean up messes at the end

Dress right (professional and comfortable)

2) Recognize that your first year is about a lot more than just Emergency Medicine.

You need a SOLID grounding in IM, ICU, Ortho, OB/Gyn, etc.

Truly immerse yourself in the services you are rotating on-look at theworld through their eyes

3) READ, READ, READ!!!

build a schedule and stick to it

Focus on basic, daily used skills (EKG, CXR, ABG, lab interpretation) Commit algorithms to memory (ACLS, basic orders for common chief

complaints)

4) Expect and be ready for formative feedback (i.e. constructive criticism)

Expect to be wrong every day, because

different attendings do things differently. Dont let this frustrate you.

Accept it as a chance to try out different practice styles, and find out what

works best for you.

5) Be humble and nice to everyone around you.

Its a small world (see below).

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6) Its NOT OK to lie! Really.

Its OK to not know the first time around (I didnt do a rectal examI

forgot to look at the x-ray)

Learn from each of these instances and take pains to not do it again.

Its never OK to lie. It compromises patient care, undermines the trustplaced in you, accomplishes nothing.and you will get caught!

7) Maximize learning opportunities on shifts.

Grab charts

Offer to do/teach procedures

Dont sign out procedures unless absolutely necessary

Read every EKG in the department

8) Pay Attention to Vital Signs and Lab Results You have to explain the abnormal!

Know normal limits

9) Structure the timeline for your patient encounter

Walk out of the room at 10 minutes and build a provisional DDx and

treatment plan.

Adjust as necessary with a long term goal of efficiency

10) Get comfortable with alternate sources of history

Call family, friends, nursing home

Look up old records, labs, D/C summary

Ask rescue what they saw, who was there, is family coming?

Call the police back

11) Dont screw your neighbor

You and your colleagues have to support each other

Kindness is paid back in kind

12) Give the patient the benefit of the doubt

Its OK to get fooled by a drug seeker, its not OK to miss real pathology

Dont underestimate pain

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13) Develop a system to keep patient data organized

You cannot keep the chart in your pocket

Ask colleagues what works for them

Only the basics, pertinent +s and s, dont rewrite the chart

14) Work on your case presentation style.

This is an actively acquired skill. Seek feedback.

Practice briefly prior to rounds-dont just wing it.

The brass ring is to know everything, but only say the minimally

necessary

This will become critical in interactions with consultants.

15) Listen to your nurses.

Some will save your butt

Some will hang you

Learning to tell who is doing what when is an integral part of your

education

16) Assume assassins are everywhere

Always be on alert

Patients will crash when you go to pee

Murphy wasnt a lawyerhe was an Emergency Physician!

17) Go to lecture. I know its tough, but where else are you gonna find two weeks

worth of information packaged into 45 minutes and delivered to your noodle?

18) Develop some social support network-and prepare them for whats coming

Let them know how important this is to you

Remind them residency is a finite time

Dont be afraid to lean on family/friends for support

19) Learn a little about the machinery that makes the residency run

ACGME, RRC-EM, Deans office

Understanding a little about some of the hoops you have to jump throughmakes them a little more tolerable.