Ten Tips for Successfully Starting your Intern Year

Congratulations, you Matched! …Now What?

The third Thursday in March, known as Match Day, has come and gone. Thousands of 4th-year medical students around the United States have opened their envelopes and learned where they will be spending the next three to seven years of their lives.

Hopefully you are one of the many students who smiled, shouted with excitement, or shed tears of relief and joy. The long journey of the residency application process has ended, and graduation is fast approaching. Soon, you will receive your diploma and take the Hippocratic Oath. With those words, you will become a physician. And as your time as a medical student ends, a new era will begin—your residency.

Preparing for residency

As you hang up your short coat and prepare to wear a longer version, you may be asking yourself how you should prepare for your first day of residency. Some new physicians approach that first day with pure excitement, others with fear or dread, and others with a mixture of the two.

While the field that you are entering and the nature of your residency program may be very different from that of your fellow 4th-year medical students, internship is internship, and PGY-1 means the same thing all over the United States. With that in mind, there are common rules which apply to all internships, and the following 10 steps can help you successfully prepare for your intern year.

Before you Get Started

This is something I want you to do right now. Go to FutureMe.org. It’s a service that lets you email yourself in the future. I want you to go there, write yourself an email about how excited you are about starting your internship, and what your goals are right now. Set it to be delivered the day after your internship is over.

When you get the email a year from now, read it, and then write yourself another one for the next year. Repeat it until you are done with residency.

Going through your internship and residency, it is very easy to get jaded and forget why you are doing what you are doing. Sending yourself an email in the future will help remind you.

Going through your internship and residency, it is very easy to get jaded and forget why you are doing what you are doing.Click To Tweet

Tips for Your Intern Year

Embrace your new role

The first day you set foot in the hospital as an intern is a day you will always remember. This is the day you don a long white coat and see your patients not as a student but as your patient’s physician.

I will never forget my first day of internship. I started recording my first patient’s vitals and heard the nurse from inside the door say, “Don’t worry Mr. S, your doctor is coming to see you now.” At that moment I knew that as unsure of myself as I was at that moment, I needed to instill confidence in my patient and make him feel that he was safe in my hands.

The first days of intern year

The first few days and even weeks of internship are a time of transition. You may feel as though you don’t yet know what you are doing. But fear not. If you do your job as an intern, you will learn what you need to know to become a great doctor. So, even in those initial days, embrace your new role as an intern.

As an intern just starting out, you will have an enormous foundation of knowledge, having just completed medical school and your USMLE Step exams. That said, medical school does not teach you how to be a physician. Residency teaches you how to be a physician.

Medical school does not teach you how to be a physician. Residency teaches you how to be a physician.Click To Tweet

Take the time you need to get your work done

When you begin, it will likely take you a lot longer to get your work done than it will months later. You are likely learning a new computer system and hospital. Even if you complete your internship at the same hospital where you had your 3rd and 4th-year clerkships as a medical student, you will have a lot more work on your plate as an intern.

When you are just beginning your intern year, it will likely take you a lot longer to get your work done than it will months later. Click To Tweet

So get there early and give yourself extra time to collect vitals, see and examine your patients, and review their labs, their illnesses, and the plan of care. Allowing yourself extra time when you start your intern year, particularly in the morning, will also decrease the likelihood of making mistakes when you write orders.

When I began my internship, I would allow myself 3 hours to pre-round; this included collecting vitals, seeing and examining my 10 patients, reviewing their labs, and writing all of my notes. Rounds would begin at 9am. As the year progressed, I became more and more efficient, so I required less time to preround. By the end of my internship, I could arrive at 7:30am and accomplish all I needed to in half the time I needed when I began.

Know Thy Patients

There is nothing more important than knowing your patients as well as you possibly can. While your 3rd-year medical student may have hours to spend with one of two of your patients, just as you did as a 3rd year, you will most certainly not have this much time. That said, you must know them as well you can.

There is nothing more important than knowing your patients as well as you possibly can. Click To Tweet

Why do you need to know your patients well? For several reasons. First, your junior/senior resident and your attending will expect you to give them the most up-to-date information about your patients. Second, you will be the responding clinician for your patients. This means that the patient’s nurse and consulting teams will look to you for up-to-date information on the plan of care.

If your patient decompensates in a code situation, you will be the liaison for the code team, letting them know what they need to know to try to revive your patient successfully. The same rule applies for surgical interns: When you go into the OR for a case, you must know your patient, the planned procedure, and the purpose of the procedure.

Remember that Patient Care Comes First

Throughout your internship and residency, always keep in mind that patient care comes first. You will likely have daily and weekly conferences as an intern in your residency program. These are very important learning opportunities, of which you should take full advantage. Many programs have a noon conference where food is provided!

Do not forget, however, that your patients come first. If your patient is becoming sick during one of these conferences, and your patient’s nurse pages you, you should drop your lunch and pick up the phone to call them back.

Get help when you need it

This is crucial. There is nothing worse than saying you can handle something when you know you can’t. You are there for the patient, not your ego. Period.

You are there for the patient, not your ego.Click To Tweet

Be a team player

Now that you are an intern, you will be a key player on a team of people working to improve the health of your patients. While in medical school, one of your priorities might have been to outshine your peers by being the most knowledgeable or the most adept at a procedure. But now your first priority must be to work well with your team to help your patients.

If you didn’t appreciate the importance of a health care team as a medical student, you will quickly learn how important the team is as an intern.Click To Tweet

If you didn’t appreciate the importance of health-care teamwork as a medical student, you will quickly learn how important the team is as an intern. In teaching hospitals nowadays, you can’t accomplish anything without a team. Your team is made up of your fellow interns, your junior/senior resident, attending, nurses, medical assistants, case managers, social workers, phlebotomists, hospital transporters, technicians, and secretaries.

Without all of these people working in sync, nothing will happen in a hospital. As such, you need to learn to work well with others on your team. If one of your co-interns is having a rough day, pitch in to help him or her, as everything you do is in service of the care of your patients who are relying on you to help them.

Learn on the Go

In medical school, you learned how to be a professional studier and test-taker. As you become an intern, the time for dedicated learning will quickly shrink, so you may be wondering how you will ever learn what you need to take care of your patients.

A wise attending of mine once said, “Allison, don’t go home and read a random chapter of Harrison’s. Instead, when you’re on-call in the hospital, read up on the diagnosis for the patients you admit.” I never forgot his advice, and it has served me well.

The material you read while you are admitting a patient will stick far better than a random chapter here or there after a long day. Don’t try to read a ton of papers or texts just before you start. You have what you need for where you are as an incoming PGY-1 after graduating medical school. You will learn the information you need on-the-go as an intern, and it will stay with you.

Be humble and know your place

It’s true—after years of hard work and studying, you have arrived and now carry the title “doctor” before your name. That said, remember that you are beginning your journey as a physician when you set foot in the hospital as an intern in July.

You are just beginning your journey as a physician when you set foot in the hospital as an intern in July.Click To Tweet

Many of the nurses you will work with, particularly in the ICU, have been there for many years and have watched interns and residents come and go. Many ICU nurses could run a code on their own with all the experience they have. So, be mindful of the experience of those around you and remember to have respect for both your junior/senior residents, your attendings, and the nursing and other ancillary staff.

Stay sane by making time for you

As your body adapts to chronic sleep deprivation and long hours, sick and dying patients, and the many other demands on you, you must find a way to stay sane.

Many people choose exercise as a way to clear their mind. You may, realistically, have little time for exercise as an intern, but try to take even 20 minutes out of your day to go for a run or walk when you can. Play an instrument, read for pleasure, or take up knitting. These activities will keep you feeling balanced.

Rely on your support network

Throughout this demanding time in your life, it is so important to have a support network, i.e. your family and friends. Make sure you talk to them and share your experiences.

While some of your friends and family may be grossed out by your experiences with bodily fluids or horrified by hearing about your experiences with critically ill and dying patients, talk to you them about your own emotional response to what you are seeing. If you keep all of your difficult experiences to yourself—your frustration, your excitement, your sadness, your relief—you can easily feel isolated and depressed.

Talking to those who you love ongoingly about your experiences will keep you grounded.