Category: Residency

Posted on

How to Differentiate Pericardial and Pleural Effusions on Ultrasound/Echo

Although it is relatively easy to spot the difference between pericardial and pleural effusions on a chest x-ray, in medical training we have less exposure to ultrasound and it takes much more time to get comfortable looking at ultrasounds and knowing what you are looking at.

The first thing to remember with ultrasound and echocardiography is to get multiple windows! Just like any imaging study, ultrasound has its limitations. That’s why we try to squeeze our probe between or under the ribs in various areas of the chest to try and see the heart in different angles. An effusion can be obvious in one angle but be hiding in a different perspective.

This image below shows both a pericardial and pleural effusion. It’s one of my favorite images in the parasternal long (PSL) axis view via echocardiography. The quick and dirty way to tell if this fluid is a pericardial or pleural effusion is to find the descending aorta. The descending aorta is outside of the pericardium. It travels posterior to the heart down the chest. So when we see the heart in this PSL axis view we are cutting the aorta cross-sectionally. This should help bring you to identify the second important structure- the pericardium, or the connective tissue sac that the heart sits in. Knowing where these two structures are will allow you to more easily identify this fluid accurately as either a pericardial or pleural effusion.

View Image
Pericardial and pleural effusion

The second tip to correctly identify pericardial versus pleural effusions on ultrasound or echocardiography is to practice and get multiple windows! Getting multiple windows, or ultrasound view points of the heart, has the same importance in getting a 2-view chest x-ray. Multiple vantage points lets you better see the same structure from different angles and can help you clarify what you are looking at when it is not so obvious.

For further resources check out the following links I found helpful. A lot of these blogs are fantastic ultrasound information for individuals who want to dive deeper into echocardiography as well as ultrasound.

Subscribe! 
Posted on

How To Survive 28-Hour Residency Call Shifts

In my internal medicine residency program we work 28-hour shifts while rotating through the medical and cardiac ICU every 4 days. You show up at 7am and work your usual shift and then cover all of the patients in the intensive care unit when everyone else goes home. You see new evaluations on the floors and in the emergency department and help run any codes that happen throughout the hospital. The following morning you get to leave at 11am if all the work is done and do it all over again 3 days later.

Thankfully the CCU and MICU rotations usually are only 3 week stretches at a time but it is still mentally and physically exhausting. Here are my tips to getting you and your patients through your overnight shifts alive.

 

 

Sleep (duh)

Never stand when you can sit, never sit when you can lay down, and never lay down when you can sleep. At some point you will be able to find some down time so take advantage of it when you can. I’ve found that if I can get 4 hours of sleep overnight I can somewhat function well enough the next day. 3 hours and everything takes me a little bit longer than usual. Anything less than that and I’m a zombie. Bonus points to whoever can manage to have a nap during the day before your evening call shift starts.

 

 

Pack an overnight bag

I have the same routine during every overnight shift. I claim my favorite call room with the best AC, steal an extra pillow from an unused call room, and snag two towels from the linen cart. Usually sometime around midnight or whenever there is a lull in the action I wash my face, brush my teeth, and throw on some new socks and underwear. If nothing else it makes me feel a little more refreshed and clean after being in the hospital for close to 18 hours. Of course, this plan goes sideways if I forget to bring my overnight bag. My overnight supplies consists of the following:

  • Toothbrush and toothpaste
  • Face wash
  • Contacts/glasses
  • Fresh socks
  • Fresh underwear
  • Advil

 

 

Meal Prep

My usual goal is to bring at least one full meal with me for my overnight shift. Sometimes that consists of a Trader Joe’s burrito or home made mac ‘n cheese while other times its simply some yogurt and a coffee K-cup. It takes minimal effort but makes a big difference when you’re tired and hungry. This way you can just be tired! Not to mention that ordering take out gets old and expensive pretty quickly.

 

 

Go home and sleep afterwards..but set an alarm

The best overnight shifts, and rarest, are ones where you get enough sleep during the night that you can just go home, take a quick nap, and have the rest of your day off to enjoy. Typically what happens is I get home by 11:15am, eat something small, and pass out. When I first started working overnight shifts as a junior resident (PGY-2) I would sleep as much as I wanted. The problem I encountered is that I would wake up at 7pm and not be able to fall back asleep until 3am. Which would be fine if I didn’t have to be back in the ICU by 7am the next morning. To avoid this sleep schedule nightmare I always set an alarm for somewhere around 3-4pm. This way I would get enough sleep to be able to function for the rest of the afternoon and also still be tired enough to have an early night. Or catch happy hour depending on the day.

 

How do you survive your 28-hour overnight shifts? Don’t forget to subscribe so you don’t miss my next blog post!

[button link=”https://wp.me/P31Asd-mT” icon=”envelope-o”]Subscribe![/button]

Posted on

How To Find Research in Medical School and Residency

One of the most frustrating aspects of medical school and residency is the hidden curriculum. The stuff you kind of just figure out along the way and wish you knew from the beginning. One part of the hidden curriculum of medical school and residency is research. Here are my tips on how to successfully get published.

 

First off, why bother doing research?

If you are a medical student it will make you stand out when applying to residency and if you are a resident applying for certain fellowships it might as well be mandatory. So the first reason is for your resumé. The second reason is that research forces you to learn a topic more extensively than you normally would otherwise. That’s my favorite reason to get involved in research. You end up learning so much more compared to just reading topics and doing practice questions. Additionally, you also learn to

 

 

Find a topic or field that interests you

The only thing worse than doing research is doing research on a topic or in a field that bores you. That’s why all of my research is in cardiology. So find a research project in a medical specialty or disease process that you find interesting.

 

 

Find a mentor

Okay, so I’ve sold you on the idea of doing research. Next, you found a field that interests you. But how do you just start a research project? The best way to approach finding a research project is approaching someone who is already doing research in that field or specialty. As a medical student, I asked the cardiologist I was working with if he knew of any interesting research going on in the cardiology department. He put me in touch with the right people who pointed me in the right direction. Ultimately, I got two publications out of the experience and learned a lot about cardiac magnetic resonance imaging.

Fast forward to residency and some of the best advise I’ve received has been from my senior residents and fellows. These are people who have already done what you want to accomplish. They are probably the most valuable resources you’ve got so use them! Better yet, get involved in their research projects to get your feet wet.

Additionally, don’t forget your co-residents or medical students. Some of my close friends and colleagues are doing amazing research and their tenacity to publish their work inspires me to get on my grind. They are another valuable resource. Some of my colleagues who already have a few research projects under their belt know the system and how to maneuver it. So don’t be shy or too proud and ask your successful colleagues how they did it.

 

 

Be curious

If you don’t understand something then ask! Be curious about medicine and uncover the reasoning behind clinical decision making. As much as we know about the human body there is still so much that we don’t understand and your questions on rounds one day might be the beginning of your research project.

 

 

What did I miss? What tips do you have to help medical students and residents get published? Comment below and don’t forget to subscribe so you don’t miss my next blog post!

 

Posted on

How To Study For USMLE Step 3

In my prior post, When You Should Take Step 3,  I went over the importance of USMLE step 3 with regard to fellowships moving forward and gave some insight into figuring out the right time to take the exam. The following post covers the nitty gritty details about how to actually study for the exam including study strategies and resources. Of course, this is not the only way to study for step 3 but its the most common and the most successful way.

 

 

Format of the test

Day one is the prototypical USMLE step exam consisting of 6 blocks of 38-40 items plus 45 minutes of break time leaving you with a 7 hour test on day 1. Day 2 is a little different. It’s a 9 hour day split up into two main sections. First you start off with another 6 blocks of multiple choice questions. They only give you about 30 per section on day 2 compared to about 38-40 questions per section on day 1. After you complete all 6 sections you move on to the simulation cases. These are 13 cases that are meant to simulate how you would treat a patient in the real world. Check out the details on the USMLE website here.

 

 

How to study for it- USMLE World

I’m not kidding when I tell you that the one and only resource I used to study for my step 3 exam was UWorld. Okay, and my Master The Boards book for USMLE Step 2 CK when I couldn’t remember some obscure fact or mnemonic. Okay, and I guess I also used Picmonic cards here or there for those super rare and hard to memorize tumors from my step 1 days. But I rarely used secondary resources. I mostly jotted notes down in a moleskin notebook. UWorld or bust!

 

 

Brush up on your biostats

On day one of the exam expect to have at least 6-8 biostatistics questions per section. 3-4 of those questions are from drug advertisements. It sounds daunting but you truly just need to know the basics. I’m talking about number needed to treat (NNT), number needed to harm (NNH), odds ratio, and different forms of bias. All that jazz. Know it cold and you’ll do fine.

 

 

Interactive cases- practice, practice, practice

Half of doing well on the 13 interactive cases on day 2 is knowing how to use the interface. The medicine is actually the easy part. Personally, I did a third of the cases over the span of a few weeks and then the remaining two-thirds over the course of the weekend prior to my exam and I felt adequately prepared. A few colleagues of mine did all of them the weekend prior to their exam. They are annoying and frustrating to get through but as long as you don’t kill too many imaginary patients you should be fine.

 

 

 

Still have some burning questions about how to study for step 3? Leave a question in the comments section below! And don’t forget to subscribe so you don’t miss my next blog post!!

Posted on

What I Keep In My White Coat (mostly snacks and an iPhone charger)

I’ve written a lot about the philosophy behind surviving and thriving in residency. Which is great and all but it doesn’t help you when you forgot to charge your phone last night and you’re already operating at 20% battery. Here’s what I use on a day-to-day basis as an internal medicine resident as well as what I keep in my white coat (or hidden somewhere on the floor) to make my day to day-to-day life easier (and fully charged).

[amazon_link asins=’B00P7N0320′ template=’ProductAd’ store=’kittykatzmd-20′ marketplace=’US’ link_id=’490a6a19-5dc1-11e7-a948-d3e22f0d8d4b’]

[amazon_link asins=’B071H9L9DN’ template=’ProductAd’ store=’kittykatzmd-20′ marketplace=’US’ link_id=’5eae6ca8-5dc1-11e7-9e02-97eb826441c4′]

[amazon_link asins=’B00ESYO5IW’ template=’ProductAd’ store=’kittykatzmd-20′ marketplace=’US’ link_id=’d6ca25b2-5dc2-11e7-a781-1b61b1c49ed7′]

[amazon_link asins=’B06XKBB8DX’ template=’ProductAd’ store=’kittykatzmd-20′ marketplace=’US’ link_id=’8485ec81-5dc1-11e7-bd48-e3bbbc0eed75′]

[amazon_link asins=’B000F4OYEE’ template=’ProductAd’ store=’kittykatzmd-20′ marketplace=’US’ link_id=’4f8ed701-5dbe-11e7-9a41-195d89b14a13′]

[amazon_link asins=’B00BQ8UE1K’ template=’ProductAd’ store=’kittykatzmd-20′ marketplace=’US’ link_id=’9af5dc94-5dbf-11e7-9e5e-4da3a711bcc0′]

[amazon_link asins=’B01GJKZZYU’ template=’ProductAd’ store=’kittykatzmd-20′ marketplace=’US’ link_id=’d00b0800-5dbf-11e7-b661-e3bc8380a7ff’]

[amazon_link asins=’B00062N428′ template=’ProductAd’ store=’kittykatzmd-20′ marketplace=’US’ link_id=’0d027c82-5dc0-11e7-aeb5-43ee55e10f76′]

[amazon_link asins=’888370102X’ template=’ProductAd’ store=’kittykatzmd-20′ marketplace=’US’ link_id=’32179663-5dc0-11e7-a958-af53baa2f1e1′]

Posted on

Medical Training Doesn’t Get Easier. You Just Get Stronger

I don’t think I’m ready for my second year of residency. As second years we have to cover the PCU (progressive care unit),  a step down unit in between the general medicine floors and the medical ICU (intensive care unit). We have to cover all of the rapid responses, situations in which patients are unstable and look like they are in impending doom, as well as codes for the entire hospital, situations when the patient is literally dead already and we have to work to bring them back. On top of that, our general responsibilities on the medicine floor services go from doing most of the grunt work to leading the decision making and overseeing and teaching our intern and medical students. None of this was in the medical school brochures. But you know what, neither was everything I’ve learned intern year of residency. Or in my third or fourth year of medical school during clinical rotations.

As I’ve progressed through my medical training I’ve found that the written curriculum is just as vast as the hidden curriculum. The learning curve is steep and it’s terrifying. I still encounter situations on the day to day basis that I have never dealt with before. And you know what? I’m still standing and so are my patients.

So to the recent medical school graduates waiting to start residency on July 1st: trust your instincts. It’s going to be difficult and there is nothing you can do to prepare for it. Read up if you want but don’t go nuts preparing for the unknown of residency. Have faith that, at times, you will feel inadequate, anxious, terrified, and not quite ready. Take solace that you are not alone in experiencing those emotions. It is normal and you will be okay.

Because you’re never fully ready for the challenges that lie ahead. You just have to be ready enough.

Posted on

When You Should Take USMLE Step 3

I’m about to finish my first year of residency. Although I might not be ready to be a resident I sure as hell am ready to not be an intern anymore. Intern year of residency is exhausting. There’s no way around it. And studying for yet another seemingly pointless USMLE is the last thing anyone wants to do after a long day in the hospital.  Here are some tips to help you figure out when you should take USMLE step 3:

 

Does step 3 even matter?

Yes and no. It truly depends on what you plan on doing with your medical degree. If you don’t plan on specializing it is hard for me to see how your step 3 score will impact your ability to get a job. Especially when you have to pass a board certification exam in your respective field in order to practice.

But if you are looking to pursue a fellowship then you might not want to ‘just pass’. The 2016 NRMP program director (PD) survey asked fellowship PD’s the importance of various factors when looking at applicants. They rated importance of each factor from 1-5 with 5 being very important. Let’s take a look at a graph from the 2016 NRMP PD survey that shows which factors PD’s across every specialty found to be the most important when selecting applicants to interview:

interview 1

And now which factors were most  important in ranking applicants:

ranking 1

Ultimately, step 3 isn’t the most important factor. But it is still a factor. Additionally, each specialty is different. A vascular surgery fellowship program is clearly looking for something different than what a sleep medicine fellowship program is looking for (take a look at the data yourself if you know what fellowship you’re interested in: Results of the 2016 NRMP Program Director Survey). But in general, there are more important things than step 3 when it comes to fellowships. I would err on the side of caution however and make sure it isn’t important. Meaning, don’t score so poorly that they end up looking at your score and make it a big deal. Let it be just another check mark on your application. Something to keep you on par with other applicants.

 

 

What is your specialty?

Generally speaking, USMLE step 3 is skewed in favor of primary care fields like internal medicine and family medicine. The majority of the test is composed of medicine topics. So medicine residents see a lot of what is on the test in everyday practice. This means that medicine residents can probably wait until the end of intern year and study intensely for 2 months or so and take it and pass. Essentially, waiting till the end of intern year won’t hurt you much. However, for anyone going into specialties like pediatrics, psychiatry, OB/GYN, or surgery I suggest you take it as soon as humanly possible. Some of my colleagues from medical school even took it the first month of residency. Their program even gave them a month of ‘research’ to study for it. So for anyone not going into a primary field like internal or family medicine you should, for the most part, take it as soon as possible.

 

 

Should you take step 3 before before residency starts?

Depends on a few factors. First off, can you afford it? Step 3 costs $875. Second, you need to graduate prior to even applying to take USMLE step 3². So unless you graduate early and have a considerable amount of time prior to starting residency I wouldn’t even put the thought in your head. Trust me, during residency the last thing you are going to be thinking is ‘I wish I studied more before residency started’. But what you do prior to starting residency is up to you. So unless you are required to take step 3 prior to starting residency I would hold off on taking it until during residency.

 

 

What does your intern year schedule look like?

For the most part you only need 2 months or so to study for this exam. So find a period in your schedule when you are on a lighter service. For me that was in December right before Christmas when I had a week of clinic followed by a week of vacation and three weeks of elective followed by another week of clinic and a notoriously light general medicine service. So I had ample time to study. Find a time in your schedule that will allow you about two months of time to study.

 

 

How should you study for USMLE step 3?

That’s an entire blog post in and of itself. Keep on the look out and subscribe so you don’t miss it!

 

 

What other questions or concerns do you have about taking USMLE step 3? Comment below!

 

 

 

1-  (2017). Nrmp.org. Retrieved 23 May 2017, from http://www.nrmp.org/wp-content/uploads/2017/02/2016-PD-Survey-Report-SMS.pdf

2- Federation of State Medical Boards. (2017). Fsmb.org. Retrieved 24 May 2017, from http://www.fsmb.org/licensure/usmle-step-3/faq#g1

Posted on

Surviving Residency: 5 Tips You Didn’t Know You Already Knew

Residency is hard. Anyone who tells you differently needs a stat GI consult because they’re full of it. You will be tired physically, mentally and emotionally, regardless of what specialty you enter. The rewards of the job are sometimes short-lived and unpredictable, but their depth have the capacity to outweigh the dull and monotonous daily drudgery. One year after the Match, and nearly eight months into residency, here’s my advice to surviving, thriving and enjoying residency.

<
 

Build a positive mindset

The first year of residency and happiness are not always synonymous. In fact, being a happy doctor is sometimes an oxymoron — but it doesn’t have to be. It is entirely too easy to get sucked into the whirlpool of negativity during an average day in the hospital. You can’t control the events that happen around you but you can control how those events impact your mood. Arming yourself with positive mindset isn’t going to make your day any shorter but it might make it more bearable, dare I say even enjoyable.

 

 

Don’t neglect your mental or physical health

Being healthy isn’t one big decision. It’s multiple small choices that you make every single day. Eating healthy and exercising regularly won’t be easy during residency. You’re going to be tired and going to the gym might not sound that enticing, especially in the beginning of residency. You aren’t going to have extra time in your day to exercise or meal prep — you have to make time. So take a dose of your own medicine and make your physical and mental health a priority.

In that same regard, remember that asking for help, whether it is for patient care or for your own mental health, is a sign of strength, not weakness. Mental health issues like depression, anxiety or stress management aren’t things that you can just shrug off or ‘snap out of.’ You wouldn’t ask a cancer patient to ‘toughen up’ or ‘fight through it’ and you shouldn’t accept anything different from psychiatric issues either. Seek out help early and often. It might save your career or your life.

 

 

Maintain your support system

The corniest line of interview season, that your co-residents are the best part of residency, is also the truest. Just like during medical school, nobody else quite gets what you are going through. Your co-residents are with you in the trenches day in and day out. Whether you like it or not, you will spend more time with these people over the next few years than anyone else in your life. Embrace your new adopted family but also don’t forget about the family that helped you get to this point.

Make your friends, family and significant others a priority in your life and set realistic expectations with them. It’s unfair of you to agree to plans you know you can’t keep. Likewise, your loved ones have to understand your time constraints. Your relationships are two-way streets. Don’t let them crumble.

 

 

Just say, “I don’t know”

A mentor of mine once told me that knowing what you don’t know is one of the most valuable characteristics of a good physician. On day one of residency, you will not be expected to know all of the answers. However, you are expected to be able to collect the appropriate information and find someone who can point you in the right direction. So when a patient, nurse, resident or attending asks you a question and you don’t know the answer, simply say ‘I don’t know.’ At the end of the day, everyone around you will be happy to hear you admit that you don’t know something instead of trying to make something up. It shows honesty, integrity, and a capacity to put your ego aside. Remember that the only thing worse than an overconfident resident is a dishonest one.

 

 

Don’t worry, it gets better

The first few months of residency are the worst. Everything is brand new and it’s terrifying. But it gets better. The next few months of residency come around and you realize that it’s actually still pretty terrible. Okay, most of intern year is literally the worst. But it gets better.

You figure out the EMR and stop getting lost in the hospital. You learn to coordinate with the social workers and case managers. You figure out how to diagnose and treat bread and butter illnesses more efficiently. You start to make friends in other specialties. You never stop being tired but you learn to function with less sleep. You calibrate to a new sense of normal and realize that the only thing different from day one of residency is you. Trust that with each passing day you are becoming a better physician.
Ultimately, none of this advice is Earth-shattering or anything you didn’t already know — and that’s exactly the point. You’ve been preparing for this moment for years and there isn’t much else you can do to prepare yourself for the year to come. So if you remember nothing else just remember to trust your instincts, stay hydrated, remember to eat, sleep when you can, and always do what is right for the patient. Now go save some lives, doctor.

Posted on

The Most Frequently Asked Questions on Residency Interviews…by Medical Students

It’s my first interview season as a resident and I am loving the free lunches. Uh, I mean…meeting all of the applicants. It’s kind of strange being on the other side of things because I remember asking the exact same annoying inquisitive questions that all of you are asking. However, I’m realizing most of my answers are not specific to my program and I end up giving general residency advice like how to survive your intern year and how to create your residency rank list. Here’s what I tell the prospective fourth years:

 

 

What’s your favorite part of your residency program

My co-residents. It’s annoyingly corny but true. This is a highly sensitive test for weeding out unhappy residency programs. Residency sucks but you should at least be able to get along with the people you are stuck in residency with because the only thing worse than going through residency is going through residency alone.

 

 

If you could change one thing about your program what would it be?

Daily free lunches, a personal assistant, and a raise would be nice. Otherwise, well…every residency program has there bugs but the tell of a good program is that the administration will listen to their residents and make appropriate changes. A better question to ask is ‘what are the most recent changes that were made to your program based on complaints or concerns raised by residents’. Ask that. You’ll look like, really smart.

 

 

Why did you choose this program?

It was a gut feeling. Every program I interviewed at had essentially the same things. Maybe some had more or less research, was in a bigger or smaller city, had a bigger or smaller residency class size, or had varying degrees of fellowship opportunities. But you will likely be a successful doctor wherever you end up. The question you have to ask yourself is ‘will I be happy in this city at this hospital if I match here’. And the answer to that question depends a lot on you (and your family’s) priorities.

 

 

What stood out about your top choice residency programs compared to the rest on your list?

The program director’s leadership and enthusiasm when meeting us (despite likely giving the same speech and presentation hundreds of times before), the impressive amount of teaching that occurs during morning report (yes, it’s like this every morning), and my interactions with the other applicants and residents . Again, these residents and fellow applicants are the people you’re going to be stuck with for the next three years. If you can’t enjoy an afternoon with these people then that residency program likely isn’t a great fit for you. My favorite interview days were ones with the best lunches. And also when I got along well with the other residents and applicants. But also lunch.

 

 

So lunch is really important to you, huh?

It’s all about the little things. When a program would take us to their cafeteria for lunch it made me feel like they weren’t even trying to impress us. Sure, maybe they have an amazing cafeteria and all of the residents eat there everyday. Except it ends up coming across like a cheap date who forgot their wallet at home. It would never be a reason to rank a program higher or lower but it consistently served as a surrogate marker for other things that may be awry. Like someone who wears ankle socks with dress pants. Judged.

 

 

So you get along well with your residency class?

I enjoy hanging out and working with most of my co-interns and residents. You find your people early on and you go through hell with one another. Working on the same floor together for a month builds some pretty strong bonds. Especially if chased with tequila. Just recognize you aren’t going to get along with everybody and that’s okay. Hopefully the bell-curve is skewed towards positivity and most attendings, fellows, and residents there aren’t jerks. Again, big red flag if lots of people within the residency program don’t like one another.

 

 

Are you involved in any research at the moment?

I’m currently four months into residency. I finally have my feet underneath me and I can navigate the hospital system pretty well. Don’t get me wrong, I’m still a bumbling intern but I am more efficient bumbling intern compared to July 1st. I now feel comfortable pursuing research projects and am currently getting involved in a QI project. However, I’m waiting to take step 3 before I jump into some bench research going on in my hospital. Just beware, the only thing worse than not performing any research is getting involved in research and dropping out because you weren’t available or weren’t interested. It’s unprofessional, word will spread, and people will be less willing to offer you future research opportunities.

 

 

When are you taking step 3?

ASAP! More specifically the middle of December. Many of my friends in OB/GYN and pediatrics have already taken and passed step 3. Internal medicine constitutes a large proportion of the exam so there isn’t a huge rush for IM residents to take step 3 because you’re going to learn the majority of what’s on the exam during your training anyway. However, non-medicine residents are often advised to take the exam as soon as possible so they can get it out of the way. Personally, I’m taking a middle ground approach and will be taking it six months into my residency. It really depends on your schedule. Mine is lighter early on so I have time to finish UWorld (yes, it is the only resource I am using. Will confirm that it was a good decision once I pass). Getting step 3 out of the way also let’s you finally focus on the more important things in residency. Like research and not killing your patients.

 

 

Should I take step 3 before starting residency?

Only if you have an insane amount of time prior to residency. Otherwise, go enjoy your life and follow up on my next blog post about what to do the summer before residency! You can also check out my two blog posts on this exact subject:

Posted on

What I Learned During My First Week of Residency

In the United States July 1st marks the start date for the majority of residency programs. My residency program however starts one week early, a trend that many are adopting. It gives us one ‘extra’ week of vacation prior to the start of our second year of residency. So for all of my friends and the rest of you strangers out there on the interweb, here’s what I’ve learned after my first week of my internal medicine residency.

 

 

Not a lot of actual medicine

Most of what I’ve learned this past week is the process of being an intern like where documents are located, how to put in orders, and how to use the phone/paging system. Exciting stuff…I know.  It’s everything that you didn’t learn in med school because its the stuff that you can’t be taught in a classroom and don’t really do as a med student. You really just have to learn by doing. So, even though you are going to ignore these words of wisdom just like I did when someone told me don’t stress about the little things because theres nothing you can really do to prepare yourself for it.

 

 

Your residents and attendings don’t expect much from you

I was rounding on the weekend with my attending on my third day of residency. He asked me a simple question that any medical student can tell you without much thought. He asked, ‘what is the reversal agent for Warfarin?’. I put my notes in my pocket, crossed my arms, and struck a confident pose and loudly answered, ‘potassium’. Now for you non-medical people, the correct answer we were looking for was Vitamin K. My brain somehow spat out the electrolyte whose elemental symbol is ‘K’. And that’s basically my first week of residency in a nutshell. Looking stupid but being really confident about it.

 

 

I fucking hate fax machines

fax machine

Seriously, why are these still a thing?

 

 

And that 80 hour work weeks are exhausting

michael bluth tired

I guess I’ve never really had a full time job before but this can’t be normal. Your shift might only be 10 hours but you only get to leave when your work is done. Which is why late admissions are the worst. They’re the equivalent of someone sitting down for dinner at a restaurant right before the kitchen is about to close. Except we won’t spit in your food. Probably.

 

 

You can still make a little bit of time for yourself

One of my biggest concerns going into residency was the notion that I wouldn’t have the time or energy to continue to exercise and stay relatively healthy. I mean my body can’t be all down hill from here, right? Well if you never worked out prior to starting residency I doubt that this will be the time to begin for you. However, you certainly have enough time during the week to find a few days here and there to do whatever makes you happy whether its working out, playing basketball, reading, or just binge watching Game of Thrones (what a great finale).

 

 

Lastly, shout out to the med students

I used to hate the stupid menial labor of med school like finding out if the nurse is aware of the orders we   put in or calling down to radiology to find out when our patient was getting scanned. But now I realize that if it wasn’t for you then I would be the one doing it. Every small task is actually tremendously helpful. At least it is for me. And I always trade menial labor for knowledge (yes, believe it or not I’m actually kinda smart. I’m just really good at playing dumb). So next time your resident asks you to fax a hospital to get records just realize that you are going to be that person doing it when you’re the intern. Yeah, sucks to suck

screaming internally

 

Good luck to all of my fellow newly minted interns! And for everyone else, remember to stay out of the hospital in July or else I might be your doctor.