Starting residency depression, need advice

[Phaeochromocytoma]

I am 1 month into my residency program, just finishing my internship. This past month has been hard, my patient load has been anywhere from 15-30 patients, many people I've talked to say "you're just starting, you need time to get used to it".

I need somewhere to start. Are there any algorithms (like drugs, investigations) to rounding patients with commonly-seen problems?

Many things I have learnt isn't translating to the wards and I constantly have thought block. I don't have a framework for my daily patient notes. I end up copying everything (blood test results, XR, vitals) every day. Do many starting residents experience this?

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[NewYorkDoctors]

I am 1 month into my residency program, just finishing my internship. This past month has been hard, my patient load has been anywhere from 15-30 patients, many people I've talked to say "you're just starting, you need time to get used to it".

I need somewhere to start. Are there any algorithms (like drugs, investigations) to rounding patients with commonly-seen problems?

Many things I have learnt isn't translating to the wards and I constantly have thought block. I don't have a framework for my daily patient notes. I end up copying everything (blood test results, XR, vitals) every day. Do many starting residents experience this?

15-30 patients ? Acgme limits interns to ten patients .

Or are you a pgy2 and are making a clear distinction between intern and resident ?

In any event the interns job on the Wards is quite literally to be a PA and clerk . Anything you learn is a bonus . Just keep chugging along and reading . Everyone feels dumb until one day it clicks

 

[IMGASMD]

I am 1 month into my residency program, just finishing my internship. This past month has been hard, my patient load has been anywhere from 15-30 patients, many people I've talked to say "you're just starting, you need time to get used to it".

I need somewhere to start. Are there any algorithms (like drugs, investigations) to rounding patients with commonly-seen problems?

Many things I have learnt isn't translating to the wards and I constantly have thought block. I don't have a framework for my daily patient notes. I end up copying everything (blood test results, XR, vitals) every day. Do many starting residents experience this?

Same question at @NewYorkDoctors. Are you in the US? How do you finished internship and only just starting? Interns are only allow to carry 10 patients, unless oncall or night float. That’s in the US. Anywhere else it can be my best guess.

Keep yourself organized. Have a list of tasks of what you need to do that day. Prioritize is the key. A lot of what you do will be busy/scut, learning will come when you can actually tread water, in July I was barely keeping my head out of water.

There are handbooks that will give you some suggestions as to where to start to work up for a patient, you will recognize patterns and apply the right treatments; or at least start the correct work up and let your senior resident know.

Good luck.

 

[rokshana]

15-30 patients ? Acgme limits interns to ten patients .

Or are you a pgy2 and are making a clear distinction between intern and resident ?

In any event the interns job on the Wards is quite literally to be a PA and clerk . Anything you learn is a bonus . Just keep chugging along and reading . Everyone feels dumb until one day it clicks

well as a resident, he would be responsible for upwards to 30 pts if he has 3 interns...but then wouldn't have daily notes.

could be a DO residency...i believe they don't have caps.

 

[W19]

That sounds horrible. I am dying with my 9 caps right now.

 

[Rocher]

I am 1 month into my residency program, just finishing my internship. This past month has been hard, my patient load has been anywhere from 15-30 patients, many people I've talked to say "you're just starting, you need time to get used to it".

I need somewhere to start. Are there any algorithms (like drugs, investigations) to rounding patients with commonly-seen problems?

Many things I have learnt isn't translating to the wards and I constantly have thought block. I don't have a framework for my daily patient notes. I end up copying everything (blood test results, XR, vitals) every day. Do many starting residents experience this?

Maybe make an Excel spreadsheet with a one liner, problem list, pertinent meds/studies with room to add in new ones with a pen, and a blank section for the day’s plan which you can add to on the fly. Unless you don’t trust your interns I would let them keep track of less pertinent labs, etc and just eyeball the ones your concerned about just add those to the problem list “ie hyperkalemia 5.8”

I did something similar in the beginning but like training wheels on a bicycle, you likely won’t need it after you learn your new role.

 

[GastriqueGraffin]

It sounds like this is your PGY2 year and you must have 3 interns if you are carrying 30 patients. If that’s the case then you need to rely heavily on information the interns provide while reviewing and finding ways to cut down your list.

 

[Phaeochromocytoma]

Thanks for all your responses.

I am indeed not in the US. I work in an International City where every 3 mins a patient is admitted to medical ward. I am a resident, not a PGY2, a bit different from UK system. Of course it is divided into AM / PM / long call ward admissions and male / female admissions. But it's still a burden and I'm expected to discharge patients every day (anywhere from 2 - 5 discharges) or my patient number will skyrocket.

To NewYorkDoctors and GastriqueGraffin, I work in Asia, and we are not divided into DO or MD. We don't have PGY1 or PGY2. We have 1 year of internship and residency immediately starts. We go by the UK set of rules with MRCP -> FRCP. I am currently studying for my MRCP part 1.

Sorry I have not been replying to this thread. In this 1 month I've been working out patterns as IMGASMD suggested. Thanks to Rocher for suggesting patient lists and problem lists. I have found that useful in my first few days but now I find it a bit tedious and time consuming. I'm sure its a wonderful method for those with maybe a patient load of 8-15. But on weekends I'm rounding > 30 patients and I find that a bit impossible >.< (to W19).

 

[Phaeochromocytoma]

Thank you all for your wonderful responses again. May I ask if you guys have some patterns and follow up management plans for your patients?

I'll share one to begin with -> the commonest I've seen is pneumonia:
(After initial management)
Cont Abx (or upgrade depending on c/st results), bld x CBCdc CRP RFT, rpt sputum c/st, sputum suction prn (for sputum retention), CXR mane, chest physio

 

[IMGASMD]

Thank you all for your wonderful responses again. May I ask if you guys have some patterns and follow up management plans for your patients?

I'll share one to begin with -> the commonest I've seen is pneumonia:
(After initial management)
Cont Abx (or upgrade depending on c/st results), bld x CBCdc CRP RFT, rpt sputum c/st, sputum suction prn (for sputum retention), CXR mane, chest physio

I can point you to a few more “diagnosis” that you should be familiar with. These will probably consist more than 75% of your inpatient admissions.
1. Chest pain
2. CHF exacerbation
3. COPD/Asthma exacerbation
4. UTI
5. Altered mental status
6. Alcohol withdrawal
7. Afib

I don’t have any mnemonic, they just somehow grouped this way.

These are your run of the mill bread and butter cases that you should be comfortable with.

Then you run into more challenging stuff and can kill
Neuro: stoke
Cards: AMI (not much to do for interns, especially anywhere near a big hospital in the US, with door to cath time...)
Lungs: intubated patients, pHTN
GI: GI bleed, upper lower, hepatitis, pancreatitis, cirrhosis
Renal: AKI, ESRD
Endo: DKA
ID: anything that’s more exotic than UTI/PNA
GU: other than UTI, I’d probably call urologist
MSK: cellulitis vs osteo. MG exacerbation.

I’d think this list will include more than 90%+ of your inpatient.

Good luck! Hang in there. I don’t think I can do 30 patients a day. More power to you!

 

[Phaeochromocytoma]

I can point you to a few more “diagnosis” that you should be familiar with. These will probably consist more than 75% of your inpatient admissions.
1. Chest pain
2. CHF exacerbation
3. COPD/Asthma exacerbation
4. UTI
5. Altered mental status
6. Alcohol withdrawal
7. Afib

I don’t have any mnemonic, they just somehow grouped this way.

These are your run of the mill bread and butter cases that you should be comfortable with.

Then you run into more challenging stuff and can kill
Neuro: stoke
Cards: AMI (not much to do for interns, especially anywhere near a big hospital in the US, with door to cath time...)
Lungs: intubated patients, pHTN
GI: GI bleed, upper lower, hepatitis, pancreatitis, cirrhosis
Renal: AKI, ESRD
Endo: DKA
ID: anything that’s more exotic than UTI/PNA
GU: other than UTI, I’d probably call urologist
MSK: cellulitis vs osteo. MG exacerbation.

I’d think this list will include more than 90%+ of your inpatient.

Good luck! Hang in there. I don’t think I can do 30 patients a day. More power to you!

This is amazing advice. (Y) Thanks!