Monday, November 03, 2008

Intern Learning

At various points in medical training, you go through brief intense phases where you must acquire new knowledge at a tremendous rate. (I would say this is a "steep learning curve", but according to Wikipedia, this is the wrong way to use this phrase. Who knew?) Once you start clinical rotations, usually in the third year, you are constantly getting knocked off balance. In medical school, I rotated in 4 different hospitals and at least 6 different clinics in two years. At the start of every rotation, there's a new place to learn, new medical language (especially on OB), new medical record systems, etc. Every time you start to get into a routine and get comfortable, it's time to move on.

It's just like this as an intern, only even more dramatic, if possible. The first few days of a new rotation are, in technical terminology, guaranteed to suck hardcore.

It's November, and I'm on my 5th rotation, my 3rd hospital, my 3rd electronic medical records system, and my 4th new service. Even though I've been to this hospital before, every unit and service are different, so I'm relearning all the procedures of daily medical business, like how to arrange for discharges (on my last service, we met weekly; on this one, we meet daily). The call schedule is different and complex, with day call, night call, short call, and a ghost team that I don't fully understand. Every day, I have to try to attend morning report at 8 and noon conference (the benefit here is free food), but some days it's grand rounds here and some days it's grand rounds there and others it's simple noon conference in room X.

I have a small book of various call schedules, specialty schedules, and enough phone numbers to make a yellow pages. It takes me 3-4 minutes to find the phone numbers I need every time I want to make a call.

I had two med students over the weekend helping me out (and they're quite good), and today we acquired two more, plus a co-intern, and a new upper level, and an attending I'd never met before, so I'm thanking JCAHO or whomever that we all wear nametags or I wouldn't know who anyone is.

On Saturday, I inherited 7 patients, which is more than I've managed at one time as an intern. One had been in the hospital for 5 months when I picked her up.

Add to this the complexity of actually learning the medicine I'm supposed to learn this month. When my upper level says "replace his K" I usually go "okay, how?" Potassium comes in multiple oral and IV forms and can be administered slow or fast or even hanging upside down for all I know. As a med student, you generally don't learn medication dosing, because you're too busy learning the medicines themselves. Now, I'm trying to learn the dosing, in addition to remembering which calcium channel blocker is a dihydropyridine and which tricyclic antidepressants have the least anticholinergic side effects. Thank god for the PDA (or in my case, the smartphone) that contains the free Epocrates and gives me a starting point to say "should we start metoprolol 50 BID?" (Of course, the answer to most of my dosage offerings is "no, let's start x dose instead", which often seems to be more a matter of personal preference than anything. Or maybe I'm just always wrong.)

I spend half my day (it seems) just looking up the acronyms and abbreviations, because in every place they're different. One service used "HLD" for hyperlipidemia, this one uses "HLP". "MDS" is myelodysplastic syndrome, "SSS" is sick sinus syndrome, "AVR" is aortic valve replacement, and "FUBAR" is how I have felt these past three days. Thank god for Google.

I fully expect that by next week, I'll have my groove down. I'll fly through my notes and know how to replace basic electrolytes and remember the intricacies of acid/base metabolism and how to read an EKG. I'll know the names of the nurses (or at least the main ones) and the social workers (and of course, my team). I'll know my patients backwards and forwards and have their discharge plans in mind shortly after admission (always subject to change, of course). Seven patients will seem like nothing at all (and I'm sure I'll have more soon, as we admit q4).

Those first few days always suck, though. Welcome to internal medicine!


Dragonfly said...

Man, I miss my PDA (had one but then some douchebag ripped off my handbag while I was at work, in an employee only staffroon). Bustard!! At the same time someone stole a bunch of toys that had been collected to give to handicapped kids (seriously, you cannot make this stuff up). One day I will have one again and Oxford Handbooks will be available at my fingertips...
I found mine very useful though, even just for studying...

Midwife with a Knife said...

Ah, yes... the new rotation. As of November 1, I will never have the agony of starting a new rotation on a new service again. (I'll just do the same old rotations I've already done).

But then... in July, the job starts....

medicine girl said...

Your program may offer a full ePocrates subscription for free.

Mine, a public institution, offers it free to med students & residents. It's nice to have the full version if possible!

The ePocrates sales rep should be able to tell you if your program participates.