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The Wisdom of Interns · Style Points

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Hello anesthesia enthusiasts, I'm Nate Moore and you're listening to Style Points.
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This is a special episode because today we are going to hear from the graduating class
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of interns here at the University of Cincinnati.
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They've completed a challenging year learning the foundations of medicine along with the
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basics of anesthesia and are about to enter the promised land of their clinical anesthesia
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years.
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We're lucky to have them here today because tomorrow will be their first day as CA1 residents
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and we're going to get the chance to hear them reflect on lessons learned and experiences
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gained over their past year.
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My name is Anne.
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I learned a lot this year.
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Your first year of residency is pretty hard.
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I think there were two big buckets.
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There's all the logistic things that you learn, all the medical knowledge, learning a new
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hospital system, learning how to work well on teams.
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All of those are important but I think kind of a more important bucket to me personally
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was more so some of the emotional growth of intern year.
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I think we can get really caught up in how do we go about caring for patients from a
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systems perspective, how do we get them connected to the right medicines, the right physicians,
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et cetera, et cetera.
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But sometimes we don't always get great instruction of how to educate patients, how to understand
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what their goals are.
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And we learn all of these lovely things in med school about how to care for patients
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medically but not always how to address their needs beyond the medical issue that's on
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our problem list.
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And I have some personal bias here since I like critical care.
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I like very sick patients and I think there's a really important role for more of that emotional
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kind of care.
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So I think one of my biggest learnings this year was how to integrate that into care for
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all my patients.
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Not just trying to address their acute need for dialysis but to always keep in mind that
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this may not be what they want for their quality of life long term.
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And it's important to keep those kind of macro views about how they are as a person
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outside of their medical problem.
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So learning how to balance that with all of those other logistic things was a really big
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area of growth for me this year.
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I think that's super insightful.
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And you're right, it's not something you necessarily learn about in med school and then it can
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hit you like a freight train when you get into residency and you kind of have an idea
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of what you want to do medically and discover you might not be able to do it from a social
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standpoint.
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Any specific examples of situations where this kind of really became real for you?
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Yeah, I think you learn a lot of this through modeling and I don't think I quite grasped
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how much I learned about this until honestly this past week I finished on a general medicine
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rotation.
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We have a lot of medical students and so a lot of learners around and we had this very
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lovely patient who was very sick, had terminal cancer, had a lot of medical complaints going
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on and we were doing formal bedside rounds and this medical student was doing a very
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lovely job presenting all of the medical issues for this patient.
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Ultimately it was a very complex case and she went through all of this data and all
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of these things that we were going to try and do and she kind of paused and I cut her
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off.
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I was like, I think that's lovely but we should maybe take a step back.
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Think about what we're doing, what you want and within two, three minutes of meaningful
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discussion with this patient and her family who is there, they were already on the edge
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of I don't think we want to pursue these things anymore.
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I think we want to be a family and I think we want to be comfortable and I don't think
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we want to do more things here in the hospital.
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We were able to send that patient home that day comfortable through that conversation
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which was very validating to me that I was able to learn to balance those things this
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year.
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My name is Michelle and I think one of the things, I don't know if it's something I
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learned but something I noticed was really important for me this year.
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You know everyone talks about having a good support network but I came to a city where
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I had no support network and I know a lot of people are in that position when they're
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moving to a new city.
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Maybe they're leaving their family for the first time, they're going to a city that they've
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never been to and that's kind of the position I found myself in and although I have great
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co-residents and co-interns and I love hanging out with them, the likelihood of us having
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the same time off was pretty low.
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So like if there was ever a day where I had a random Tuesday or a random Thursday off,
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it's not like my resident friends also had that day off and so for me it was really important
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to develop a support network and a group of friends outside of medicine that they would
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be free on a random Tuesday afternoon and we could hang out.
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And so I think that's if you're moving to a new city, I know like a lot of people bop
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around for undergrad and then for med school and stuff so you're used to meeting new people
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and you're used to making new friends but I think in residency especially like having
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a group of friends, especially if you're moving to a city where you don't have family or anyone
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that you know, having a group of friends outside of medicine that you can hit up on any random
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day at any random hour is really important and it was important for me.
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So like examples, I'm a very active person so I met a lot of people through rock climbing,
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I've met a lot of people through snowboarding and just yeah, developing a network outside
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of medicine is important even if your co-residents are really cool.
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That's a hard thing about medicine too is it's super stressful and we yank you from
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one city to the next city and you need a support network to be successful at it and it can
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be really hard to keep creating new ones.
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What advice would you give to someone who feels like they're struggling with finding
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their support network when they're somewhere totally new?
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I think start with your hobbies.
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There are interest groups in every city likely in line with your hobbies but honestly try
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a new hobby.
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If you can't find a good group of whatever you're used to doing within that city, try
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something new and meet new people that way.
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I think just putting yourself out there and being open to new experiences, new things,
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new people.
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What advice would you give to someone who feels like they're struggling with finding
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their support network when they're somewhere totally new?
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Hey, hi Max.
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You know, just going through the end of my intern year I feel like that the biggest lesson
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that I've learned is that you know, no matter how hard it gets it really helps to just be
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a little bit kind.
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Like when you're in the deep trenches of intern year and you know, you are just exhausted
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by all the internal medicine you're doing and not the anesthesia, just a little bit
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can go a long way.
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I have a kind of a really surprising example of this.
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It actually just happened to me yesterday.
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I was in the ED and there's this nurse who was just like walking by and she goes up to
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me and she says, did a patient's family member take a photo of you by any chance?
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Apparently there's like a framed photo, an actually framed photo of me in the emergency
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department now.
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And I was just incredibly surprised by that.
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I was like, yeah, yeah.
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She's like, what happened?
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Why is that there?
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And so I was on long call and I was, I don't know, at like, it was probably 7 p.m. and
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I was just cross covering on all the other teams, just answering pages and one family,
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they wanted to speak to a doctor about like, you know, the plan for the day.
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They hadn't spoken to anybody for hours and hours and hours.
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It's not totally abnormal and it's not unusual for that to happen.
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But you know, it was me on cross cover.
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I really had no idea what the true game plan was for these patients.
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And when I went down there, I told them that, you know, I can only say what the team has
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told me.
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And they just said that you are being worked up for either like an infectious joint or
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maybe just a gout flare.
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But they had been sitting down in the emergency department for over like 24 hours.
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The hospital was full.
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They were admitted to the hospital, but they didn't have a room in it.
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They didn't even have a room in the emergency department.
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They were just in one of the triage chairs for over 24 hours.
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Basically, they were pretty upset.
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And you know, I told them that I would communicate with the orthopedic team.
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I couldn't make any promises, of course, and I wasn't leading their care.
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So even though the orthopedic surgeons, they said, you know, we're not going to go and
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see them.
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We'll see them tomorrow morning, just like the plan.
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They really they really just appreciated me coming down to talk to them because no one
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had for just hours and hours and hours and they were just sitting in a chair.
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And this guy was like 88 years old.
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And his wife really appreciated that somebody came down to talk to them.
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I think that's something we lose sight of too from the medicine side.
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We get wrapped up in the plans and we forget that there's a patient on the other end who
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would probably like to hear what the plan is or get at least an update about what's
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going on.
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You mentioned something interesting where a lot of times as an intern, I remember going
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down to talk to a patient and I didn't necessarily have a clear idea of what the plan was yet.
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Or when you're cross covering what the plan earlier in the day was, what are some things
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you would say in those situations to kind of update the patient?
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But when you don't have a full idea of what's going on in the background.
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Yeah, so what I really try to emphasize is that although the day team has full knowledge
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of your situation and where they plan to go with your care, I can try my best to explain
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what has been done so far.
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And that if there are any questions to definitely take them up with the day team and that I
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can pass that information along as well.
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Right, I'm Anna and I've been thinking about this.
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There's two things that I want to talk about.
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One is that doing well intern year, I think is equally dependent on like working hard
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and like gaining that medical knowledge and your ability to get along with others.
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Your team is constantly changing.
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Normally you're only like, especially on medicine, you're working with the same group for a week
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total and some some portion of that team is always going to be changing.
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And I found that the hard days weren't weren't as hard when you had a really good team and
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you worked well together and you had something that bonded you together as a team that you
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could all kind of relate to and joke around with after a really long day.
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I think that made my intern year a lot better realizing that as soon as you can make those
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connections like the sooner the better because it makes your week not so long.
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And that's a crazy thing about medicine is we really like these ad hoc teams even more
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in the OR when you have a different team every day, different surgeon, different circulator,
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different everybody.
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What were some strategies you used when you were on those days where the team was switching
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over and you had a whole new attending or other team members coming on to kind of get
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everybody up to speed?
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I think a lot of times we would try to find a common thread between the group by asking
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what do you do for fun outside of like if you weren't here, what would you be doing
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kind of thing?
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And we all would normally find something in common from those conversations and then draw
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back to those every day or talk about a similar artist that we liked, play that music in the
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workroom or something like that.
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My second thing is as a med student, I was full of anxiety.
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The transition from fourth year of medical school to being an intern was a little bit
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it was it was difficult at first because I was still in the mindset of kind of like being
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evaluated and constantly being watched and I was like that's not going to be sustainable
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for intern year for an entire year.
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So every morning on the drive into work, if I started to feel that like anxiety creeping
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up, I would just tell myself like I am now here to learn.
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I'm not here for an evaluation.
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I'm not here to prove myself.
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I'm here to learn.
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And that really, really helped change my perspective.
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I wasn't going home and like being just completely exhausted at the end of the day anymore.
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It's like I was able to enjoy my time at work way more once I was able to look at it that
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way.
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I'm Garrett.
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A few things I learned from intern year is hard because I learned a lot during intern
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year.
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But something I think that helped me a lot and it's probably going to help me going in
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the future is just trying to be kind to and as friendly as you can with all of your co-residents,
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even if they're not in your own specialty, at the very least cordial and also even if
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it's like a rotation that you're not too excited to do, trying to show up to work every day
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eager to learn and eager to help the team as best you can.
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I feel like if you do that, then the people that you're working with, your seniors, your
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faculty, they kind of they notice that and it provides you a lot more opportunity and
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it allows you to have a little bit more independence than if you're not showing up as eager to
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work.
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I've heard some seniors that say, I was on these rotations I didn't really like, so I
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just tried to do the bare minimum.
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But if you're expected to go to work every day and you show up giving your best, then
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it really gets noticed and it allows you to have more opportunities, more procedures,
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which is something that I really tried to do.
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When I was on my ICU rotations, they saw that I was a hard worker and they would knew that
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I was interested in procedures and would seek me out if they knew there was something that
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I wanted to do because they valued the way that I presented myself on a day to day basis.
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So I think that that's something that was really valuable during my intern year and
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something that I would recommend doing for any incoming interns, regardless of the rotation
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that you're going to be a part of.
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I think that's super insightful and I definitely agree.
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I think when you're kind to other people, especially in the hospital where people often
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are not very kind to each other, that's reflected back at you and it makes your life easier.
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Any specific examples of when someone was kind to you and that made your day better?
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I think that just by presenting myself as being kind and you can tell some people have
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bad days and you can't take a lot of that stuff personally because it doesn't always
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reflect their true character.
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I think that almost every day I had positive interactions with the majority of the people
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that I worked with.
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I can't think of one particular example, but I know that things like when I was on the
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emergency department and I would call my medicine colleagues that I had worked with for five
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months when they pick up the phone, they're not excited to get admissions from the ED,
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but I would be like, oh hey John, it's Garrett.
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They would, knowing that it's me, would break the ice or take a little bit of the edge
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off and sometimes I would apologize like I am sorry.
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I know you guys are getting slammed right now, but I have this new admission for you
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and it made everything a little bit easier with that regard.
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I think that moving forward, some of these relationships, especially in the ICU, are
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going to need to be maintained, so it can only help moving forward as well.
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My name is Claudia Mort and I am going to be a CA1 in about a week.
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One of the most important things that I would say I learned was the importance of a routine.
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I basically would set everything up so that the morning before work, it would be super
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easy to just grab my stuff and go.
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At the beginning of the week, I would set up all my outfits.
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It was basically always the same, but I would set up all my outfits.
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I would just grab the one at the top of the pile and put it on.
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I had the same breakfast I think almost every single day and that just made my mornings
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way better.
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In that, I was able to find time for myself, which I think is so important in this transition.
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As we shift from like medical students to caring for other people, it's easy to forget
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to take care of yourself because you're so focused on doing well.
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In that, it's so important to recognize when that's happening and find a way to step back
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to care for yourself.
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With this routine, I was able to carve out time to do my makeup in the morning.
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That was a form of self care that I know I'm going to have every single day.
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That's one thing that made me feel good.
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I could do it consistently despite of whatever's going on.
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I had a good start to the day.
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That's super cool.
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That's something I now wish I had done during my intern year.
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It's so much easier.
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You make so many decisions throughout the day.
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It's nice to take some of those other decisions off your plate and make your day a little
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easier.
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What are good breakfast options when you're prepping for the next day?
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I need to know for myself.
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I did have two options.
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One was overnight oats.
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I made it super boring, but I worked.
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In a container that I could take to work with me in my bag to eat while charting, I would
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just take oats and I would put almond milk the night before or maybe a couple nights
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before and then the morning off, I just add blueberries to it.
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Or I would have a smoothie.
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It's the same smoothie every single time when I have a smoothie.
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That definitely sounds like it made life easier in a potentially stressful year.
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It allowed me to prioritize myself in the aspects I cared about and it made me feel
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good.
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All right.
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I'm Morgan.
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A few things that I learned during intern year.
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One would be relying on the class above me, especially asking questions when I felt like
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maybe things weren't going the way I maybe I had expected and that maybe my experiences
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weren't meeting what expectations that I had for that rotation.
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Just reaching out and getting advice or support I felt like was really helpful and put things
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into perspective.
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Then the other thing would be feeling as an intern that every time you got a call that
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you were expected to solve the question that was presented to you and fixing all of your
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patient's problems, which is not possible at sometimes.
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One of the things would be some of the little calls you'd get about a patient having a
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little bit of a headache or a little bit of stomach pain, something like that.
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After asking all the important questions, making sure they didn't have any red flag
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symptoms, just asking the patient, often they'd say like, yeah, I've had something like this
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before.
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Especially if it's like a headache, you could be like, well, what do you usually do when
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you get a headache?
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Sometimes they'd be like, I'll just sleep it off and drink some water.
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You can say, all right, let's try that first.
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You don't have to always give them Tylenol or if you do give them Tylenol, that might
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work and that might be fine and you don't need to go further than that.
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It's okay to always just take a step back and not fix everything right in the moment.
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I think that's definitely really important, especially starting out and especially when
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you don't know what's a disaster situation and what's not yet, what needs to be escalated
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and what doesn't need to be escalated.
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Can you tell me about a time where you got a question that you didn't know the answer
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to and how you work through talking to a more senior person and came to a solution together?
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I don't know.
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I think just one case, I think trying to learn sick versus not sick is hard sometimes, especially
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as an intern.
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It's something that really just takes time, but I did have this one patient that was on
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my team, but it wasn't my direct patient that I was caring for that day.
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When I saw the patient that morning, I didn't have any indication, but when I looked at
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the patient, I was just like, you look sick.
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Everything seems different after seeing this patient after a few days.
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Didn't have any indication, and then I was there on long call and then got called back
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to the room.
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I was like, there's obviously something wrong.
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I was like, I don't know why the patient needs to go to the ICU, so we ran a bunch of labs
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and their hemoglobin was extremely low and they had a GI bleed.
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While I couldn't figure it out before, eventually I was like, okay, my suspicions were correct
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that something else needed to happen with this patient.
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My name is AJ Pagan.
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Some things I learned about intern year, I think really investing in your intern class
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is really important.
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We had a unique experience where we had six people from where I went to med school, UC,
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join our class.
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I wasn't necessarily friends with them in medical school, but starting residency, we've
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gotten very close.
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I think that's been a great experience for all of us.
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Getting close, we've built this friendship past just colleagues.
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We do lots of things together, and then I think it extends into work where we're always
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willing to help each other out, whether that be on an internal medicine rotation where
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someone's getting swamped in the OR when we're on anesthesia and we know that you're having
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trouble setting up a room or something.
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I think just taking that extra step to get to know each other goes a long way both academically
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in your career and then outside of work.
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It's always good to have a lot of new friends wherever you're moving to.
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I think that's a really good point.
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It's so important to have people you trust as your support system because intern year
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is stressful and you're going to need people to lean on and help you out.
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Do you remember what things you did or the group did at the start of intern year that
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brought everyone together so you had that cohesive group?
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Yes, since a lot of us are from the area, we grabbed a lot of dinners together, places
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that we recommended, and we made sure to include each other, significant others in there to
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actually get to know your family and everything.
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What is important to you to get to know you more than just the surface level of I'm XYZ
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and I'm interested in anesthesia and the one or two things.
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Now I think our significant others are also friends with each other.
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I think that's important too because residency is stressful, time consuming and having your
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significant others also have a support system that extends beyond their own friends is important
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because everyone's kind of going through the same thing and having the chance to have common
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experiences and bonding I think has been important too.
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Now I have to ask this.
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What's your favorite place to get dinner in Cincinnati?
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Oh, that's a good question.
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I think the best bang for your buck I think that I've been going to recently is Pepin
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Delores.
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It's an Italian restaurant.
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Really good homemade pasta for a pretty affordable price, but we've gone to Mattria Bunch as
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a class.
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They have pretty good pizza there and then the beer is also very good.
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My name is Nate.
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I'm one of the residents at UC.
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I'd say the biggest thing I learned this year that I took away from was how to advocate
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for myself and how to advocate for others.
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I found that at least from my experience going through engineer there were several opportunities
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that came up where there were things that maybe to me appeared like they could be improved
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upon.
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So I reached out to my seniors, to my faculty to discuss ways that we can make things better
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and I feel that as an intern sometimes that can be intimidating or sometimes you feel
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like that's not your place to do that.
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But I think one thing that I definitely took away from this year was that everyone has
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the opportunity to do that.
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It doesn't depend on what year you are, if you're a junior or senior, et cetera.
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I think that's really insightful and it's really hard to do when you're just starting
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out as an intern, especially if you're going to a location you haven't been before.
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What was kind of your process when you saw something you didn't think was right?
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What did you do to get in touch with people that could help?
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So I think the first thing for me is trying to get feedback from my peers immediately
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to see if what I was feeling was out of the norm or if things are part for the course
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and maybe that I was just experiencing sort of the status quo.
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If something was unusual or if we feel like the experience is something that is not in
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line with what it should be, then I would reach out to my seniors to get their feedback
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on it.
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And then depending on that process, then going up to faculty.
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And here I would say I'm very fortunate that I have very supportive seniors and faculty
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and staff and I always feel empowered to be able to bring things up.
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So in terms of advice, I would say for any prospective students, definitely look at programs
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where you can feel empowered to do that, where you are comfortable speaking and being able
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to advocate for yourself and others.
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I definitely think that's important.
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Are there any questions you think applicants could ask when they're on the interview trail
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to kind of get a feel for how receptive senior people are at people advocating this way?
27:27
Yeah, absolutely.
27:29
I think on the interview trail, it was a good sign if the program themselves advertised a
27:35
system.
27:37
So I know coming here from UC, that was something that was highlighted, the feedback system,
27:42
you know, multiple residents, multiple faculty talking about like there are ways to escalate
27:48
concerns.
27:49
And so that's already a green flag here on the interview trail and you see that.
27:54
If I don't hear anything about that, then I begin to ask simply, is there a system for
27:59
feedback?
28:00
Is there a system?
28:01
Like if I have concerns, is there a system in place to allow residents to express their
28:07
concerns?
28:12
I am Brian Upton.
28:14
I think the biggest things I learned from intern year is just how quickly you progress.
28:20
So I think everyone starts off pretty timid and uncomfortable with the amount of knowledge
28:24
that they have, but kind of there's a point through intern year where all of a sudden
28:29
things just make sense.
28:31
All of your training kind of kicks in and things just start flowing.
28:35
I think that's when a lot of people really feel like they're getting into their rhythm.
28:38
That was something I didn't quite expect.
28:40
I think for me, it came out of after doing one of the ICU rotations, I came back to the
28:44
floor and like everything just seemed simpler after that.
28:48
I think a combination of having some ICU experience seeing sort of what the edges of physiology
28:54
could be and then bringing it back to patients that aren't to that extreme and it just kind
28:59
of put everything in perspective and was easier to manage at that point.
29:03
ICU rotation can definitely be eye opening.
29:05
Definitely for people who haven't had a lot of ICU experience before, you see some crazy
29:08
stuff and that makes you better.
29:11
Were there any specific experiences you had in the ICU where you really had a moment or
29:15
learned a lot you feel?
29:18
I don't think there's any one experience, but just seeing patients on ventilators, patients
29:25
on multiple pressers, patients in various arrhythmias.
29:32
Not just one case, but the collective of all of them.
29:35
That's really where it's not just one organ system anymore.
29:38
Everything's interacting.
29:40
From the anesthesia side, I know we often like ICU rotations because we get to do a
29:44
lot of procedures.
29:46
What strategies did you use to make sure you got access to doing procedures or kind of
29:51
put yourself out there to get more experience with them?
29:54
I was relatively proactive just if a procedure needed to be done, just volunteer like, hey,
29:59
I'd love to do this.
30:01
I think one area that I was able to get a lot of extra experience was in the emergency
30:06
department.
30:08
Once the nurses learned that I was in anesthesia and could do IVs, they would come get me if
30:13
they couldn't get it or if they needed an ultrasound IV, they would usually come to
30:18
me or one of the emergency medicine residents.
30:21
Even though there were other off-service residents there, they knew that anesthesia was capable
30:24
of doing them.
30:25
It was a good chance to do a lot of ultrasound in the ED as well just because you need it
30:32
and you're there.
30:33
Those are definitely the things where you can only learn so much reading a textbook.
30:36
You kind of have to do a few to get good at it.
30:38
Exactly.
30:39
Did you have a favorite rotation from intern year?
30:42
I mean, anesthesia.
30:44
That was an easy question.
30:53
Thanks again for joining us for our special episode with my co-host, Nate Moore.
30:57
I started my intern year 10 years ago today.
31:00
I still remember the feeling.
31:02
I also want to thank our outstanding incoming CA1 class who put significant thought and
31:08
effort into what they shared with us.
31:10
If you enjoyed this month's podcast, please feel free to drop me a line at stylepointspodcast.gmail.com.
31:17
Leave a review or feel free to share it with your friends or your mom.
31:22
All right.
31:23
Take a deep breath.
31:24
Open your eyes.
31:25
We're all done.
31:26
We're all done.