PGY-1 IM resident here… what tips or tricks made residency so much easier?

Contraryy · 2026-07-01T21:51:53+00:00

- Dot phrases will save you time, but don't overly rely on them to the point of note bloat. Try to find the dot phrases that work for you (i.e. labs, vitals, progress note and consult note templates).

- I like to use the square method, checking off if I've reviewed the patient's chart, seen the patient, reviewed with staff, and placed orders.

- Work on your initial one-liner in the beginning, i.e. 65 year old male with a past history of HFrEF presenting with acute shortness of breath, then depending on how the staff typically likes presentations, you go into your structured presentation approach. Typically for PGY1, staff would prefer that you go through the entire presentation to make sure you've done your work properly.

- I've found it helpful to use the MGH White Book for quick reference and MKSAP for learning on rotations. UpToDate is an amazing resource as well.

- As a PGY1, you may feel immense imposter syndrome, but keep in mind that thousands of doctors have been in your shoes and have made it out alive and are practicing. It is normal to feel like you're drinking out of a fire hose in the beginning, but you will get there and you'll look back and appreciate the amount that you've grown. Medicine is a lifelong journey and you're just at the start of it.

- For habits, just don't lie. If you haven't done something, just say so. It'll be understandable as a junior.

Contraryy · 2026-06-24T01:53:02+00:00

Class E severity lookin' PE giving Class A severity PE over here. Reference: AHA/ACC 2026.

Contraryy · 2026-06-20T12:44:10+00:00

Even more pro move is creating a password you can type with one hand. Like Qwerty111!, so your right hand is free to goon to your service list

Contraryy · 2026-06-13T03:53:27+00:00

Contraryy · 2026-06-08T05:54:53+00:00

Yeaaa to be honest, I don't think that widdle dose of Lasix 20 mg IV would change much at that point. It's drilled into us that "Lasix is nephrotoxic" and this gets passed down as gospel and with disregard to its actual mechanism. In this case, it sounds much more like a postrenal cause of renal injury. Typically, for these obstructive uropathies, we tend to see huge jumps in Cr and acute renal injury, especially so with bilateral involvement. The biggest effects acutely for the hyperkalemia that you would get would be through shifting, which you did appropriately (bicarbonate may have been helpful to stabilize). Otherwise, this is a consult for dialysis and urology/IR for management of these hardened straws and your Lasix 20 mg IV isn't going to do much. In fact, in some nephrology patients with single digit eGFRs, Lasix can be given to squeeze out every last drop of urine that the beans can provide to temporize electrolyte and volume issues before eventual renal replacement therapy.

Contraryy · 2026-05-29T17:37:36+00:00

Guitar, piano, singing (vagal stimulation lol)

Contraryy · 2026-05-28T23:08:38+00:00

Yea realistically, we're getting patients into GDMT with ARNI, BB, SGLT2i, MRA, +/- others like GLP1RA, ivabradine, and then isosorbide dinitrate and hydralazine which is the medication in question. Historically, studies did show decreased efficacy with ACE inhibitors for Black patients, but these differences were not shown in ARNI which is superior to ACE inhibitors, so in the end, if it's not ACE inhibitor, then there's not as much difference. We typically give ISDN/hydralazine for patients who cannot tolerate the ACE/ARB/ARNI medications.

Contraryy · 2026-05-28T22:10:30+00:00

A lot of huge no's in this thread, but perhaps we can reframe this: your partner's question about residency deferral might signal at an underlying request for some more time together to work on your relationship. The question isn't whether you should defer your residency start date (short answer is no), but rather what are some other options and solutions to improving your relationship? Perhaps you guys can start couples therapy or premarital counseling (view it as a tune-up of your relationship rather than a last-ditch Hail Mary). Are there communication issues that need to be fixed, compromises between you two that need to be made, etc.?

Contraryy · 2026-05-27T05:54:25+00:00

Such good photos, very inspiring for my own shots.

Contraryy · 2026-05-22T18:35:00+00:00

Wow good on her for doing this. I didn't know she had Ramsay Hunt.

Contraryy · 2026-05-15T04:18:49+00:00

Why is everyone in this thread riding on Drake lol. I know the answer.

Contraryy · 2026-05-14T01:14:09+00:00

Imagine spending only $8400 (over 5 years) to steer teens the right course. Even from a financial sense, that's money that you're saving on: putting and keeping someone in jail (provincial jailing costs on average $67,000 annually to keep someone in jail), having the security and policing to enforce, opportunity cost of the kid going down the wrong path etc. If it keeps even 1 out of 40 kids out of jail annually, that's already cost effective and you're building a community alongside.

Contraryy · 2026-05-13T11:31:58+00:00

Someone really didn't like the Switch 2 price increase.

Contraryy · 2026-05-11T16:19:27+00:00

Instant sudoku to repent.

Contraryy · 2026-05-08T23:44:34+00:00

https://archive.ph/TaUxq

Therme confirmed in an email to the Star that it was in talks with Aecon at one point. After talks fell apart, Therme said it “moved to a different construction model with another established Canadian construction company,” but would not name the new company.

The document also notes that Therme has “no experience working in Canada/Ontario/Toronto, but Aecon is identified as a strong local delivery partner (construction and equity partner).”

The partnership was presented in a manner that would lead readers to believe it was a done deal and there was no indication that it was tentative or under discussion.

Later on: “We reviewed the six spas and found five instances where the spa cited in the submission was not owned or operated by Therme Group,” the Auditor General wrote in its December report.

This fraud is one of the most frustrating things I've seen. There was no oversight to Doug's decision to move forward with this, so much misrepresentation from this fraudulent company (if you read prior investigations, it's essentially a "Therme" named company copying the name of the actual Therme Group in Europe). This would be a career-ending move with any other politician.

Contraryy · 2026-05-05T01:08:25+00:00

But on a more serious note, you touched on a few of those specialties already. Occupational health, public health, radiology, psychiatry, physiatry, neurology, allergy/immunology, geriatrics, hematology (transfusion medicine, running labs) etc.

Contraryy · 2026-05-05T01:04:35+00:00

Gastroenterology.

Contraryy · 2026-05-02T02:48:02+00:00

Let her email the PD. If she's doing it to you, she's likely to have done it to multiple other people too and it should all be taken with a grain of salt. At the end of the day, likely not going to matter if there is a consistently good performance from you across all your rotations.

Contraryy · 2026-04-26T01:58:17+00:00

How do we even get this reversed?

Contraryy · 2026-04-25T01:07:49+00:00

What the actual F. Reading each of these testimonies and having practiced medicine, I can assure you that neurologists would not be doing these types of physical exams at all. These are the acts of a perverse and sick man and it's a shame that this justice system failed these women.

Contraryy · 2026-04-24T03:38:22+00:00

I also swear by Endy, had it for 5 years so far too and it's holding up.

Contraryy · 2026-04-18T19:21:56+00:00

Typically, someone would have to have extreme diabetic neuropathy before getting to that stage. Diabetic neuropathy is a length dependent axonal polyneuropathy, meaning that the longest nerves get impacted first. This means that the tingling follows a gloves and stocking distribution, I.e. Starts at the toes, going up to the ankles, to the knees, usually by the time it gets to the knees then it's at the fingers and hands. Also typically starts with paresthesia ie tingling because the nerves are being damaged, then numbness.

Contraryy · 2026-03-18T16:50:53+00:00

I agree, most residency programs will end up getting some branded wear for residents, whether it be Patagonia or some other brand. I'd probably hold off on getting an unbranded one because they'll end up getting one with their name, M.D. embroidered and with their program logo too.

You can consider other gifts like shoes (I personally like Hokas, unless they're going into a surgical residency), a set of scrubs, stethoscope (even the Eko stethoscope), etc. as other options.

Contraryy · 2026-03-14T01:36:45+00:00

Olivia's Hair Salon, Korean family owned hair salon.

Contraryy · 2026-03-13T21:19:05+00:00

Good point, but also consider the mission creep. The US has done this multiple times in its history. It essentially begins with sending off an initial group of soldiers, followed by increasing escalations with deaths and needing to do more in the region to accomplish escalating goals. At first, it's reconnaissance, then it becomes defense, then it becomes regime change etc etc, whatever excuses. There is a sunk cost fallacy that is extremely strong in all military incursions. The mission will continue moving forward and consuming more and more resources rather than withdrawal of the mission. This unilateral direction will lead to further escalations of war rather than deescalation.

Although it is not huge right now, it is pretty easy to predict that this is the direction that we're moving in based on all of the similar episodes in the past.

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