What is it Like to be a NASA Intern?

We asked prospective interns that follow us on social media what questions they had for our current interns. 

You asked…they answered! Let’s take a look:

Answer: “Yes, sometimes astronauts request to run through the International Space Station simulation that we have using the hyper-reality lab.”

Answer: “Persistence is the key to getting your first NASA internship. Work hard, study hard, keep applying and persevere.”

Answer: “NASA is looking for passionate, smart and curious, full-time students, who are U.S. citizens, at least 16 years of age and have a minimum 3.0 GPA.”

Answer: “In addition to STEM majors, NASA has many opportunities for students studying business, photography, English, graphics and public relations.”

Answer: “The highlight has been the chance to learn a lot more about embedded systems and coding for them, and just seeing how everyone’s efforts in lab come together for our small part in the AVIRIS-NG project.”

Answer: Yes! Here at the Kennedy Space Center is where all the action takes place. Check out the schedule on our website!”

Answer:  “There are 10 NASA field centers and they all accept interns.”

Answer: “Yes, we do! I am currently working in tech development for an X-ray telescope that is launched into space to take pictures of our galaxy.”

Answer: “The greatest thing I’ve learned as a NASA intern is to not be afraid of failing and to get involved in any way you can. NASA is a very welcoming environment that offers a lot of opportunities for its interns to learn.”

Answer: My favorite experience from being a NASA intern is meeting people from all around the world and being exposed to the different cultures.”

Want to become a NASA intern? Visit intern.nasa.gov to learn about the open opportunities and follow @NASAInterns on Twitter and Facebook for regular updates!

Watch the full story on NASA Snapchat or Instagram until it expires on April 6.

Make sure to follow us on Tumblr for your regular dose of space: http://nasa.tumblr.com

MEDICAL BOOKS

If you’re looking for some medical (non-textbook) books to read in your limited amount of spare time, check out some of my favorites below:

The House of God by Samuel Shem

A classic pre-medical school book. It details residency life in the 1970s. You can talk about this book with almost any medical student or attending. It is practically a medical school requirement. 

Intern: A Doctor’s Initiation by Sandeep Jauhar

A more modern look into medicine residency intern year from the perspective of Cardiologist Dr. Sandeep Jauhar. Comes with the highs and lows you can expect. After having been through 6 months of residency, I would say it is very accurate.

Gifted Hands: The Ben Carson Story by Ben Carson. Just because I find Ben Carson incompetent as a politician does not mean I do not respect him as a doctor. He is a phenomenal pediatric neurosurgeon and this book details his story.

On Doctoring: Stories, Poems, Essays by Richard Reynolds

A book of stories and poems from doctors throughout time and also from famous poets and authors depicting their views of medicine.

Private Practice: In the Early Twentieth-Century Medical Office of Dr. Richard Cabot by Christopher Crenner

An interesting look into a Boston medicine clinic from the early 1900′s. With excerpts from old patient notes which I found very interesting. 

And if you have an interest is something more dark:

Blind Eye by James B. Stewart

The real story of a doctor murderer from the 1990′s who killed multiple patients without getting caught for several years.

Devil in the White City by Erik Larson 

The story of the World’s Fair in Chicago in the late 1800′s. A great look into the history of Chicago and the murderous doctor who roamed its streets.

And lastly:

The Hitchhiker’s Guide to the Galaxy by Douglas Adams. Just a great book in general. My favorite.

Suggested by other users:

The Making of a Woman Surgeon by Dr. Elizabeth Morgan

Suggested by http://thetay-in-the-757.tumblr.com

This book is my all time favorite, as I am a female aspiring to work in the healthcare system myself. Dr. Morgan chronicles her own journey in the male-dominated arena of medicine in the 1970s and 1980s, as she struggles to maintain an appropriate balance between remaining empathetic towards her patients and yet must toe the line of not becoming too emotionally involved with her patients so that she burns out, as well as maintaining her own femininity in a man’s world.

When Breath Become Air by Dr. Paul Kalanithi

Suggested by http://nandemokandemo.tumblr.com

When Breath Becomes Air is an autobiography written by an esteemed neurosurgeon who discovers he has Stage IV lung cancer in his final stages of residency. It appeals to not only medical students, with his profound impressions of cadaver dissection and his first life and deaths, but also to current medical professionals by questioning philosophical domains of mortality and what a meaningful life is, as well as to non-medical professionals with moving thoughts on family, life, death and meaning. It is not a novel to be missed by any person.

Time flies - An Open Letter to Incoming Interns

BrDear brand new PGY-1s, 

In just a few days you’ll probably be starting orientation, and a few days after that you’ll be working your first shifts, answering a page for the first time, telling someone that you’re the doctor on call. 

I remember with incredible clarity the first shift I worked as an intern. I remember the mind-bending terror that came when I was left alone to take care of sixty patients overnight. I remember googling the dose of Tylenol, even though it was something that I myself had taken dozens of times before in my adult life and it sits in our medicine cabinet. 

Over the last year as an intern, there have been some things I’ve learned about being a resident that I think might help you as you go into your first days. Things that people either told me along the way or that I learned myself. 

1) It’s always better to overcall than under call. Especially in the early days, if you think that a patient might be having a serious issue, it’s better to reach out to your senior and ask for help than to think something can wait till the morning. If you’re afraid a post-op patient is bleeding or someone is getting septic, or the chest pain really could be an MI instead of just reflux – better to call for help than miss the emergency. 

2) Write it down. If you do anything for a patient overnight, just make a note of it to yourself on your rounding sheet. It’s good to be able to remember which patient’s pain meds you increased a little bit earlier so you can remember that when that patient has respiratory depression later or keeps having pain. Sometimes the phone calls will come so fast you think you’ll be able to remember everything but you just can’t do it. 

3) Somethings can wait till morning. Sometimes you’ll get asked in the middle of the night to deal with a non-urgent issue that is clearly a day team issue. Don’t be afraid to say so and let it wait till a whole day team can have that family conversation or advance a diet. 

4) Take a breath In the middle of a shift or a busy call night you can end up working and working and working and realize that you haven’t eaten or peed in an unreasonable number of hours. There is no shift so busy that you should have to go the whole time without eating or peeing or getting a cup of coffee. You are a better doctor when you are a little more awake and fed and hydrated and don’t need to pee 

5) Ask early Before a shift starts, talk to your senior about what they like to be notified about and how they like to be notified. It’s good to know that your chief would prefer a text message about non-urgent patient issues, or wants to be notified every time you order blood for a patient before you give it. This makes your communication so much easier!! Some chiefs even have very specific plans for escalation of methods of communication (i.e. if it’s an emergency call my work number and if that doesn’t work here’s my personal number) or the like. 

6) Ask a nurse Lots of the nurses will have been around the block longer than you have so it’s usually a good idea to ask them what’s usually done for patients with this problem, or what a certain attending likes to have done for their patients. Chances are they have some good tips to help you out! 

7) That said - don’t be afraid to overrule a nurse. You went to medical school for a reason. Sometimes you know the contraindications for a medication better than anyone else in the room. 

8) Trust yourself Often you will feel like the stupidest person in the room because all the many years of residents above you have so much more experience. But trust what you do know and feel confident enough to speak up. 

9) Be humble Going with the above, there’s a lot you don’t know. Be ready to ask questions and ask for help (a lot!) 

10) Leave work behind when you can When you can sign out, sign out. Don’t feel like you have to stay at work after your shift is over. Patient care will always be an overwhelming task. Don’t spend all your time at home working on work tasks - spend time with family, workout, live your life. Taking time away from work makes you more recharged and ready to work the next day. 

Above all, new interns. Remember that thousands of people have made it through intern year before you. There were people who were less motivated than you who did this, people who were less strong, less smart, and less caring. You too can survive this. 

All shifts ends - this year ends. You will survive and you will learn a little along the way. 

Love, 

Katharine (Intern year survivor) 

Welcome to the new interns!!

Moving, returning from vacation, orientation, and anticipation are likely all contributing to your sense of confusion, fear, and excitement! Trust me when I say that all of us, every single one, has been where you have and felt what you’ve felt. 

That said, I’m not here to reinvent any advice. Below is a collection of links to some of the things I’ve written as an intern and R2 and those not written by me that have helped me along the way. Hopefully will serve to help make the transition less chaotic, less scary, and a little more enjoyable.

And remember interns, all of us in the medblr-sphere are here for you during these wild first few months and we’re excited to watch you grow!

——————

Let’s start succinct with @ladykaymd​‘s true and relevant rules here

Then, it’s time to embrace your new intern status, as @wayfaringmd will tell you here

If you’re looking for something that may or may not help, there’s The intern survival guide (pdf and doc forms!)

Streamlining your H&P from @pagingmedicine

In case you wonder if you’re the only one who feels overwhelmed, let me share some thoughts from interns at the start of the year who are about to become R2s

My intern rules for survival  (eat breakfast is still #1)

how to be an awesome med student (and your intern’s best friend)

Medical students are a precious commodity in the intern world. A good medical student makes it a lot easier to get through the day and get all the jobs done. But it’s a fine line between being a clingy medical student and a helpful medical student, and one that’s difficult to work out. So, this is my wish list for all my future medical students – do this and I’ll be indebted to you for life.

  • Ask for our number and give us yours. I’m always happy to be texted by a keen medical student who wants to put in lines and take blood and clerk patients. If you let me know you’re free, I’ll let you know how you can help.  Just don’t page me. Interns are perpetually one page away from a nervous breakdown.
  • Please carry files on ward rounds. I know that you’re not a human bookshelf, but there are a lot of files and I only have two hands. Any help here is greatly appreciated, and extra points if you volunteer to write notes. It lets me give my hand and my pen a break!
  • Learn to love the list. The patient list is the most important thing an intern has, and we need our medical students to value this. Whether it’s writing down jobs on the list, helping us type it up, or keeping track of the registrar’s list (he or she will inevitably misplace it), your contribution is noted and appreciated.
  • Ask questions. Interns are fresh out of medical school and know a lot of things. Most of the time, we’re happy to answer (and it makes us feel like we might actually be semi-competent doctors!). Just pick your moment – over coffee is good. During a code blue is not so good.
  • Volunteer to do practical things. An IVC resite can take half an hour. If you volunteer to put a new drip in (or even put an IDC in!), we will be forever grateful. I’m even happy to supervise whilst you do it – it gives me a moment to sort through my pages and even delete a few).
  • Remember that you’re going to be an intern soon – and internship means paperwork. The more you can help us with our paperwork, the better prepared you will be for your internship, and the more likely we are to pay you in coffee.
  • If the interns are busy, ask us for patients to clerk. I love it when medical students show an interest in my patients and in learning – do this, and I will always listen to you present your findings. It’s a good skill to learn, and it shows that you’re keen to be a part of the team.

I know this sounds demanding, but spending time on the wards with your intern not only prepares you to be a junior doctor, it gives you a lot of hands-on experience that you can’t get from your physiology textbook. And the more time you spend on the wards, the greater your chances of being rewarded with coffee.

Hope to see you on the wards soon!

That Fleeting Feeling

My intern year has progressed in distinct phases. For the first three months I lived in a state of perpetual fear. Each time a nurse would call about something, like Tylenol, I would rewind in my head every possible contraindication. Did I know this patient’s liver enzymes? How much had they already had today? Could they have an unknown allergy? I would freeze up with the constant worry I might unintentionally injure someone.

This uncertainty trickled into everything I did. My admit notes were many paragraphs long, just in case the fact that a patient had a rabbit as a pet in first grade might be useful to the diagnosis of their community acquired pneumonia (#alwaysruleouttularemia?). My exams were extensive and thorough, but I worried about documenting findings or exam signs others had not. I would look at consultant notes and worry that perhaps the boiler plate “regular rate and rhythm without murmurs, rubs, or gallops” meant that the murmur I heard wasn’t actually there.  

Slowly I learned that patients were much more resilient than I had been led to believe by standardized tests. In the coming months I gained some confidence in making decisions, making my own diagnostic judgements, and note writing. My admissions got smoother as I figured out what to ask and how to document it. My orders became less complex as I figured out to properly do a med reconciliation. I began to see complex patients as an entire entity rather than the sum of each problem on the problem list. Perhaps most important for my patients, I began to gain a better understanding of pain medications and my fear of them began to abate.

As we passed the new year, I began to feel like a well-oiled machine. I could knock out admit notes and progress notes without issue. I called all my own consults. I began to have enough procedures logged to be signed off. I was beginning to peak as an intern. Wards became something that was fun instead of frightening. I had time to read about my patients and do some teaching for the medical students. As the weather warmed for spring we began to get off work earlier and earlier.

Then April hit and attendings began to make seemingly innocuous comments like, “I think you are ready to be a senior,” or “you are really operating at a senior level.” Slowly the terror drifted back.

Originally posted by collegerunningprobs

Holy shit, I have to be a senior resident soon.

In just two months I will be responsible for twice as many patients. I will have 24-hour call. I will have two clueless and terrified interns who can’t even prescribe acetaminophen. I will have to stay late for them to finish their 4 page long admit notes. And I will have to answer for their mistakes.

I feel like another intern year might be beneficial. I was just getting the hang of being an intern and I want to hold on a little longer to this feeling of competence.

It is interesting how medical training always works like that. Just as you get comfortable in one setting you are whisked away into another and put back into a situation where you are uncomfortable. Whether there is much intention in that, I am not sure. But that is what seemingly makes medicine such a difficult profession. There really is no such thing as mastery. You just progress up the chain and hope that each year you get better.

An attending recently told me that there will never be a time you can rest and stop studying. If you are practicing right, you will always face new challenges that force you out of your comfort zone.

Dang. I really like this fleeting feeling of competence.  

One liner on the specialties thus far

I have been really enjoying my off-service rotations so far. It’s been keeping me busy, but time has flown and I only have 3 more rotations until I go on service.

ICU: wean down vent settings.  

Peds cardio: just ECHO everyone. Musical/harsh/high-pitched murmurs are all bullshit. Your ears lie. ECHO does not. 

Gen surg: don’t fuck with the pancreas. 

Gastroenterology: The liver is a very forgiving organ. Until it is not. 

Neurosurgery: just CT everyone. Neuro exams lie. CT does not. 

Pediatrics: play the phone-tag between all the sub-specialties (admit your own f*ing patients, GI/immunology/respirology)

General Internal Medicine: plan? incentive spirometry and PT/OT. 

Peds Orthopedics: go hide in the library and avoid the 12 hour ORs. 


…I may or may not be in the library, writing this post, avoiding the above 12 hour ORs. 

Advice for ob/gyn interns

Hello! I am an ob/gyn resident just about to enter my last year and I figured that brand new ob/gyns would like some advice before they enter this crazy, rewarding, confusing career. 

For starters, you’ll be fine, we all make it through intern year, though, it will be important to prioritize sleeping and eating well and taking care of yourself. Remember you will make mistakes, but my motto intern year was not to make the same mistake twice, it served me well. 

Things I wish I knew when I started this craziness: You will make the best friends you might ever have. You spend 80+ hours with these people doing crazy and surreal things that no one else really understands. And even though it will not feel like it, this too shall pass. Now that I have one year left, the end seems frighteningly close.

As far as resources go, it will be important for you to figure out how best you study/learn because you will have limited time to do it and not a whole lot of motivation. If reading works well, use textbooks or ACOG, especially the Committee Opinions and Practice Bulletins. You can also find Prolog books for each subject which are more question/answer. There are places on the web where you can buy questions (similar to U World) if that works best for you. You can join AAGL online and get access to surgery videos (called Surgery U on the site). As you start out, it will probably be most helpful to read about a procedure, then watch a video. I usually try to study the procedure the night before the OR.

Also, forewarn your family/SO that you will be busy, and sleep-deprived, and cranky at times and to respect your time/space. For example, my mom would call me every night if it was up to her, however, I call her on a night where I have time and will not take out my frustration on her. This is a journey for your family too.

My favorite apps are UpToDate (our program pays for it), ASCCP (pap guidelines & management, sooo worth the $10), LactMed which has meds safe in breastfeeding and the CDC has several apps, including for the treatments for STDs - including PID, and one for the medical eligibility criteria for birth control