Some Rules to Help You Shine in Your Intern Year

(stuff I wish someone had told me…)

Tom Morrissey and David Caro
Dept. Emergency Medicine
UFHSC-Jacksonville

1) This is really a job, and an important one!

• Professionalism is an absolute must
• Show up on time ready to go
• Clean up messes at the end
• Dress right (professional and comfortable)

2) Recognize that your first year is about a lot more than just Emergency Medicine.
• You need a SOLID grounding in IM, ICU, Ortho, OB/Gyn, etc.
• Truly immerse yourself in the services you are rotating on-look at the
world through their eyes

3) READ, READ, READ!!!

• build a schedule and stick to it
• Focus on basic, daily used skills (EKG, CXR, ABG, lab interpretation)
• Commit algorithms to memory (ACLS, basic orders for common chief
complaints)

4) Expect and be ready for formative feedback (i.e. constructive criticism)

• Expect to be wrong every day, because…
• …different attendings do things differently. Don’t let this frustrate you.
Accept it as a chance to try out different practice styles, and find out what
works best for you.

5) Be humble and nice to everyone around you.

• It’s a small world (see below).
6) Its NOT OK to lie! Really.
• It’s OK to not know the first time around (…I didn’t do a rectal exam…I
forgot to look at the x-ray…)
• Learn from each of these instances and take pains to not do it again.
• It’s never OK to lie. It compromises patient care, undermines the trust
placed in you, accomplishes nothing….and you will get caught!

7) Maximize learning opportunities on shifts.

• Grab charts
• Offer to do/teach procedures
• Don’t sign out procedures unless absolutely necessary
• Read every EKG in the department

8) Pay Attention to Vital Signs and Lab Results

• You have to explain the abnormal!
• Know normal limits

9) Structure the timeline for your patient encounter

• Walk out of the room at 10 minutes and build a provisional DDx and
treatment plan.
• Adjust as necessary with a long term goal of efficiency

10) Get comfortable with alternate sources of history

• Call family, friends, nursing home…
• Look up old records, labs, D/C summary
• Ask rescue what they saw, who was there, is family coming?
• Call the police back

11) Don’t screw your neighbor

• You and your colleagues have to support each other
• Kindness is paid back in kind…

12) Give the patient the benefit of the doubt

• It’s OK to get fooled by a drug seeker, it’s not OK to miss real pathology
• Don’t underestimate pain
13) Develop a system to keep patient data organized
• You cannot keep the chart in your pocket
• Ask colleagues what works for them
• Only the basics, pertinent +’s and –‘s, don’t rewrite the chart

14) Work on your case presentation style.

• This is an actively acquired skill. Seek feedback.
• Practice briefly prior to rounds-don’t just wing it.
• The “brass ring” is to know everything, but only say the minimally
necessary
• This will become critical in interactions with consultants.

15) Listen to your nurses.

• Some will save your butt…
• Some will hang you…
• Learning to tell who is doing what when is an integral part of your
education

16) Assume assassins are everywhere…

• Always be on alert
• Patients will crash when you go to pee
• Murphy wasn’t a lawyer…he was an Emergency Physician!

17) Go to lecture. I know it’s tough, but where else are you gonna find two weeks
worth of information packaged into 45 minutes and delivered to your noodle?

18) Develop some social support network-and prepare them for what’s coming
• Let them know how important this is to you
• Remind them residency is a finite time
• Don’t be afraid to lean on family/friends for support

19) Learn a little about the machinery that makes the residency run
• ACGME, RRC-EM, Deans office
• Understanding a little about some of the hoops you have to jump through
makes them a little more tolerable.