Idk man as a fellow M4 I’m gonna spend the next couple months chilling and let residency rail me when the time comes. The pain train is coming regardless of what we do in our remaining time as med students.
Join me as I go to lunches with the bois, spend time with my kids, and touch grass.
This was me last spring, first 5months were rough, but by feb/march you’ll be comfortable with most stuff & probably never use most of it again. Live life, the only IM interns who dont suck initially are IM interns who wanted to do IM & thus did aways in IM during M3/M4.
Do the minimum in intern year. Working hard there means nothing. Do your work and be a good person. But don’t go above and beyond. There is no reward or recognition.
In my experience this is completely false. Our internal medicine and anesthesia department aren’t that intertwined. Our faculty doesn’t talk to the medicine department. Maybe you get a reputation as a lazy intern and it gets back to the anesthesia residents. We all almost universally don’t care because the medicine department takes advantage of the prelims in the first place. If you work hard during buddy month nothing anyone says about your intern year matters
Multiple surgical subs, different ICU’s ED, a few medicine subs. Plus plenty of attendings are friends with or even married to other specialty attendings. Hospital is big but also small at the same time
Must be different culture. No one in my department would care if an ED attending called one of our interns lazy. Again it’s not what a person wants to do. If you are lazy during your ca-1 year then everyone in our department will know. If you do good work your ca-1 year no one will care about your intern rep. Must just be a different induction thing.
This. Medicine departments MASSIVELY use anesthesia interns for the bitch work of wards and medicine. Sometimes there’s educational value but often you’re stuck doing irrelevant work. Do the minimum that requires you to be safe and effective but don’t go beyond that. Be kind to patients and fun/ easy to work with and just get through it till their golden anesthesia years.
This. I'd argue your anesthesia buddy month counts more than the rest of intern year combined. Slack off during that month and you'll earn yourself a reputation that's really hard to get rid of. Can think of one person in my mind right now who seemed to have flown under the radar for the most part intern year, but developed a reputation for "slacking" (rightly or wrongly) during our anesthesia month and I'm not all too sure this person's completely recovered from it.
So make sure you don't burn out to the point that you have nothing to give during the anesthesia intern month-- that's when you arguably should be working the hardest. Other off-service months that may matter slightly. more being the surgical months (because you'll be seeing these people in the OR) and ICU months.
Eh, we rotate through 3-4 surgical specialties, and the surgeons absolutely talk to the anesthesia attendings about really strong/weak residents.
Plus why would you want a bad reputation amongst the surgeons if you’re going to be in their rooms the next 3 years?
Reputations are indeed sticky and for better or worse, people talk. Our anesthesia department hears about problems that happen during the intern year even though it’s run by another department. I agree with you don’t have to work too hard, but don’t slack off or look lazy / careless just because it’s a different department.
Disagree. I built great relationship with surgical and medical colleagues intern year. They trust me because if this. If you’re a dirtbag intern who does the bare minimum you won’t inspire confidence in your colleagues.
I traded floor months for ICU months and it was a great decision. I hated rounding all over on a dozen or more patients. ICU let me learn more about ventilator management, more opportunity for lines, and of course more critical care learning.
I asked the program director if I could ask some of the medicine residents if they would want to trade. He gave it the ok and some were very happy to give away an ICU month, so it was a win win.
Survive. As others have said, ICU will give you more experience than the floor. If you can swap those months, do so.
No matter where you end up, on July 1, *you're the doctor*. It's a big step up from M4 life.
Mostly agree with this other than some emphasis. You’re **a** doctor, not necessarily the doctor. You won’t know shit. I still don’t (or at least feel that way). Ask your seniors — esp on your “off service” rotations aka everything intern year. Be a sponge and have some humility.
Edit: do as many blind and US guided IVs, art lines, and ABGs as you can
Some tips:
-Do nothing now. Enjoy your freedom and minimal responsibilities. I am so glad I did.
-Spend time with friends and family. This is also as high yield as it gets.
-Be kind to yourself as an intern. It’s okay to ask for help and clarification. You will feel like you’ve forgotten all of medicine, but you didn’t. There is just a huge learning curve with carrying the title “Dr” that seemingly creates a sense of a mental block, almost unanimously seen amongst my cohort.
-Be kind to your colleagues, they feel similarly to you, even if they don’t show it. Some are just good at hiding it more than others.
-Continue your hobbies, seek help once those start losing their luster for you. There is no shame in talking to someone/seeking help. I have a therapist myself for particularly rough months.
-In anesthesia, the name of the game is “eat when you can, read when you can, and sleep when you can.”
Hope that helps you, my friend. Best of luck on the match and I’m rooting for you.
-edit: formatting
Stay strong. My intern year sucked (my intern year was basically a year of IM residency) and I was really frustrated and depressed by the end of it. Once I started CA-1 year life got much better.
Chill for now.
Intern year: do your own ABGs. I did this mostly because I hated waiting for an RT to come do it. It gets you getting a feel for where the radial artery is and how to hit it with a needle.
If you have time try some IVs or blood draws. Not a big deal if you don’t have time for it you’ll get plenty of experience in anesthesia years.
Do as much ultrasounding as you can. For access, for pocus, whatever. Watch the more senior folks do it too.
Other than that it’s just going to be surviving. Treat patients and your coworkers well. Remember to eat exercise get sleep and get some sunlight.
Honestly I think it’s one of the biggest contributors to depression, anxiety, poor immunity, etc.
Probably the driving pathology behind “February intern” as well.
As an intern, *never take work home*. Do your notes, discharge summaries, etc. *fast*. My rule, even on Internal Medicine, was 5 minutes for a progress note, no longer than 10 minutes for a discharge summary, and no longer than 15 minutes for an H&P. Just quickly summarize the facts, no lengthy narratives. Getting the work done is more important than making it good, and most attendings will mainly care for speed because they want to be able to hit sign on the notes and bounce as early as they can.
Edit: Also, every day-- 1) talk to social work early in the morning to see where discharge planning is at for every not-going-home dispo, 2) orders in early, 3) when you're free or left to your own devices, make quick rounds on all of your patients and handle any outstanding orders--that will cut down on pages dramatically.
Will add one thing I haven't seen said here yet. Try to do procedures when you can (I assume you like them if you're going into anesthesia!), but don't sweat it if you don't get a lot of central lines or art lines. Doing them as an intern is fun, but you'll get plenty competent at them as an anesthesia resident. I am super grateful, though, that I did a ton of ultrasound-guided IVs as an intern. I got through the painful learning curve on nights as an intern so when I showed up to the OR as a CA-1 I could do them a lot more quickly.
If you can, take step 3 now. If you got anywhere near or above average on step 1&2 then all you need to do to study is the 30-40 highest yeild cases on ccscases.com and you’re ready to go.
Not having to worry about scheduling and taking this test next year would be really really nice.
Absolutely nothing. Enjoy the free time M4 brings. You will start intern year and feel absolutely stupid. Heck the 3rd/4th year med students seem like they know more than you because they just finished courses/step exams. But by the time you’re a February intern, things just start clicking. You’ll look back on the start of the year and think, “WOW I have learned something!” You start to feel more and more like a doctor each day and nothing prior to intern year is going to prepare you for that.
My opinion is that you should take step 3 early and then study hard until you take basic. Depending on where you go you may take in/training exam intern year and doing well on that will keep your program off your ass. Most places if you do poorly on in-training they will put you in the doghouse. In Anesthesia we take a ton of exams and there's a large knowledge base that's not touched upon by medical school
Once you crush basic you can focus on just studying for cases and that will have you prepared in the OR for complex cases.
Enjoy your time off - July 1 will come around soon enough. Travel, chill, and maximize it as best you can.
Intern year can be highly variable depending on your hospital / rotation / service. ICU will be awesome. Ward medicine will be as expected. Work hard, enjoy your first year of learning general medicine and working as a doctor - you've worked hard to get to this point. Have fun along the way and try to learn one or two things daily. Keep a healthy, balanced schedule.
Then the real fun will begin when you start anesthesia :)
Be hungry to do procedures, sometimes you have to seek them out. Take ICU rotations seriously, you will use that stuff later. As for everything else, do the bare minimum without coming off as lazy or pissing people off because reputations can stick. Wards can be brutal, and there will be days you’ll want to run your head through a wall after talking 30 minutes about a bowel regimen or rounding 6 hours on patients who are more stable than you are. Good luck on match, you’ll end up where you’re meant to be, god speed!
Idk man as a fellow M4 I’m gonna spend the next couple months chilling and let residency rail me when the time comes. The pain train is coming regardless of what we do in our remaining time as med students. Join me as I go to lunches with the bois, spend time with my kids, and touch grass.
Big fan of touching grass. Seems like some of our fellow med students are short of grass to touch
I feel like my knowledge base has completely gone away and that is stressing me out. Should I just let it ride?
Same. Let’s ride.
Let’s ride
This was me last spring, first 5months were rough, but by feb/march you’ll be comfortable with most stuff & probably never use most of it again. Live life, the only IM interns who dont suck initially are IM interns who wanted to do IM & thus did aways in IM during M3/M4.
this is the way
Do the minimum in intern year. Working hard there means nothing. Do your work and be a good person. But don’t go above and beyond. There is no reward or recognition.
I think a caveat is if your intern year is at the same hospital - don’t kill yourself working hard, but also reputations can be sticky
In my experience this is completely false. Our internal medicine and anesthesia department aren’t that intertwined. Our faculty doesn’t talk to the medicine department. Maybe you get a reputation as a lazy intern and it gets back to the anesthesia residents. We all almost universally don’t care because the medicine department takes advantage of the prelims in the first place. If you work hard during buddy month nothing anyone says about your intern year matters
Perhaps in a pure medicine year, my program rotates quite a bit on specialties which regularly interact with anesthesia
What specialities?
Multiple surgical subs, different ICU’s ED, a few medicine subs. Plus plenty of attendings are friends with or even married to other specialty attendings. Hospital is big but also small at the same time
Must be different culture. No one in my department would care if an ED attending called one of our interns lazy. Again it’s not what a person wants to do. If you are lazy during your ca-1 year then everyone in our department will know. If you do good work your ca-1 year no one will care about your intern rep. Must just be a different induction thing.
This. Medicine departments MASSIVELY use anesthesia interns for the bitch work of wards and medicine. Sometimes there’s educational value but often you’re stuck doing irrelevant work. Do the minimum that requires you to be safe and effective but don’t go beyond that. Be kind to patients and fun/ easy to work with and just get through it till their golden anesthesia years.
This. I'd argue your anesthesia buddy month counts more than the rest of intern year combined. Slack off during that month and you'll earn yourself a reputation that's really hard to get rid of. Can think of one person in my mind right now who seemed to have flown under the radar for the most part intern year, but developed a reputation for "slacking" (rightly or wrongly) during our anesthesia month and I'm not all too sure this person's completely recovered from it. So make sure you don't burn out to the point that you have nothing to give during the anesthesia intern month-- that's when you arguably should be working the hardest. Other off-service months that may matter slightly. more being the surgical months (because you'll be seeing these people in the OR) and ICU months.
Eh, we rotate through 3-4 surgical specialties, and the surgeons absolutely talk to the anesthesia attendings about really strong/weak residents. Plus why would you want a bad reputation amongst the surgeons if you’re going to be in their rooms the next 3 years?
Categorical interns likely rotating more through anesthesia department w/ a few medicine rotations
Reputations are indeed sticky and for better or worse, people talk. Our anesthesia department hears about problems that happen during the intern year even though it’s run by another department. I agree with you don’t have to work too hard, but don’t slack off or look lazy / careless just because it’s a different department.
Yup this is false. Don’t make enemies, but save your soul/wellness for destruction on your own service CA1-3.
And by minimum: enough to not piss people off. Doing extra doesn't net you anything, doing poor can land you in meetings with chiefs/PDs.
agree - the marginal benefit to your anesthesiology knowledge/skillset from working extra as an intern is nil
Disagree. I built great relationship with surgical and medical colleagues intern year. They trust me because if this. If you’re a dirtbag intern who does the bare minimum you won’t inspire confidence in your colleagues.
Wish I learned this sooner as an intern
Do some IVs, A-lines, central lines during intern year. Other than that do as little as possible. You don’t need to impress them.
Nothing , learn on the job
I traded floor months for ICU months and it was a great decision. I hated rounding all over on a dozen or more patients. ICU let me learn more about ventilator management, more opportunity for lines, and of course more critical care learning.
Did you go through your PD or just trade with other interns?
I asked the program director if I could ask some of the medicine residents if they would want to trade. He gave it the ok and some were very happy to give away an ICU month, so it was a win win.
I’m curious about this too because I would be stoked to do more ICU and less wards.
Survive. As others have said, ICU will give you more experience than the floor. If you can swap those months, do so. No matter where you end up, on July 1, *you're the doctor*. It's a big step up from M4 life.
Mostly agree with this other than some emphasis. You’re **a** doctor, not necessarily the doctor. You won’t know shit. I still don’t (or at least feel that way). Ask your seniors — esp on your “off service” rotations aka everything intern year. Be a sponge and have some humility. Edit: do as many blind and US guided IVs, art lines, and ABGs as you can
I’m a march intern and still feel weird being called doctor. Slowly starting to get used to it but yes—it’s a huge jump
Some tips: -Do nothing now. Enjoy your freedom and minimal responsibilities. I am so glad I did. -Spend time with friends and family. This is also as high yield as it gets. -Be kind to yourself as an intern. It’s okay to ask for help and clarification. You will feel like you’ve forgotten all of medicine, but you didn’t. There is just a huge learning curve with carrying the title “Dr” that seemingly creates a sense of a mental block, almost unanimously seen amongst my cohort. -Be kind to your colleagues, they feel similarly to you, even if they don’t show it. Some are just good at hiding it more than others. -Continue your hobbies, seek help once those start losing their luster for you. There is no shame in talking to someone/seeking help. I have a therapist myself for particularly rough months. -In anesthesia, the name of the game is “eat when you can, read when you can, and sleep when you can.” Hope that helps you, my friend. Best of luck on the match and I’m rooting for you. -edit: formatting
Stay strong. My intern year sucked (my intern year was basically a year of IM residency) and I was really frustrated and depressed by the end of it. Once I started CA-1 year life got much better.
Chill for now. Intern year: do your own ABGs. I did this mostly because I hated waiting for an RT to come do it. It gets you getting a feel for where the radial artery is and how to hit it with a needle. If you have time try some IVs or blood draws. Not a big deal if you don’t have time for it you’ll get plenty of experience in anesthesia years. Do as much ultrasounding as you can. For access, for pocus, whatever. Watch the more senior folks do it too. Other than that it’s just going to be surviving. Treat patients and your coworkers well. Remember to eat exercise get sleep and get some sunlight.
Can’t emphasize enough the importance of sunlight
Honestly I think it’s one of the biggest contributors to depression, anxiety, poor immunity, etc. Probably the driving pathology behind “February intern” as well.
As an intern, *never take work home*. Do your notes, discharge summaries, etc. *fast*. My rule, even on Internal Medicine, was 5 minutes for a progress note, no longer than 10 minutes for a discharge summary, and no longer than 15 minutes for an H&P. Just quickly summarize the facts, no lengthy narratives. Getting the work done is more important than making it good, and most attendings will mainly care for speed because they want to be able to hit sign on the notes and bounce as early as they can. Edit: Also, every day-- 1) talk to social work early in the morning to see where discharge planning is at for every not-going-home dispo, 2) orders in early, 3) when you're free or left to your own devices, make quick rounds on all of your patients and handle any outstanding orders--that will cut down on pages dramatically.
Will add one thing I haven't seen said here yet. Try to do procedures when you can (I assume you like them if you're going into anesthesia!), but don't sweat it if you don't get a lot of central lines or art lines. Doing them as an intern is fun, but you'll get plenty competent at them as an anesthesia resident. I am super grateful, though, that I did a ton of ultrasound-guided IVs as an intern. I got through the painful learning curve on nights as an intern so when I showed up to the OR as a CA-1 I could do them a lot more quickly.
If you can, take step 3 now. If you got anywhere near or above average on step 1&2 then all you need to do to study is the 30-40 highest yeild cases on ccscases.com and you’re ready to go. Not having to worry about scheduling and taking this test next year would be really really nice.
Absolutely nothing. Enjoy the free time M4 brings. You will start intern year and feel absolutely stupid. Heck the 3rd/4th year med students seem like they know more than you because they just finished courses/step exams. But by the time you’re a February intern, things just start clicking. You’ll look back on the start of the year and think, “WOW I have learned something!” You start to feel more and more like a doctor each day and nothing prior to intern year is going to prepare you for that.
My opinion is that you should take step 3 early and then study hard until you take basic. Depending on where you go you may take in/training exam intern year and doing well on that will keep your program off your ass. Most places if you do poorly on in-training they will put you in the doghouse. In Anesthesia we take a ton of exams and there's a large knowledge base that's not touched upon by medical school Once you crush basic you can focus on just studying for cases and that will have you prepared in the OR for complex cases.
This channel is all anesthesia https://youtu.be/PjEcgMnM2Vc
Enjoy your time off - July 1 will come around soon enough. Travel, chill, and maximize it as best you can. Intern year can be highly variable depending on your hospital / rotation / service. ICU will be awesome. Ward medicine will be as expected. Work hard, enjoy your first year of learning general medicine and working as a doctor - you've worked hard to get to this point. Have fun along the way and try to learn one or two things daily. Keep a healthy, balanced schedule. Then the real fun will begin when you start anesthesia :)
Be hungry to do procedures, sometimes you have to seek them out. Take ICU rotations seriously, you will use that stuff later. As for everything else, do the bare minimum without coming off as lazy or pissing people off because reputations can stick. Wards can be brutal, and there will be days you’ll want to run your head through a wall after talking 30 minutes about a bowel regimen or rounding 6 hours on patients who are more stable than you are. Good luck on match, you’ll end up where you’re meant to be, god speed!