Every year, nearly 8,000 (according to ABIM) Internal Medicine interns will join the ranks in residency programs across America. This possesses challenges for the residency program and the new intern. Well, July 1 marks that transition: The new interns are here! What everyone should expect:
Having interviewed many candidates months earlier, rank listing, and awaiting the match results this is the moment where programs figure out if they got it right with resident selection. Most programs stick to certain algorithms so it takes much of the guess work out. But with the average tenure of program director being only 5 years, programs are in perpetual periods of change.
Starting at least a month before (June), there are many behind the scenes challenges: vacations, release of PGY 3s for board review courses, outgoing residents moving, and interviews always made the schedule tight. So, preparation has been at a feverish level for nearly a month with residency program coordinators contacting all incoming interns, scheduling orientation, and with any luck getting everyone where they need to be on July 1st. Yes, programs got used to everyone being where they are supposed to, like a big game of musical chairs everyone gets up and shifts to new roles and responsibilities.
Graduating PGY 3s:
That time has come. You’ve been reading extra to prepare for your IM Boards and trying to find your next move in your career: begin your career as a physician (hospitalist/private practice) or continue learning in Fellowship, maybe move to a new city and all the challenges that go along with it. Either way, senioritis is in full swing and you are already moving to the next phase of your life. You worked hard so at graduation, take pause, enjoy the moment and take it all in.
PGY2s => PGY 3s:
You are finally considered the veterans of the group that everyone looks up to. Some of you achieved the coveted spot as chief resident, which has its own unique set of challenges. Time to get all those extra electives you’ve been craving for the past 2 years. Time to teach your junior and increase your reading to prepare for your Board exam
PGY1s => PGY2s:
I guess you are mostly just relieved that you’re no longer an intern. The transition seems to quickly happen from mentee to mentor, but believe that all your experiences during this past year has groomed you to be a supervising resident. Pretty cool!
Well, with your new, starched and very white coats, you will be hit with more information than you can absorb. (Note: when you screw up someone will say “don’t you remember we covered that in orientation”). Well statistically, you only remember about 30% of what’s covered in orientation so it’s important to know what your alternatives are. Here are a few tips from the field:
- What’s really covered in orientation – All hospital and departmental systems including policies and procedures, EMR, new email new passwords, HR, schedules, hospital layout, daily routine. Grab the important stuff, take a few notes and move on. Better to spend the time getting to know your routine and your colleagues. There are countless leaders giving inspirational talks and encouragement on how “it’s going to be a great year.”
- Who can I turn to with a question? – The beauty of residency structure is that you’re never alone. If your senior resident is not available then you can call your chief resident. If they are unavailable then always call the attending (yes, even at 2:00am). Better to get it right then to make an error. If the attending is for some reason unavailable, other program leadership like the APD or PD will always give you direction (Make sure it’s important and you have all the facts). In all cases, it will frustrate the person you are calling if you first have to start checking things. Know the labs, the meds, and the significant change in condition prior to the call.
- Who else? – Well believe it or not RNs can be extremely helpful. Particularly when it comes to systems and processes. Remember they have been there for years. Medication issue, consult with the pharmacist but remember you have the ultimate scrip writing power.
- Typical day - Check in rounds, round your patients, morning report, teaching rounds, lunch/conference, more rounds, check out rounds, try and go home.
For many programs the legacy residents are leaving meaning that the remaining ones and the incoming ones will only know EMRs. This technology revolutionized the way we:
- document our encounters,
- charge capture (bill)
- best practice modeling
- performance / quality improvement
- report / metrics / meaningful use
- communicate and care coordination
These interns are going to have to learn a new type of medicine, to practice in ways that are far different from their predecessors, even just 5 years ago. There is a new set of Alphabets that they need to know and understand. To name a few:
- PCMH - patient-centered medical home
- ACO – Accountable care organizations
- PFP – Pay for Performance
- JC – Joint Commission (Formerly known as JCAHO)
- EMR – Electronic Medical Record
- CC – Corporate Compliance
- MU - Meaningful Use
- RVUs – Relative Value Units
- ACGME - Accreditation Council of Graduate Medical Education
- DOH - Department of Health
And yes, if not understood can cost you money.
I have always said that access to healthcare has non-traditional barriers as well (More on this on my next post). It seems as though the more we try to fix it the more we box ourselves in by adding more regulation. The planets really need to be aligned to make access smooth. All that said let’s inspire the new interns and role with the times!