Corner Stitch: A letter to new vascular interns

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Kirthi Bellamkonda

Every intern starting vascular surgery this year is incredibly talented, and soon to be a member of a tight-knit, supportive, and fiercely passionate group of surgeons. I remember being on the cusp of my first day a year ago, having spent the interview season talking the talk, yet wondering whether I could walk the walk. In surgery there is really no “trial run” to internship—most sub-internships are focused on operating room (OR) time and interviews on non-clinical achievements, so I’m hoping to pass on some of the lessons I learned this year.

There will be many false alarm pages. Don’t let complacency creep in. We like to find patterns in everything. After seeing five pages about postoperative pain in five different patients, all benign, it’s natural to assume the same on the sixth. That is when you will miss a graft thrombosis, a compartment syndrome, a hematoma, or an infection. The pager will “cry wolf” most of the time, but the safest intern always assumes the wolf is really there and acts accordingly.

Know how (and where) everyone on your team does their job

There are many things in your day-to-day that happen in the background of your awareness—but if you are responsible for making sure it gets done, then you should also know how to do it. I have had to program an intravenous (IV) pump, dig through central supply for an obscure dressing, and sign for unlabeled specimens in the lab building. Pay attention, not just to what other physicians do, but what the support staff do. Ask your techs to show you how to work the ultrasounds. Ask the critical care nurses to show you how to pass meds in a code. Ask physical therapy how to safely mobilize a patient. Know how to spike an IV. Drive a bed with someone from transport. And when you have a few spare minutes, find dialysis, magnetic resonance imaging (MRI), computed tomography (CT), hyperbaric, pathology, pharmacy, central stores, instrument reprocessing—you should be able to find your patients and your tools at any point in the day.

Experience and knowledge are not interchangeable

Being present and caring for patients is a critical part of training, but that alone will not get you to the level of knowledge needed. As hard as it is, carve out time to read Rutherford and do Vascular Education and Self-Assessment Program (VESAP) questions, even intern year.

Efficiency comes from observing efficient colleagues often

Everyone in medicine develops a system for looking through a chart and managing workflow, and it’s easy to become attached to the first thing your first senior shows you in your first block. I would encourage you to keep watching co-interns and seniors do “basic” things, even after you know how to do all the usual intern tasks. There will always be someone who has found a new shortcut or an automation. My personal efficiency tips: Medical issues should always be addressed face-to-face with patients, but the operator can always help you call an inpatient for quick questions about rides home or pharmacies to save time. If you have access to a mobile app/orders for your electronic medical record (EMR), use it. I always knock out—at least—one task while walking somewhere. It also sends me push notifications for all important lab results. Organize your EMR tabs to chart round in the fewest clicks. Most modern EMRs have huge amounts of personalization options.

You are never truly alone

In the clinical world, being on call without an in-house senior can seem lonely. But most life-threatening overnight inpatient issues are medical in nature, and you will have in-house critical care and senior medicine trainees. Although not part of their job, our in-house trauma, cardiology and anesthesia trainees have reinforced that they would always help an intern finding themselves all alone in an emergent situation, no questions asked. It is always better to call for help than to demonstrate your independence at the expense of safety.

And finally, a few practical points: Always hold pressure for longer than you think you need to after a groin puncture; take the United States Medical Licensing Examination (USMLE) Step 3 before you forget how to read a fetal heart tracing. Intensive care unit (ICU) is a good time, and buy the best own-specialty private disability insurance you can afford.

The learning curve is steep, but your knowledge this year will grow exponentially without you even realizing it. Don’t forget to step back and take time for yourself on days off and acknowledge all the hard work you have done. Good luck!

Kirthi Bellamkonda, MD, is a PGY-2 vascular surgery resident at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.

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