o**i
发帖数: 1165 | 1 谢谢tele十分detailed intern工作生活的讲解，联想起自己久远的实习生活，现在反
而没有那时候的大胆。用手机听的讲座，没法提问，其实想听听关于intern和以后
resident期间的家庭生活，和家人一起住还是完全照顾不到家（其实看看她们的
schedule也知道了）：（
1. preparation for intern--
1.1) limited license: since PGY-1, can prepare for limited/full license,
which is required before PGY-4(fellowship begin), have prescription number.
some start it since prematch.
check state board of medicine, have meeting every month. Prepared in April.
Email documents to programm, ask medical school mail documents to programm.
GOY (5th yr) and ...year(6th yr) have one year gap. Some delayed started
day because lost document by board of medicine.
搞清所在州的board of license的要求，把自己的实习时间等都一致。国内的医学教育
时间一般比美国学生多，每个州有minimun requirement，预防医学的clerkship时间有
些不同。
1.2）练习case presentation--in group , one sp(choose real case)---one doctor
, 3rd one as attending.
XXXX, y/o M, with past medical history of , presented with….for …...-----
written format.(short part--PMH too long for oral present)
XXXX, y/o M, presented with….for …, his PMH is...-----better oral format.
XXXX, y/o M, PMH significant of …(choose 1-2), presented with….for …, his
other Hx include----better oral format.
[cc description] 3 days ago, she started to have running nose, SOB,
productive cough, no blood...
[ddx related]no edema, weight change; no travel, leg pain;
[ROS] no nausea/vomit, diarrhea, blood in stool,.........(or all negtive
except for HPI)
[PE]: vital sign stable; relevant positive finding(RUQ tenderness without
rebound or guarding, bowel sound present)
[workup]: lab test( WBC, chemical), radiology(CT..)
Attending may ask , “what do you think?”
repeat HPI-XXXX, “y/o M, with past medical history of , presented with….
for …..., “significant positive workup.
I think the ddx could include 123,
for PE, I want to do..
for PMH, I plan to add ….
assessment & plan:
1)regular clinic: active issue(SOB)--asscessment as pneumonia, plan 123; (
chronic HTN)--plan 123; (acute renal failure)--assessment as dehydration,
plan; (hyperthyroidism)--continue medication, test TSH.
2)according to different system(cardiac--Afib, CHF; endocrine--DM,
hyperthyroidism; Pulmonary--) used mostly in ICU. in each system, address
the active issue first.
present when
1) ER to attending (present all, and assessment & plan)
2) morning report (for discussion, usually present until PE)
3) sign out cases to cointern
1.3）pgy-2 12月前把step 3 考完，高成绩对fellowship有帮助
2. Being an intern
2.1) you won’t be fired in PGY-1 usually. they need you.
subintern(4th yr Graduate student), they are used as intern, and better than
us. They help us to receive new pt.
My PD subdivide medical graduate into : 1. AMG 2. Carribean MG 3. IMG .
these 3 groups would converge into one group within 2-4months.
2.2) lower your expectancy in the 1st month: Good attitute is most important
. patient encounter as CS is good enough!
2.3) “slocan” in each pt card: we receive 10 pts each. We might forget
info about each pt in the afternoon. they might be in different levels of
hospital.
S--seen;
L-lab ordered;
O--OT/PT(occupational/physical therapy assessment)-where do they go after
discharge; Case manager manage discharge time, they coordinate with
insurrance.
C-consult (case number, brief case presentation, call after morning round,
usually done before 1-2pm; they might ask you Qs)
A--attending?
N--patient note.
as well,senior resident: give missions, write it down, and make mark if it
is done.
2.4) code system--DNR/DNI, full code
3. Sign in/Sign out交接班 (brief, most important),
what do you need from the on call intern? easy to follow command. If A then
do AA.
pt status(stable/crashing), will they ask for painkiller(what to give),
anything will happen tonight, code...
Team--attending, senior resident, 1-2 interns,---20 pts in this team
attending is the final responsable to this whole tea.
fellow from each专科，give consult, attending decide if we accept the
recommendations from fellow(usually yes)
fellow--ward fellow(subspecialty), consult fellow.
Communicate and make sure no double the command or do the oppesite.
Run the list with senior or attending 1-3 times per day.
4. elective --how to choose
Do not choose your target specialty(cardiology), do not give a bad
impression.
choose big and difficult department, time to learn, follow fellow, usually
be free at 2-3pm, 2 days off in weekend. can read after that. We have one
week off in elective.
Infective department: many pt, know antibiotics.
Pul, ICU...are good choice.
pgy-1 in ICU, wards is good too, since senior will have more response.
away elective-resident in state A, elective in state B even another country,
but insurance/malpractice may not cover. Programm coordinator may know.
Q:mentor system in some programm: May I ask for a specific mentor? (Coffee)
A: we are randomly set to PD. He asked me some future plan, encourage me to
apply to fellowship directly.... they will talk with you every half yr.
PGY-2 end apply fellowship.
You should ask for your favorite mentor, you may have the opportunity to do
some research with your mentor.
Q: the relationship between co-intern? (coffee)
A: Don’t worry. Everyone is necessary in the programm. You coordinate, and
help each other. During meeting, someone likes to show up. It is not a bad
thing. Usually, they ask you the thing you may know. If not, answer “I do
not know”, but give some impression. The 竞争 is very few between co-
interns. When you sign-out, or someone cover you when you are sick, you are
helping each other. Only when you are too slow on your work, your pt are
subleased to the other co-intern, or your senior help the other co-intern,
you might feel unbalanced.
5. no time to learn and read at home. I write pt discharge at home.
uptoday-查药，病等
6. Triage/ admission
ER--decide admission--call Triage resident, send new pts to different groups.
Triage might call your senior resident, he will sublease the pt to you. You
should admission the pt in ER within 30 minutes. Triage will report the case
to attending as the same time. Your pt encounter might be a repetitive to
the patient. Explain that my mission is to admit you into hospital. Check
your system, pt’s primary care info might be there.
make sure to write down the right home medication.
7 most common chief complain in ER, many related with psycho
syncope, COPD, CHF, chest pain, GI-vomit/diarrhea, confusion, delirium
8 common procedure:
ABG, 腹穿、胸穿，尿管，胃管，先看学生做，如果学生不行自己上手，不会一个人。
pap smear。
急救的操作培训可以报销。
9
relationship with Attending:
listen and obey from them, after consul, text page him and make sure to
order.
relationship with senior:
respect, some aggressive (run the list about pt each hour), they are very
helpful
10 intern life schedule
in charge of 10 pt/intern, 2 new admission pt /d each intern
--6:10am get up
--7:30am sign in 交班
--7:30-8am check lab, vital sign, in & out volume
--8am-
--8:30am-12pm 查房 20pt, 穿插着order on system，call consoult
--12pm-1pm noon conference
--1-3pm discharge, prepare出院指南 回家；如果去nursing facility，需要在出院
前准备好出院小结，（dictation最快2 hr，在2pm前done）， 和case manager交流好
出院准备。期间有很多打扰。
--4-5pm出院
--10:30pm回家，几乎所有intern都超过80hr了. PN可以回家写一点。一般提前把病人
的出院指南、小结准备好。
--11pm go to sleep
----eat whenever you can, rest whenever you can, take care of yourself,
feels not as tired. | x********o
发帖数: 181 | | M**1
发帖数: 327 | | D********r
发帖数: 119 | 4 Thanks a lot!!!
★ Sent from iPhone App: iReader Mitbbs 7.52 - iPad Lite | s********o
发帖数: 3319 | 5 这个也记得很好的说，谢谢！
number.
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【在 o**i 的大作中提到】
: 谢谢tele十分detailed intern工作生活的讲解，联想起自己久远的实习生活，现在反
: 而没有那时候的大胆。用手机听的讲座，没法提问，其实想听听关于intern和以后
: resident期间的家庭生活，和家人一起住还是完全照顾不到家（其实看看她们的
: schedule也知道了）：（
: 1. preparation for intern--
: 1.1) limited license: since PGY-1, can prepare for limited/full license,
: which is required before PGY-4(fellowship begin), have prescription number.
: some start it since prematch.
: check state board of medicine, have meeting every month. Prepared in April.
: Email documents to programm, ask medical school mail documents to programm.
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