This column was originally posted in July of 2007.
For the benefit of the new interns, I'll now present my own perspective on internship.
I like to think that my own internship was more like this guy's
than the type being advocated amongst some of my fellow medbloggers these days. I was a mediocre medical student, smack dab in the middle of the bell curve, but I ultimately became the best intern in my large program. "How could that be?" you might ask. Simple...I worked harder than anyone else. If you finished medical school at the top of your class, you are ahead of the game and you probably are already anticipating your cushy Dermatology lifestyle. Otherwise, if you want to be successful, you are going to have to turn it up a notch.
Here's a newsflash for you....the most competitive post-residency positions (whether they be Chief Residency slots, rare subspecialty fellowships, prestigious academic appointments, or deluxe private practices) tend to accept the very best residents rather than the slackers. The best residents, in turn, tend to be those who were the harder-working interns rather than the clock-punchers. This first year can really set the tone for your entire career.
On a non-call day, when everything is done then you might as well leave...but preferably not before the attending does. On call nights, there is always something to learn. I read about the medical conditions of my new admissions whenever I had time, because the most effective learning occurs at the point of contact. Memories are hard-wired when you can associate a medical condition or technique with a specific patient situation. I identified residents and attendings who had outstanding skills that I admired, and I learned as much as I could from them. But you aren't learning anything if you aren't in the hospital.
Extra effort counts. Come early, stay late. Be ultra-aggressive about tracking down results of labs and studies. Take the specimens to the lab yourself if it will speed things up. I did my own wet preps of cervical discharges. I went to the micro lab at midnight to personally gram stain the sputum of a couple of my new patients to impress one particularly venerable old-school attending. Obviously, this was before JCAHO screwed everything up, but nobody did those things back then either. I was hardcore.
I stayed up at night on call in the ICU to hand-draw graphs of the anion gaps and electrolyte trends of my DKA patients so I could post them outside the patients' doors before rounds. I spent extra time talking to families and planning discharges. I picked the brains of my fellow residents to find out what the special (quirky) interests of my next month's attending were, so that I could shine on the first day of rounds by demonstrating my newfound interest in inverse ratio ventilation or the nuances of pulmonary artery pressure measurement. One particular attending forbade the mention of trade names, so if a sleepy intern said Lasix
instead of furosmide or Atrovent
instead of ipratropium bromide, rounds would come to a halt while he got pimped and chastised. I wasn't that guy. Learn what your attendings want, and give it to them without their having to ask you for it. Your job is to make their job easy, and in doing so you will be amazed at how much you learn from the experience. If you hate your job, it's going to show. Be energetic and enthusiastic.
The first two months of internship everybody's pretty much just trying to stay afloat, but by the third month I knew my patients better than anyone else on the team, and I would arrive as early or stay as late as it took for me to make sure that they were well-cared for. I never called in sick the entire year, nor have I ever missed a shift since then.
When I trained, there were plenty of slacking interns. They were easy to identify because they didn't know shit about their patients, and it showed. They got embarrassed by their residents and attendings because they were worthless and weak
. I wasn't that guy. I was the guy the residents and attendings wanted on their team. And yes, I was (and still am) married, and my wife was very understanding. Hundred hour plus workweeks are indeed difficult, but it's only for a year. Deal with it.
This first year as a physician is the foundation for the rest of your career. You can use this time to learn more about being a doctor than you did during your entire four years of medical school, or you can bitch and moan about how sleepy you are and how much abuse you are suffering at the hands of your cruel taskmasters. Your choice.
There are plenty of average interns out there. Don't be one of them. Use their mediocrity to make yourself look excellent by comparison.
Labels: internship, tips