Advice for starting your intern year of residency
This post was first written and published on my old website on June 29th, 2020, the day of my last shift as an intern (PGY-1). I am sharing it here on my new site, as I hope it contains valuable lessons for those of you starting your residency in July 2022. Sincerely, Jake.
I write this post after completing my very last shift of my intern year in internal medicine. It has been quite a year, to say the least. I’m not sure there’s been a more unique year within the past century in medicine. We are facing a global pandemic due to a virus unlike anything we have seen since at least 1918. On July 1st 2020, thousands of medical students turned physicians will begin their first days as residents. This July 1st will be unlike any July 1st for the past 100 years. This year, new interns will be thrown onto the front lines of the battle against COVID. Day one of residency is scary enough as it is. Throw COVID into the mix, and it becomes an even greater beast. However, I want to reassure you that as new doctors, you will have plenty of support, oversight, and encouragement as you start out. Very little is expected out of interns. Ultimately, the goal of the intern is to learn how to be a doctor and to understand how hospitals function. Medical decision making and patient management are more in focus during later years of residency, and are not the primary learning objectives of intern year. With all this being said, below I reflect on my top 10 tips for new and incoming interns.
Write everything down. You’ll have anywhere between 5-10 patients at a time. It is absolutely impossible to remember every single lab value, medication, or vital sign. I kept notecards for each patient that I was rounding on. I wrote down every single thing an attending or upper level resident told me to do. I crossed these tasks off once they were completed. I think it is absolutely essential to be organized as an intern, and notecards and/or a folded sheets of paper were effective tools for remaining organized. Your goal for week one should be to find a system that works for you.
You will likely be out of your comfort zone quite a bit, especially early in the year. It’s hard to be a brand new doctor. Calling consults, presenting on rounds, and trying to make decisions on management are intimidating tasks when you don’t have a ton of experience. You will slowly grow and improve, and as you do this you’ll become more and more comfortable. Growth can be uncomfortable at times, but it is necessary.
You will get paged all the time on some days, which can make getting all your notes and orders in challenging. I struggled at first trying to get work done when I was constantly being paged about my patients. Most of the time the pages are not urgent matters. But, try to return them promptly (usually within 20 minutes or so). It takes some time and adjustment to deal with these constant distractions. You’ll have to learn how to compartmentalize your work. If you’re doing something important or putting in a very important order and are paged in the middle of this, either finish the important work first or write down exactly where you left off to remind yourself to finish that work after returning the page.
Residency is a different kind of stress than medical school, at least in my experience. In residency, it is easy for a lot of work to pile up quickly. Throw in a pager that goes off every 10 minutes, and it’s easy to feel completely overwhelmed. You’ll inevitably be overwhelmed at times, but rest assured this is normal and you will grow during these times. In medical school, I felt like the primary stresses involved performing well on objective measurements of knowledge. In residency, however, my biggest stress has been learning to remain composed while trying to perform lots of work efficiently in an environment of constant interruption.
No one expects you to know anything. I hope this makes you feel a bit better. There is a reason residency is (at least) three years long. You need time and experience to learn how to be a doctor. No matter how much you read books, it is the patient experience that you need in order to actually learn medicine.
Don’t take things personally. I made the mistake of doing this a few times this year. Anytime you call a consult, there is a very small likelihood of being yelled at (unfortunately). The reality is that many doctors are burned out and anytime you call them you’re adding to their workload. I was once told to “go back to 5th grade to learn to count.” That was probably the lowest point of my year because it happened on an already really tough day. Rest assured, if you’re ever yelled at, it’s likely not something you did but rather a mean doctor who needs to chill out. Almost all of the time, however, attendings and consultant physicians are totally nice. I just want to prepare you in case you’re ever yelled at. Think back to your step 1 days and the idea of displacement. That is all that this is. I cannot speak for surgeons though, that’s a whole different story.
You’ll be challenged, probably more so than in medical school. But, you’ll be far more rewarded than you were as a medical student. For the first time ever, you’ll refer to yourself as a doctor. Also, you’ll have patients literally thanking you for saving their lives. This happened numerous times throughout my year.
I was once told “residency is the most fun you never want to have again.” I can’t put it better myself. There are a lot of really fun times to look forward to.
You’ll make mistakes, and it’s important to not beat yourself up about it. This is obviously easier said than done. But, every single physician alive has made a mistake. Do not expect perfection of yourself, or you’ll become burned out.
Treat every day as a learning opportunity. If you get 1% better each day, soon you’ll be twice as proficient. The growth will only continue from there.