Medical school is classically described as “drinking from a water hose” due to the amount of information learning doctors must take in. Intern year is more like being a “sponge” to absorb all the doctoring knowledge needed to set a good foundation for the duration of residency.
Water analogy or not, there are many things you can do to prepare for intern year of residency, however the most important is to take time for yourself before starting your new job. Please soak up all the free time that you have before you start residency!
Below are some clinical and non-clinical tips I compiled from personal experience that can help you get through intern year successfully!
Clinical
- Don’t be afraid to ask for help. The joy of intern year is that you will always have a senior or attending who you can access with questions. Always "ask before you do," especially if you are unsure about something (remember medicines are helpful but can also harm!). Hospital logistics can be confusing; it’s okay to ask how the flow of things work at each hospital system a few times before you get the hang of it. It’s okay to wake up doctors at night to get reassurance or ask for help, that is part of their jobs. It’s okay to not know the answer, and to read about it on reputable sources. Ask, ask, ask, ask, ask! Curious minds are celebrated!
- When with your patients, start by listening more than speaking. Your patients know the most about their health. Listen to them, don’t brush them off or undermine them. I repeat, your patients know the most about their health. The times residents prove they are smart are the times they have done the most listening.
- Be open to trying a few different flows for pre-charting, rounding, presenting, etc. You will more than likely experience attendings who recommend different ways to round (bedside vs. table vs. discovery), write notes, prepare for clinic, and more. Be open to trying many different systems of organizing medical information so that you can adopt a method that works best for you.
- Create an inpatient pre-charting flow and stick to it. Every. Time. I personally like to pre-chart in the same way that I present my patients during rounds (overnight events, vital signs, I/Os, labs, imaging, MAR review, current orders/meds, nursing and consult notes). The same goes for finding a flow for admitting patients to the hospital--for example, finding flow in taking a history (OPQRST, medical conditions, medications, allergies, family history, substance use, code status, etc.) and doing a physical exam (HEENT, heart, lungs, abdomen, extremities, neuro exam, etc.). Remember that relevant information will change slightly if you are in the ICU vs. the floor vs. seeing newborns vs. L&D. However, the best way to make sure you never miss anything is by having a pre-charting and admission flow that you stick to every time, with slight modifications for each clinical setting.
- Prepare for outpatient clinic. Some people like to prepare the night before for the next day of patients. Some people prefer to wake up early and pre-chart the same day for clinic (note that attendings do recommend this, as it will be on your side to have added time to each patient chart for billing purposes when you are at an attending level, since the “time in chart” only counts on the day of the visit). Some residents don’t prep for clinic at all! Figure out what works best for you and stick to that method. It is especially important to prepare for procedures, like doing a shoulder injection, skin biopsy, IUD placement, Nexplanon placement, endometrial biopsy, etc., as you may not have time during the clinic day to review the details of the procedure.
- Ask for note feedback early. Inpatient notes look different than outpatient notes. Outpatient FM notes are typically in APSO format, and may be more brief. Inpatient notes have a particular level of detail that is required. Take a stab at writing these notes independently, and then ask your seniors and attendings for feedback/guidance on how to make the notes stronger early on, so you practice note writing in the way your program and healthcare network expect. The better your notes, the less coding inquires you will get from the billing department.
- Set boundaries with your patient portal messaging. Treat your in-basket/patient messaging like an email. Keep it professional and keep it succinct. Forward it if it’s something someone else on your team can handle. Say “sayonara” to the messages that have nothing actionable. Have patients come into the office or make virtual visits with providers if they have extensive questions over portal messaging. Many outpatient doctors choose not to check their patient messaging portals on weekends and do not call patients on weekends or after business hours. You will find what works best for you and how you want to feel balance within your life and your patient care. The same goes for a chat feature (if your EMR offers that); you may want to silence this during vacations or during your time outside of the hospital so that you cannot be reached if you are not on call.
Non-Clinical, but Related to Residency
- Show interest in your patients. Your patients are often not super happy to be in the hospital. It is an honor to care for them and to learn with them. Please remember to show interest in all your patients (even if it’s your eleventh CHF exacerbation admission that month). Each patient has a story, a whole life they are living outside of the hospital. Your residency will be more enjoyable the more time you spend getting to know your patients and listening to what they share. Curiosity prevents burnout!
- Everything with learning in mind. It’s okay to be nervous to present to attendings and upper-level seniors! Remember that they are on your side. Try not to not take anything too personally--people go into academic medicine because they like teaching. Everyone’s style of teaching is just different.
- Treat feedback like a sweater. This is some of the best advice I got intern year: if the feedback feels warm and cozy like your favorite sweater, let it sink in! If feedback feels itchy or like it doesn’t fit quite right, it’s okay to let it roll off. Remember, you will get a ton of feedback during residency, as it is the job of your program to make you the best possible training doctor you can be. Not all feedback will feel good, and some may even make you want to cry or quit, and it’s more than okay to let that feedback go. The best feedback is actionable, clear, and doesn’t comment on your core personality.
- Be a team player. Your team is everything--your family, your friends, and maybe most importantly, your colleagues. Practice compassion for yourself, your teammates, and your patients by supporting the team as a whole. Sometimes that means taking an extra shift. Sometimes that means covering someone’s patient portal messages. Sometimes that means taking on an extra admission for the day. Your teammates are your people for the next few years; they will go through what you go through and understand your struggles more than anyone else in your life. Treat your co-residents with kindness and respect always. If someone calls out sick or has a family death/event, please support your co-residents and cover their shift without question, just as you would ask them to cover you if you had an emergency occur in your personal life. Your family and friends should also be made aware (if you haven’t told them already) that you will more than likely have to miss family events, weddings, bachelor parties, baby showers, birthday parties, and more, because you have very limited time off. It’s an important expectation to set before starting intern year to make sure all your team members are on your side.
- Carry forward kindness in medicine. If someone is not kind to you, go to your chief resident(s) and your program director to report the situation. Hospitals now also have online reporting systems that exist to make sure such incidents are addressed and ideally not carried forward. Medicine needs more kindness!
- All emotions are valid. This job is heavy. It’s okay to cry during rounds, or in the bathroom, or in your car on your way to/from work, or in your bed, or a million other locations. It’s okay to be frustrated, it’s okay to scream in a non-clinical setting. It’s okay to feel down because your patients are very, very sick. It’s okay to not be okay. Lean on your friends, family, co-residents, chiefs, and PD. Reach out to the suicide hotline and/or a licensed therapist if you have any suicidal ideation. It is not okay to be aggressive or rude while at work; always maintain professionalism and take anything hugely concerning to a chief resident or your PD.
- Set reminders for everything. Your schedule will change week to week, month to month, even day to day. Set multiple alarms. I set an alarm to remember to leave the hospital in time to make it to clinic, to stop rounding to make it to a virtual meeting, and even to remember to put gas in my car. Your brain during residency will be operating at a mile a minute with the amount of information you’re trying to store; make it easier on yourself and just set alarms to remind you of where you need to be when, or what task needs to get done at a specific time. (This method also works for patient care, however many people will keep a paper to-do list rather than digital list for patient responsibilities and to maintain HIPAA regulations.)
- Be open to change. Residency programs and program directors are constantly thinking through ways they can better your education and your wellness. Keep in mind that your intern year schedule may look different than the class above yours did, and that when you’re ready to become a senior, things may change again. Be okay with change; nothing you do or experience is a constant. And that is a good thing, so that programs can continue to provide quality and informative education to residents.
Life Outside of Work
- Never forget you are a human caring for other humans--prioritize well-being! Many physicians, particularly in primary care, are facing burnout. Some of the best ways to try to maintain a sense of wellness during intern year include but are not limited to: Leaning on your co-residents and chief resident(s); Eating healthy plant-forward foods; Getting movement in each day (a variety of cardio and strength); Spending time off of technology; Attending personal doctor/dentist/therapy appointments; Practicing a non-medical, creative, artistic hobby; Reaching out for support when you are not well.
- Be smart about vacation time. Some vacations, you may feel ready for adventure and take an out-of-country flight! Other vacations, you may need a staycation and to rest at home. During vacations, sign out your patient portal message to your co-residents and take a much needed total break from medicine and work. Believe me when I say your patients will be okay for one week without you answering messages.
- Pause on extracurriculars; attempt to keep up 1-2 hobbies. Don’t overcommit during intern year. It will feel different than medical school, when you had time for clubs, extracurriculars, and dinners with friends. Internship is way more structured, you do not decide your schedule like you could as a med student. Try to keep up with a few things that really matter to you. Do you like to read? Like to bake cakes? Like to crochet? Like to play pickleball? Pick a hobby and attempt to keep up with it, but don’t feel pressured to have a lot of extracurricular involvements. Your one day off per week may be spent just getting groceries, sitting in your house, drinking coffee slowly, calling/seeing family, cleaning/organizing your space, or doing your laundry. That’s more than enough tasks for your off day--don’t feel pressured to overcommit. You will regain more free time as you become a senior resident, and will remember what hobbies/extracurricular activities you want to engage in again.
Have questions, ideas, or thoughts about resident well-being or surviving intern year? The ACOFP Resident Council is here to support you! Reach out anytime at residentcouncil@acofp.org—we’d love to hear from you!
