Intern year! It can be a big, scary proposition: soon you’ll be there on night float managing 50 patients, cross-covering multiple teams, when in medical school you only had to carry 3 patients max. Instead of vignettes about crashing patients, you will be the first responder to crashing patients. No longer will you merely be responsible for cataloging information, you’ll have to process it, and make a clinical decision that the care team will enact. It’s a lot of responsibility right out of the gates.
Don’t fret! You’ve literally been training for this moment for years. You’ve put in thousands of hours to learn the ins-and-outs of taking care of sick humans, and preventing their disease. You’ve put yourself in these scenarios both through standardized testing and throughout clerkships. The medicine is all the same, why should this be any different?
The reality of it lies in-between. Intern year might knock some of the wind out of your sails, and make you feel like you didn’t learn much throughout your time at medical school. But you did learn something, and you earned a spot at this residency program, and you are going to be great one day. There will just be some growing pains along the way.
I felt the best (and most fun) way to convey the way to survive would be through some quotes that really stuck with me from early intern year, spoken by some of my chief residents. Some were on the record, some off, and some more professionally appropriate than others.
As the sun sets on my own residency, I offer these translations to help get you through the early days of your training.
“You stink. But that’s okay; everyone stinks at the beginning.”
I remember starting intern year on night float, not yet with scrub access, sleeping in a call room bed in my dress clothes. It was on! I was a doctor. But what if something serious happened? I could handle a patient in pain, or with itchiness, but a cardiopulmonary decompensation at 3AM?
I told my chief, “I don’t know if I could come up with stellar workups on the fly.” It was way easier to mull over a difficult question stem, but if people turned to me in the heat of the moment, I would have been flummoxed!
He explained that there’s a learning curve, and the basics are always the same. Help is never far away, even when you feel isolated on lonely overnights. Improvement will come in time. Just do your best, and have a very low threshold to recruit others before you are totally underwater.
“There is nothing that can prepare you for the shock and awe that is the first 6 months of intern year.”
One of my favorites. There is no standardized test or sub-internship that can make you truly know what intern life is like. It’s often fraught with feelings of inadequacy and occasional stand-offs with other members of the care team, for 80 hours per week. Gone are the safe words “I’m just the medical student.” You have to take ownership of everything you do, even if you are not sure that you are doing the right thing. If you don’t feel ready by the time day one rolls around, that’s fine. There have been lesser doctors that survived, and your experience will be no different. Accept the fact that it’s trial by fire, and remember, it gets better.
“There are two kinds of interns: those who write everything down, and those I don’t trust.”
There’s too much information to internalize. Tasks will get farmed out to you at any given moment, even when your mind is necessarily and completely elsewhere. There’s no way you can remember every order that someone asks of you, and naturally, some of these orders will be way more important than others. Write everything down. Everything. It’s your only hope in making sure that all the work gets done.
“Every one of these patients is ‘mine,’ too.”
While you might be the covering provider for a given patient, responsible for orders and real-time treatment, you are not the only one who is responsible for their well-being. There is a chain of command above you that (for better, and not for worse) your patient also belongs to. They want to know when major changes happen, and calling them about said things is not a sign of weakness. Especially early on, asking for help is never a sign of weakness. It’s a sign of maturity.
“Go and see the patient.”
This one needs no translation. I remember having a patient whose pain wasn’t well controlled with the IV opioids that were holding it at bay earlier in the day. A small red flag, but easily something that could have been handled without me leaving the call room, with another order for Dilaudid. I went to see the patient, only to find his small bowel herniating through his ostomy and growing dusky. He went to the OR for a HOT revision of ostomy.
Over time you will develop a better sense of judgement. But it is always a good idea to go and see the patient when you get called about them.
“Can s/he leave [the ICU] today?”
Your chief will constantly be asking you if care can be de-escalated on all of your patients. Can the ICU patient go to the floor? Can the floor patient get discharged? They are not being heartless, they are simply trying to keep patients moving along through their recovery, and getting them out of the hospital before something goes wrong. The hospital is brimming with nasty bugs, “sick” mentalities, and an invisible shackle chaining the patient to the bed. At home, patients truly recover, going through their daily activities of living and returning to normalcy. Discharging patients will keep your list under control, and open up precious beds for the newly ill. While no patient should be discharged before they are ready, no patient should be relegated to their hospital bed for longer than necessary. If they have no hospital needs, send them on their way.
“This ain’t no Step 1, baby.”
Your colossal (or abysmal) Step 1 score doesn’t matter anymore. Whether you scored a 200 or a 265, you are going to have to work really hard, be dependable to those around you, build and exercise good judgement, and become a better and better team player. Despite them being the most important part of your ERAS application just a few months ago, now that you are in residency, no one cares about your board scores anymore. They do care about you taking great care of your patients. That’s what is important now. Go and do it.
Want more tips for intern year? We have you covered: