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Alumni Corner: Matt Stier, M.D., Ph.D. (’19) Intern Year Update

Posted by on Friday, January 31, 2020 in Alumni .

by Matt Stier, MD, PhD, (’19)

Something I’m learning from intern year

People say this all the time, but I really agree with it – one thing you learn how to do during intern year is to identify patients who are really sick, meaning they need an extra level of critical insight and timeliness. You start to appreciate the subtleties of a patient that may look fine at first glance, but be much worse off than they appear. For instance, back pain could just be musculoskeletal, but in the right patient with the right symptoms it might be an emergency like spinal cord compression.  Intern year helps you frame all of that. With the high volume of patients you see, you have a lot of opportunities to hone those skills.

Another thing that the residents and fellows are so good at doing, and I’m still learning, is conceptualizing complex patients in a succinct way and then doing that for a panel of a dozen or more patients. While you’re dealing with the daily nitty gritty issues as an intern, it can be hard to have that big picture view, but with time and experience you learn to move past simple tasks like repleting electrolytes to meaningfully contributing to the big picture care plan for the patient.

Something I didn’t expect about intern year

Having a longitudinal clinic where you are the primary provider for a given set of patients adds a layer of complexity – you are managing the same problems that you manage in the hospital, but with substantially less data like daily vital signs and labs.  This requires an extra degree of thoughtfulness, and it’s a little nerve wracking sometimes to send a patient out the door with a 90-day prescription and follow up in a few months. If I started that medication in the hospital, I’d be able to check their vital signs and labs in real time to make sure that everything goes as expected.  A lot of our training in medical school is based on inpatient medicine, but virtually all specialties will have an outpatient clinic, and I think that longitudinal clinic helps interns hone a different, important aspect of their medical skills.

Advice for intern year

The jump in responsibility from medical school to intern year is substantial. On your first day of intern year, you’re a medical student plus one day. Yet you might be the one at the head of the bed telling a nurse what medication to give, via what route, and at what dosage. You will have support, undoubtedly, during this transition. At the same time, extending your knowledge from textbook to practical particularly for common urgent and emergent situations for your respective speciality will help ease some of the anxiety about this transition to being an intern. It is never too early to start learning common dosages for medications like ativan or versed in the setting of status epilepticus, or for how much insulin and D50 to give for hyperkalemia. When you’re on the wards as a medical student, this level of detail will be around you. You won’t need it per se in medical school, but you will as an intern.

I would also advocate for maximizing your 4th year of medical school. There are really meaningful things you can do to optimize yourself for the start of intern year, and even beyond. Residency will be the most rapid learning of your life, but there are constraints that simply don’t exist as a senior medical student. For instance, as a fast tracker into pulmonary critical care, I took an anesthesia elective so I could learn and practice intubations, which I’ll be expected to do as a fellow but will have limited opportunities to practice during residency. Courses in palliative care, ICU, emergency medicine, and radiology are broadly applicable to virtually all specialties, yet you may not have formal opportunities to experience all of these disciplines in your residency program. Your final year of medical school is your time to immerse yourself without any significant responsibility; take advantage of it.