Pearls of wisdom for interns

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It’s June and, in less than a month, a swarm of new faces, and freshly minted MDs and DOs will descend upon most academic teaching hospitals.

Many will just be getting used to being called “Dr.” They may look around when first addressed by that title. They may feel giddy (or terrified) when they place their first order and someone acts on it. Overall, however, they will be…

Eager. Diligent. Cautious. Respectful. Ready.

These interns are ready to take on the responsibilities of internship, and to handle a suddenly never-quiet pager.

Because surgical internship presents a mixed bag of emotions and a hidden curriculum, I want to share some aphorisms that helped me through this phase in the hope that it helps some, inspires most, and allays fears.

‘Put the patient first and you’ll rarely go wrong’

If given the choice between checking on that worrisome patient one more time, and calling it a night, go check on the patient. Don’t be afraid to alert your immediate senior to your concerns about a patient. Don’t be afraid to advocate for your patient—even if you don’t know all the answers. Ask for help if you feel overwhelmed. You are rarely alone in the hospital. Surgery is a team effort.

Listen to your patient. Listen with your ears. Listen with your heart. Take note of the little things. Ask about the patient’s dog or cat. Talk to the difficult patient. Often, you’ll find their difficulty to be a facade for fear, loss of control, helplessness or despair. Listening can be therapeutic—sometimes even more so than the scalpel.

As many know, patients with vascular pathologies are some of the sickest in the hospital, and those who have had “routine” procedures require the same amount of vigilance (if not more) as those who have had big operations.

Who are these patients? The fresh amputations, the dialysis access patient with end-stage renal disease (ESRD), the endovascularly-treated peripheral arterial disease (PAD) patient. These are the patients who can turn on a dime quickly, and, before you know it, a code is being called. Remember that the most significant postoperative complication from vascular interventions is myocardial infarction. Be vigilant.

‘In the race to average, enthusiasm will set you apart’

With every gain in medicine, you become more of the average. The top college student becomes the average medical student. The top medical student finds that they are now an average intern among other stellar interns. Remember that you are enough. I repeat you are enough.

Being enthusiastic does not mean being insufferably Pollyanna-ish, but it does mean that you show up. Be punctual. Be reliable. Be honest. Be humble. Own your mistakes. Read. The more people can rely on you, the more responsibility you’ll gain, the more you’ll learn and the more goodwill you’ll build. Which leads me to my next point…

‘Your reputation is built in the first 3–6 months of residency… and it will follow you until graduation’

First impressions count in surgery. Work diligently and with humility with the allied health professionals, operating room (OR) and nursing staff. Most will want to help you succeed. Questions posed with the intention of gaining knowledge are always welcome… and honestly, most people want to teach you about their job. Build a solid reputation now, and like a bank deposit, it will offer you the trust you will need from your attendings and senior residents in the future.

‘Work on your craft’

You will suck at first in the OR—and that’s normal. Especially that first time when the senior resident looks up at the end of a case, mumbles “You got this?” and de-scrubs, leaving you with a 12cm wound to close. It’s OK to suck at first. The key is to keep improving.

Grab supplies and practice at home. Practice knot tying and throwing knots— one-handed, two-handed, nondominant handed. Practice with Castro Viejos. Repeated exposure and practice is the key to surgical training.

‘To thy known self, be true’

Wellness efforts are rampant these days and sometimes it’s reduced to a buzzword. Take care of you. Surgical residency is a marathon, and not a sprint. Know your limits, ask for help, take that vacation, go see that family. Residency is hard enough. Make friends and don’t go it alone, if you can help it. Don’t forgo family. Save money if you can. Get a low-maintenance pet. Be forthright with your PD if you need time off for personal reasons.

‘Pay it forward’

All of a sudden, with a medical degree behind your name, you’ll find that, in the presence of a student, you won’t be the first person called to answer a question in the OR anymore. The great thing about having gotten this far, is that you’ve likely observed some great teachers and some lousy ones.

Now it’s your turn. Most students are not looking for you to solve all of surgery. Most are happy if you include them in patient workup and/or tasks. It’s not difficult to impart what you do know to your juniors. Take them aside when you have a down moment and do mock oral sessions helping them prepare for their exam. Point out ‘shelf-worthy’ pearls pertinent to vascular and/or general surgery. If you are able to, pay for the med student’s lunch or dinner when they’re with you on call. It’s the little things that count.

In the end, surgical residency will always demand more and more of you. July will have its learning curve. You must protect the greatest asset that you cannot get back: time.

With this, I hope you’ll be encouraged on your first call shift in July knowing that you’re not alone and many of us (even those of us not at your institution) are just an email or phone call away, and are willing to help.

Christopher Audu, MD, is an integrated vascular surgery resident at the University of Michigan in Ann Arbor, Michigan.

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