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Internist in Training

August 16, 2020
by Mark David Siegel

Hi everyone,

What kind of internist will you be? A stunning diagnostician? A deft proceduralist? The one colleagues call for tough cases? The one they trust their loved ones to? What kind of internist will you be?

Great internists are multi-dimensional. They reason, listen, and communicate. They know when to act and when to hold back. They’re technically proficient and they’re trusted teammates. They’re reliable, respectful, compassionate, honest, and self-aware. They put patients’ needs above their own.

Great internists also know things. No book, no on-line resource, and no subspecialty consultant can substitute for knowing things yourself. You need to know, for example, that many patients with PE are neither hypoxemic nor tachycardic, so you’re not fooled by a heart rate of 84 or an SpO2 of 96%. You also need to know how to calculate Winters’ formula, so when you see this ABG— 7.20/32/84/12—you’ll recognize the peril of an uncompensated metabolic acidosis.

Great internists seek knowledge, both broad and deep. Learning is key to our work, at the bedside, at conferences, and when we sit down to read. We also need to gauge our knowledge, to find the gaps and fill them in.

Over the next few days, most of you will take the annual In-Training Exam (the “ITE”). The main purpose of the test is to gauge your knowledge. The stakes are low: your score has no bearing on promotion or graduation. The point is to identify your strengths and weaknesses. The results will show you where to focus your studies. For seniors, the scores will tell you where you stand as you prepare for the boards. Finally, for residency leadership, the ITE tells us where to direct our teaching efforts, both for individuals and for the program overall.

From year to year, we do well on the ITE; most residents score well above the national median. I’m sure we’ll do well this year too.

It’s sometimes said we focus too much on test results, and there’s some truth to that. Many essential skills, like counseling and communication, can’t be tested easily. Focusing too much on test results can also undermine learning, overemphasizing “getting the answer right” instead of encouraging residents to wrestle with complex ideas, explore science, question established wisdom, and untangle controversies. But ultimately, you still need to know things, and to know things you need to study. Fortunately, the love of learning is ingrained into our DNA. And when you love to learn, studying comes easily, and good test scores inevitably follow.

So good luck with the ITE. Get a good night’s sleep the night before, eat a good breakfast, and do your best.

Enjoy the rest of your weekend, everyone. I’m my way to South Hero on Lake Champlain, to spend a few days hiking, biking, eating, and playing Scrabble with the family. Pics to follow.



Submitted by Mark David Siegel on August 16, 2020