Post-Residency Review

Tl;dr: Residency sucked.

On a more detailed review.

Regarding Internal Medicine residency.  

From a mostly in patient perspective.

The way a lot of medical education, in medicine specific training, as opposed to surgical which I'm not as familiar with, gauge you is through the RIME scale.

R - reporter

I - interpreter

M - manager

E - educator

As reporter, you're able to reliably obtain information from the patient and chart, and present it correctly, or give the needed information reliably when asked for something.

This is something you must be able to do by the end of medical school without any issues.

As an interpreter, you need to make sense of the information you're gathering and present it in a way that makes sense.  

-For example:  If you have a patient with fevers, right upper quadrant pain, and jaundice, you must interpret that as ascending cholangitis.  A reporter wouldn't quite make the diagnosis but present the patient's findings plainly.

As a manager, you need to make a plan to take care of the patient.  Regarding in-patient, the way I recommend you think about it is, "Why is this patient admitted to the hospital, and how can I get them to the point where they can be discharged."

-From our above example, you need to treat the ascending cholangitis.  A good starting plan is probably antibiotics and fluids.  But which antibiotics and fluids? What dose, how much?  

Finally, as an educator, you will be able to clearly explain, and teach, to your teammates and medical students your medical knowledge.

First year:

This year is essentially your free pass to come off as sort of dumb, for the first few months.

Do not continue to be dumb beyond that, because I saw it keep a couple people back a few months before they could start second year, and one person got kicked out, for not being adequate.

To be successful, put in the work during your third and fourth year of medical school.

I recall reading on reddit.com/r/residency, and on the SDN forums, during my third year of medical school, that you should take it easy in fourth year.

THIS IS WRONG.

Yea, I had a chill time in my last few months of medical school, but it led to me being chronically behind my peers in residency by about 3-6 months.  By the end of second year, I closed the gap, but it was a very not fun struggle.

Expect half of your year to be inpatient rotations, with one or two months of ICU.

Make sure to do one or two ICU rotations during medical school.  

Make sure to do one or two ICU rotations during medical school.

Note that I wrote the above line twice for good reason.

By the end of your first year, you need to be at least in the lower end of the manager part of our grading scheme above.

Second year:

Finally, your chance to lead the team.

Depending on your program's culture, this could be that interns present to the attending, or that they present to you, with the attending essentially as the team's consultant

This year of residency, you need to start learning and knowing medical guidelines.  

With the goal that you can treat patients according to medical guidelines, where medical guidelines exist.

Not every medical issue has guidelines, but those that do, mean that there is a standard of care, and you must follow it.

For example.  It is generally accepted how to treat septic shock.  We'll use septic shock secondary to pyelonephritis as our example.

If an elderly patient is brought in with blood pressure 80/40, fevers, malodorous urine, and poor oral intake, they likely have septic shock from pyelonephritis.

What I would do in this situation, is obtain IV access, start giving the patient fluids, obtain blood and urine cultures, and start broad spectrum antibiotics.

This is a simple plan above, but some details, are that a generally accepted guideline is to give 30cc/kg of the patient's weight (consider doing ideal bodyweight if they have something like heart failure), as a fluid resuscitation for their blood pressure.

Third year:

In short, you need to be able to function independently by the early to halfway mark of third year.

Start interviewing for jobs in the Fall.  People who don't match into fellowship will start interviewing, and you will have more competition for jobs if you wait.

This whole post was a draft for the past few years.  

Posting it now, late 2024, as I'm resuming this blog.

-Be Good.