It’s a cold December morning in New York City. I arrive at the hospital at 6 am and inhale my bagel as I ride the elevator up to the 3rd floor telemetry unit, slightly tachycardic myself. As an intern, I ask myself: out of the ten patients I will care for, how many will be critical? How many families will I have to console regarding their loved one’s illness? How many stat blood draws/IVs will I have to help the overworked nurses and lab techs with? Will I even eat a lunch today?Now let me take you back a year earlier to my sub-internship. It’s a beautiful sunny day on the Jersey shore. I arrive to the hospital at 8am, belly full and coffee in hand. As I go see my two patients, I ask myself: will I have a third patient today? Am I going to get the sandwich or the salad for lunch? Will my intern let me out by 3pm so I can take my fiancé out on a date?
Prior to being thrown into the gauntlet as a new intern, I could not have imagined the tremendous transition of responsibility that would happen in the 2 months between my last day of medical school and my first day as an intern. In hindsight, I now realize that my sub-internship was not at all reflective of what my life as an intern would be. I had wasted an entire month celebrating my match results and my liberty from test taking (for a bit). I underestimated the valuable lessons my intern had taught me and shirked her insistence that I take on more patients each day. I didn’t learn from my patients, their families, or their diseases. It was my fault; I did not put in the work.
Making your sub-internship a reflection of your internship can help bridge this gap and get you off to a strong start as an intern. You can gain an appreciation for the workload while learning basic workup and treatment algorithms for common pathologies on the floor (COPD, ACS, HTN, diabetes, etc.).
To get the most out of your sub-internship, take four simple steps to put yourself at an advantage during your first month as an intern.
1. Gain an appreciation for the work load.
Take more than 2 or 3 patients; take the full list! Learn everything you can about each patient under your care and spend the time learning their treatment plan. Write 10 notes each day and spend the time talking to each consultant. Ask appropriate questions to each person in charge of the patient’s care. This will give you an appreciation for what you’ll endure for a whole year as an intern.
2. Learn from your patients and their families.
The second step, and the most important, is to learn from your patients and their families. Spend time with your patients and conduct a thorough interview. Ask about their ailments as well as their recoveries. Learn how to talk to and console your patients and, in turn, you will become an advocate for them. Learn to interact with their families and answer their questions. Ask your patients how your clinical care compares to their expectations and standards; then meet or exceed them. As you’ll soon realize: the more you respect and care for your patients, the more trust and compliance they will offer you.
The most overlooked step is to READ. No, don’t just re-read Step Up to Medicine. Rather, read guidelines for standard of care! Don’t wait until you’re an intern to read the JNC8 guidelines for treating hypertension — you won’t have the time! Learn it now, and manage your patients appropriately. Your attending counts on YOU to have a plan of care, so learn the guidelines for proper standards of care!
4. Find a way to cope with the stress.
Finally, figure out a way to cope with stress. Establish good habits such as: working out, eating properly, and practicing mindfulness, among many others. Learn what helps you relax and make it an integral part of your life. Setting yourself up to have a healthy work/life balance as an intern won’t be easy, but it’ll be easier if you take the steps now and get into healthy habits in advance.
To summarize, treat your sub-internship as your internship. Take the load and get a feel for what will be expected of you the following year. It will make you a better resident, doctor, patient advocate, and person.