https://www.zhihu.com/question/419161777/answer/1567213970
Actually, affiliated hospitals do not lack people to do the small tasks for interns (except accompanying examinations). Having been in two affiliated hospitals, after the chief resident assigns interns to groups, even the most enthusiastic attending physicians usually only ask a couple of questions like “Which undergraduate school are you from?” and “What rotations have you done?” Most attending physicians can’t even manage the standardized training residents properly, let alone pay attention to interns. Interns are usually assigned work by the standardized training (ST) residents. Most of the time, interns quietly listen to handovers, quietly observe rounds, and quietly watch the medical orders. There are no computers for interns, and patients are not forced upon you, so if you want to slack off, there is plenty of time for that.
But if you’re not here to slack, you basically get to swim in a sea of knowledge every day!!!
On the first day, you start by listening to handover. What does one listen for during handover? First, what situations occurred during the night shift, how the on-duty staff handled them, and the outcomes after treatment. Second, the patients on the ward—who are the critical patients, typical cases, and rare disease patients. Write these down, and if you have time, review the medical records and orders.
Reviewing medical orders in front of the computer before rounds is also a great learning opportunity. What does the attending do? For new patients, the resident reports the medical history, then the attending summarizes the key points, identifies the focus, assesses the condition, and comments on the orders. At this time, you need to practice following the teacher’s thought process, see how well the resident reports the medical history, whether the key points of diagnosis and treatment have been clearly summarized, whether unclear situations have been covered by tests and examinations, what initial medications were prescribed, why they were prescribed that way, what the attending is focusing on today, and why. If you don’t understand these questions, write them down and look them up later. After about a week of rounds, the key diseases of that specialty will basically have been covered.
What do you learn during rounds? Rounds are also full of valuable content. In teaching hospitals, rounds will still consider the existence of interns and provide appropriate teaching, making it an excellent opportunity to practice real-world physical examinations. If you don’t do well, the teachers will correct you. Rounds are also when teachers casually drop knowledge points. It’s okay if you don’t understand something; write it down and look it up later.
After rounds, standardized training residents start working intensively on orders, conversations, and medical records. At this time, the person you follow switches from the attending physician to the resident. Follow a senior student or resident closely, ask them to add you to their group, watch them write orders and documents. After watching enough times, they will let you try writing. After writing enough progress notes, they will let you write major medical records and discharge summaries, even 72-hour notes. This is when you practice your understanding of diseases—what should be emphasized, what can be passed over briefly. Documentation also has its value. If you can pass the discharge summary, you have at least mastered half of it.
After lunch, if there’s no computer in the afternoon, do you have nothing to do? No! When admitting new patients, follow along, ask the resident to let you ask first, then supplement. After practicing a few times, you will be able to conduct interviews. Physical exams are the same—do it first, then get confirmation from the resident. Actively ask to write major medical records. No computer? You will have access after work.
In the evening, review the knowledge points from the day. For what you don’t know, read the books; for what you know, consolidate and add details. Textbooks then get imprinted in your mind and the corresponding scenarios.
Senior teachers all say it’s true: now that there are so many standardized training residents and so many interns are eager to apply for postgraduate exams, everyone should be clear about their needs and part on good terms; this is indeed the best choice.
But I feel that if you truly want to learn, reading books five times can’t compare to deeply managing a typical patient. That is… real combat experience. If you want to be a doctor, isn’t giving up such a precious opportunity a pity?
Patients you earnestly managed during your clerkship and internship, and the cases you handled, still help me a lot now. The thick notes accumulated during clerkship and internship are still often reviewed and were a strong support for my postgraduate exam, medical licensing exam, and standardized training graduation exam. The efforts during internship can also be considered achievements; during postgraduate interviews, discussing cases from your internship and receiving high praise from teachers definitely adds points, right?
Of course, if you were conscientious during clerkship and have already checked in, slacking off during internship is not impossible either. Actually, internships have largely been replaced by standardized training now. Many first-year residents, who come in knowing almost nothing, are too many. But is this the right way? The purpose of internships should be to become standardized training residents who can work competently, and the purpose of standardized training should be to become attending physicians who can perform clinical decisions. I feel there are really too few who can truly make clinical decisions after standardized training.
Maybe this sounds extreme, but from the learning perspective, clerkship and internship really should be seized well…