r/emergencymedicine • u/Aromatic_Life9260 • 2d ago
Discussion Residency beginning soon
Any tips/insight to succeed during PGY1 year? Apps to download, what to expect in general (I know it varies by program), how to be as sharp as possible, etc. Terrified and excited simultaneously. Will be at a Level 1 academic medical center.
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u/meh817 ED Resident 2d ago
You’ll be okay. Be nice, be normal, be on time.
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u/procrast1natrix ED Attending 2d ago
There was one, the year behind me, who just quietly showed up fifteen minutes early, reliably, every single shift. Their human stuff (food, water, caffeine, bathroom, have a pen and shears) always sorted out. They got to cherry pick the first good patient just be being there. Great reputation. Went on to do well.
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u/Kolack6 2d ago
Introduce yourself to everyone you meet. Especially before you ask them to do something for you. Be respectful. Do your best. You are NOT expected to know anything at all tbh but you are expected to put in effort and be teachable.
Take 1 case each day and read up about the related pathology/diagnosis/management, especially if you didnt know on the spot what to look for or how to handle it.
You will be nervous/anxious going into shifts. That’s normal especially if you truly care about the people you are taking care of and wanting to be the best doctor you can be. Im almost at the end of intern year and i still get that pre shift anxiety and from what ive seen in this sub it still happens to seasoned attendings from time to time. Give yourself grace on this and for when you don’t know/make mistakes. You are in training, you’re not supposed to be perfect.
Also please enjoy yourself. Both on shift and off. Residency is hard but its also super fun and rewarding. Don’t forget you are still a human being and need sunshine and social interaction and exercise and sleep. These will all take hits but be very mindful to protect them as much as possible.
Good luck!
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u/Suitable_Status_5212 2d ago
WikiEM I still use daily on shift to double-check my work a lot of time. MD calc for all of the things I’ve never memorized and clinical reasoning tools we use. PediSTAT is a one-time payment app but is great in sick kids and I use it pretty frequently. OpenEvidence I use for the weird cases that come in that “just want answers.” It doesn’t usually change my ED work up a whole lot but sometimes I can give them more things to talk about with their PCP later. I also use OpenEvidence to look up random things on shift that I just don’t have time to look up papers for (ie, one med vs another in managing xyz).
Otherwise, good luck! The start is rough for everyone, we expect it, so just have fun, be teachable, read something after shift and ask lots of questions!!
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u/procrast1natrix ED Attending 2d ago
Get every single part of the rest of your life sorted out to the max, and then trust the program.
Do NOT try to run your own parallel DIY residency program by prioritizing blogs and apps over what the residency provides. These resources are good and interesting but they do not at all replace the fundamental curriculum.
So. Get your teeth cleaned, your annual physical done, have your entire wardrobe for the year ready (throw out all the old socks and underwear) including a pair of new running shoes. Get your car maintained. Whatever your study materials are, pens and binders or battery packs, lay in a stock. Figure out some fantastic shelf stable and freezer meals and snacks and lay them in for grab and go. Buy birthday cards for the people in your life for the entire next year and have them ready to go.
Drive around the new neighborhood and figure out where you are going to buy gasoline and get your hair trimmed and buy milk and go to the gym and a list of local nature hikes.
Aggressively go after every part of life that is outside of residency and tune it up.
Consider looking up the local quirky things: how nearby is the local VA and what's it called? What are the names of biggest SNFs in that neighborhood, drive by them and see which ones are dumps. What are the names of the big primary care and pediatrics groups there? What are the names of the clinics where the IM and FM programs provide primary care, and where are they? Where do the local unhoused people sleep and get their care? What are the local detox facilities? How do local people get around, is there a bus system or a subway? Get familiar with it.
Those are all little details that may trip you up and prevent your brain from focusing on the medicine.
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u/Penlight_Nunchucks ED Attending 2d ago
When you present, have a plan and a reason for ordering what you're ordering. You can be totally wrong, and that's totally okay, but at least have a reason to be wrong. Just show me you're thinking critically and I can mold that into an awesome attending
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u/needdlesout 2d ago
I used Amboss clinician mode throughout intern year for quick reference. Kept a note on my phone with what my top differentials should include for X chief complaint that i could reference until it became more intuitive/second nature. Then started a separate note for the little random clinical pearls (one liners) you learn along the way that I could quickly reference later (starting dose for prostaglandins in crashing baby, ETT size needed if I do a cric, how to mix push dose epi, etc. random stuff I dont want to have to hunt down again in a pinch). Try to get in the practice of doing some part of the note (HPI and PE is my rec) as you go along no matter how swamped you are. It’ll all be fine!!
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u/forever_a_servant 2d ago
As an intern. Do we tell nurses and staff that our name is Dr. Lastname or have them call us our first name?
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u/procrast1natrix ED Attending 2d ago
I think this is highly regional, so go with what is happening in front of you.
"Hi, I'm Jane Smith, PGY1 rotating from x service.". If they start up with the Dr stuff, I'll say one time "Please call me whatever you feel most comfortable with".
Can't go wrong with that. I'm highly informal but I've worked some places where the staff have a pattern and just seem more comfortable sticking with their habit, and I don't want to make them uncomfortable or distracted.
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u/AnimeTriPhosphate Resident 2d ago
I used my first name initially , and mentioned i was a resident, but then they started calling me the med student.....I've since said "Dr [last name]".
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u/RickyRandy69 ED Resident 2d ago
PGY-4 here. You'll do great!
Show up early/on time, be curious, jump into whatever procedures you can, take advantage of nurses knowledge as much as possible, be teachable/coachable and have a growth mindset. I found PGY-1 like drinking from a fire hose (in the best way!)
On shift, I frequently use: UpToDate, infectious disease resource app (whatever that is at your centre; ours is FirstLine), PediSTAT, MDCalc, OpenEvidence when I have a more complex question. The AHA ALCS app is great too for ACLS algorithms/timing codes (although your nurses will usually be doing this).
Have a note on your phone of common doses for resus meds, analgesia, RSI meds, etc. to refer to in the moment.
Like other people said, most of all, have fun 😄
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u/Intelligent_Bet_5401 RN 2d ago
Make friends with the nurse. I don’t mean the young ones..but the ones that have done ED forever. They will teach you, ‘cause they know more than you and it’s important to remember that Nurses are your best app to download 😎😎😎😎😎😎
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u/diniefofinie 2d ago
Everyone in the department knows more than them right off the bat, be nice and make friends with everyone.
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u/Febby1329 2d ago
I’m definitely biased but you should check out r/fullcodesimulator fullcodemedical.com
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u/metforminforevery1 ED Attending 1d ago
Please enjoy the next month or so. Hang out with friends or family. Go on a last minute trip. Get an exercise routine down. Look up recipes for bulk cooking/meal prepping. Get a nice eye mask and blackout curtains.
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u/EnchantingWomenCharm 8h ago
Prioritize the core things that keep you healthy and sane: Sleep, eating, exercise.
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u/Sedona7 ED Attending 2d ago
Work hard. Show up early. Stay late.
Read something about a case you saw that shift every night. Much better way to learn/remember than just randomly reading Chapter #xxx.
Best app is https://www.theairwaysite.com/mobile-airwayapps/
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u/needdlesout 2d ago
Don’t stay late on purpose. You likely will until you get a decent grip on the department, but afterwards when you’re done, you’re done. Residency is hard, take your time after/off work seriously and protect it at all costs
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u/MLB-LeakyLeak ED Attending 2d ago
You got a month or so… Go spend it with family