Sunday, March 17, 2013

For the MS4: Create your own Capstone

Some medical schools will provide you with an end of fourth year experience to prepare you for internship.

But some do not.

Do not despair soon-to-be-doctor.  You can still prepare yourself for July 1st.

There are some common concerns newly-minted interns share:
  1. Procedural inadequacies
  2. Getting yelled at by consultants and admitting doctors
  3. Not being able to function in the ED

And there are some things you can do about them:

1.  Procedural inadequacies mostly fall into two categories.  The skills you are expected to have and the skills you are afraid you do not have.  In your remaining rotations, take the opportunity to draw blood, start peripheral IV's, and do ABG's.  These are skills you may be expected to possess.  Most residency programs do not expect you to be an expert at central lines, lumbar punctures, and intubations.  But they are very happy when you show up and know why you would do these, how they are supposed to be done, and are thus ready to learn them early in your training.

2.  Start practicing diagnosing your consultants.  Put yourself in the shoes of the people you will call.  Think about what they want to know and how they want to be approached.  An internist may want more detail and to discuss your differential and management so far.  A surgeon may only want to know what you would like removed from the patient.  Residents are going to want different information than attendings.  Everyone needs to be communicated with differently in the middle of the night than at 10 am.

3.  Emergency Medicine is hard.  You will not be expected to be proficient immediately.  Your residency is expecting you to show up, try hard, care about your patients, and to improve.  Start practicing now the things that will help you get better.   Think about how you approach patients.  Start thinking about serious causes before you go into the room.  Force yourself to present an assessment and your plan, regardless of the setting you are working in.  Make a habit of reading about your patients.

Finally, there is something you are going to have to accept.  You are going to make mistakes.  No amount of experiential preparation will change that.  You should still strive to minimize errors, but they will occur.  Everyone makes mistakes.  Even your clinical mentor, as brilliant, unflappable, and supremely competent as they may appear/pretend to be.  

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