Growing up, my street was on a bit of a hill.  It was annoying to lose a ball into the road and have it stop rolling a dozen houses down.  Learning to ride a bike was especially challenging.  During the training wheel transition I had plenty of near misses (and full-blown crashes) with trees, fire hydrants, and mailboxes.  Though I got plenty of scrapes and bruises along the way, in the end I somehow managed to master the two-wheel art. 

This week I’ve felt my educational “training wheels” begin to loosen.  My classmates and I submitted our applications for residency, and some have already started to receive invitations to interview.  This month I am doing an acting internship (AI) in the Pediatric Intensive Care Unit (PICU).  AI’s are chances for 4^th year students to assume the roles and responsibilities of 1^st year residents (aka interns).  We have the opportunity to manage a larger number of patients and be more involved in the day-to-day plan of care than a student normally would. 

I’m working in the PICU at Toledo Children’s Hospital.  At first I was a bit nervous about starting in an area that took care of the most critically ill little ones in the hospital.  It certainly felt like I was jumping into the deep end of the pool.  However I’ve managed to stay afloat so far and learn a great deal.  The majority of the kids I saw this week had respiratory problems including pertussis, croup, and status asthmaticus.  Fortunately I was able to see most of the little whoopers, croupers, and wheezers improve enough to leave the unit.

As a student it seems I am constantly reminded of how “green” I remain in many areas.  I wrote almost all the orders for my patients this week, with an attending physician co-signing them.  While there are plenty of equations and protocols for calculating fluids and medication doses, so much of practicing medicine is based on experience and that clinical “gut” instinct.  Is this child ready to be taken off continuous aerosol treatments?  Should I recheck his potassium level in 6 or 12 hours?  Do the steroids alone account for this high blood sugar?  Luckily I have gotten some great practical advice from my preceptors and some tremendous nurses.  Perhaps realizing just how much there is to learn is the most authentic “intern” experience one can have.

I’m glad to have this acting internship to give me a preview of what residency will be like.  There’s a mix of exhilaration and a bit of terror that comes with removing training wheels.  I look forward to what this month has in store for me (while hopefully avoiding wayward trees or fire hydrants in the process!)