A day in the life of a UT Emergency Medicine Intern

Intern year is one of those once-in-a-lifetime experiences that one looks back on with surprise at how fast it seems to go, how much learning you are capable of doing, and how much care you are able to provide at such an early stage in your training.

University Hospital cares for some of the sickest and most indigent patients in South and Central Texas. Their disease processes are varied and sometimes exotic. As an ED intern, you have the privilege of getting to experience many of the sickest patients in the hospital both downstairs in the ED and upstairs on the ward or in the ICU.

What your individual day looks like depends largely on what rotation you are on. ED interns spend only about half their year in the ED and the rest of the year is spent on the Medicine Ward, in the ICU, or on consulting services like OB, Anesthesia, and Orthopaedics. The goal of the year is to provide training on the fundamental concepts of Emergency Medicine across all areas of general medicine and the specialties.

A day in the ED consists of either a day, an evening, or a night shift. The intern is expected to show up early and ensure the airway supplies are working and appropriately stocked so that in a moment of crisis one has all the tools necessary to save a life.

Most interns see between one and two patients an hour. They are expected to rule out the immediate life threats first and not simply diagnose what might be most common. The patients' care is managed in accordance with the senior resident and attending physician who supervise their care and provide much of the teaching on a particular case. On certain days of the week, interns are expected to attend EM Didactic Conference to further their knowledge in the fundamental concepts of Emergency Medicine.

At the end of each shift, the intern attempts to make a disposition on each of their patients and to effectively turn over care on those patients where more work-up is required to their on-coming classmate. A good ED intern spends at least some of their free time after each shift reading on their patients so that their fund of knowledge continues to grow.

In months where the ED intern is on another service the day usually starts early with pre-rounds on inpatients, followed by formal rounds with the attending physician. ED interns spend the afternoon writing inpatient care notes, coordinating care with consultants, and participating in both diagnostic and therapeutic procedures. The purpose of these off-service rotations is to get a feel for what medical practice is like for their future consultants and to further their knowledge on how ED management affects inpatient care.

By the end of an internship in Emergency Medicine, the physician in training should be comfortable managing a vast array of medical conditions and be developing the skills to effectively intervene on the sickest patients in the department. They should continuously strive to further their medical knowledge and build good working relationships with their colleagues upstairs.

Truly, this first year provides the foundation on which a successful second and third year are built.

Nicholas P. Gorham, MD
University of Texas Health Science Center at San Antonio Class of 2010