Amanda Heuszel, MD
As I’m nearing the end of my intern year, I cannot help but be thankful for my time spent in the University of Iowa Internal Medicine program. When I was going on residency interviews, I was looking for a program that emphasized education, research, and encouraged high morale. Iowa has exceeded all those expectations. From the start of intern year, I have had supportive staff and senior residents who allow autonomy. People kept saying the phrase “Iowa nice” on my interview and that is so true regarding this program. Faculty treat residents as peers. Many of my staff have brought the team coffee and treats and even taken us out to dinner after our time on service together.
I begin my day on an inpatient ward team around 6:45. I arrive with a coffee in hand, to get sign-out from our night intern at 7am. I then begin pre-rounding on all my patients. I gather data from Epic, speak to the nurses taking care of the patients, and then examine each patient. Then, if I have any questions about plans, I speak to my senior resident. Also, if a medical student is following the patient, we usually discuss the plan before formal rounds. At around 9am, we begin our bedside rounds with our interdisciplinary team which typically includes an attending, residents, medical students, and a pharmacist. Working with an interdisciplinary team allows for us all to be involved and provide the best care for our patients. We also do bedside teaching which includes going over patient’s pertinent physical exam findings and teaching topics surrounding certain diagnoses and treatments. After rounds, I have time to begin working on progress notes, calling consultation services, and placing orders for the day. I then attend our noon conference where lunch is served daily. Our noon conferences are protected teaching time. A staff from our program holds our pagers and answers pages. That way, we are only called out of conference if it is critical to patient care. The rest of the afternoon is spent catching up on work, updating patients’ families, and doing procedures. If we are the on-call team that day, we also will do admissions. Typically, each intern gets one to two new admissions per call day. At the end of the day, we can sign-out at 6pm to our night intern.
Roger D. Struble Jr., MD, MPH
PGY-1 Internal Medicine
5:45 am. The alarm rings after 7 gorgeous hours of slumber, nothing better. Sleep is precious; as a doctor you learn to take care of yourself first.
6:10 am. Attack the day!! I’m out the door, running or biking to work. It’s only a couple miles, but the blood flow gets me awake and motivated. There’s a shower in the wellness room where I can change into scrubs and style my hair after I spend a few minutes lifting weights.
6:50 am. COFFEE!! There’s a Keurig in the resident lounge where I stash some pods, but Java House has cinnamon, half and half, and I’m going to regret it all morning if I don’t cave into this craving. Treat yo self!!
7:15 am. Morning Report. The senior from the general medicine overnight service stops by to present a case to the room. Cases are one of my favorite ways to learn the trade of internal medicine. Each case can teach you something about history-taking, pertinent physical exam findings, lab tests to order, interpreting radiology, or management of disease.
7:45 am. More Coffee! My favorite part of the morning is drinking coffee and reviewing charts.
8:00 am. Time for work!! We meet the fellow in the team room and decide which residents will be following each of the old consults. First, I look at the vitals, review the labs, check the MAR, then read the notes. All this data is synthesized into an assessment, which allows me to come up with a detailed plan of care. On a consult service you have fewer patients and are more focused on one organ system. You have time to review guidelines, search primary literature, and synthesize a solid plan of care for complicated cases.
9:00 am. ROUNDS. You round as a team and present to residents, a fellow, and an attending doctor, who all weigh in with valuable input into the plan. You learn quickly that medicine is a joint effort, and that Iowa works hard to create a team atmosphere.
11:55 am. BREATHE! It’s time for noon conference and the best part of the day. You walk into a room of people who are not just your colleagues, but have quickly become your best friends. You share stories, exchange laughs, then get in line to eat some free food. At the end of the line is a nice person with a smile who asks for your pager so you can spend the hour focusing on learning.
1:00 pm. Stop in the chiefs’ office for candy, say hello, then realize that Cindy has better candy in her office. Say hello, walk back through the hall where Dr. Suneja is out catching up with residents, huge smile on his face, reminding you that no matter how hard things get on the wards he will have your back.
1:15 pm. Head back to the team room and wait for new consults. You usually have seen all the old consults in the morning, but sometimes you may have a few to staff. In the afternoon you will break off to see new consults then the team will stop by and discuss.
4:00 pm. All the new consults have been staffed, notes have been written. Hopefully at some point in the afternoon I found a free moment to go for a walk, maybe sit down and play one of the six pianos on campus, stop by the medical museum, hang out on the 7th floor atrium in the sunshine, squeeze in a couple MKSAP questions, or review some new literature in a field of interest.
6:00 pm. Head home after a long day, hoping that I learned something, enhanced my skills as a doctor, and made a real change in someone’s life. At the end of the day it’s easier to reflect on how we lucky we are as doctors. Each day at the hospital is an opportunity to touch someone’s life, to help a fellow human in need, to learn. Best job on earth!
7:00 pm. Head down to the hospital gym to play basketball, go to a local pick-up soccer game, catch a movie at FilmScene, or grab a burger at Stella’s with some fellow interns. You must fill up your basket with apples so that you can hand them out the next day. Each day should be filled with something that brings you joy.
Tomorrow is another beautiful day at Iowa.
[…] year, we asked two interns in the Internal Medicine Residency Program to each provide an account of what a typical day looks like. Over the next couple weeks, we will post diaries from second- and […]