Being an intern is wildly different than being a fourth year medical student.

There is nothing that can prepare you for the shock and awe that is the first 6 months of intern year.

No longer can you think “I’m just the student, and my purpose is learning.” Overnight, you will become laden with real responsibility. Gone are the days spent relaxing and studying for the next big exam. Enter the long nights in stuffy call rooms getting paged about patients that just “aren’t looking good.” Enter the frustration of waking up to a 4 AM phone call asking if your NPO patient can eat “just a little bit of ice cream.”

You can do your best to prepare by firming up your knowledge base, your work ethic, your ability to work well with others, and the thickness of your skin. The rest is trial by fire. You probably have a vision crafted in your head about what the year will look like, but you will undoubtedly run into your fair share of surprises. We’ve compiled a short list of things to expect when starting out your residency:

1. Some people will respect you as a resident. Some people won’t.

It’s official. You are a doctor and no one can take that away from you (except maybe the state licensing board). You have true medical knowledge (even if you don’t feel like it). A lot of people are going to turn to you for guidance, despite your youth and inexperience. They will respect and understand the residency system — that you are a full-fledged doctor in a phase of training. They will ask you questions about their medical care, and what you say will actually matter. Medical students will look up to you (at least a little bit). Even though you are at the bottom of the totem pole of doctors, your patients will put their trust in you. This is a great responsibility and honor.

On the other hand, some people may not give you great respect. People might call you “nurse” and ask to speak to “a real doctor.” Nurses might strongarm you into ordering a test or medication that you don’t think you should. Some attendings will think that you are not fit to touch even the bottom of their shoe. Understand that this is an inevitability, and work to earn the respect of everyone around you by working hard and striving to do the right thing.

Even more importantly, assert yourself, or “fake it till you make it.” The more confidence you have in yourself, the more others will respect you. There is a good chance you know more than you think you do. Trust your gut and be strong!

2. The learning curve for new doctors is really steep. 

In my beloved home state of New Jersey, as a student, placing an order was forbidden. We could look over the resident’s shoulder and get a sense for what they were doing, but in 4 years of medical school, I didn’t place a single order. Even students in other states who can place orders need to get them verified by a licensed practitioner. In residency, your life will revolve around placing orders. You are constantly tasked with doing something you have never done before. You know the treatment for this likely pulmonary embolus is anti-coagulation, but do you use lovenox or unfractionated heparin? Do you bolus and start a drip? What are the doses? What are the contraindications?

Once, I got a call from the nursing staff to place an ultrasound-guided IV. The most skilled nurses on the floor had failed multiple times, and the patient’s level of frustration, fear, and anxiety was at an all-time high. Then, they called upon me, who had placed about 5 IVs over the course of my life, none of which included an ultrasound. I had to learn by doing.

While it is daunting, you will learn more about how to manage patients and perform procedures in your first few months of residency than you learned in 4 years of medical school. It is a scary and awesome thing.

3. In the hospital, teamwork trumps everything.

In residency, there is no room to be selfish. You will always be dividing up a heavy workload between your peers. Senior residents will ask you to complete 73 tasks throughout the day. The nursing staff needs you to come talk to patients and explain stuff as “the doctor,” and you need the nursing staff to be the gatekeeper patients, making sure no one needlessly monopolizes your time. You need to be able to depend on your co-interns to manage all of the work together. Your seniors depend on you to take care of business, and you depend on them to advance your learning and show you how to survive.

A great way to look at it is this: The patients you are covering need a finite amount of work to be completed by your team. Every time you finish something, your team is one step closer to completion. Help each other out! Also, it should go without saying: never throw anyone under the bus. Be diplomatic.

4. In residency, reputation is everything.

In concert with being a team player, developing your reputation through hard-work, fairness, dependability, and utility is essential. You will get a reputation early on, and it will spread like wildfire. Do what it takes to show that you have the essential attributes. There are no shortcuts or games to play; everyone in the hospital will be able to see your true colors. Getting labeled as disinterested, lazy, or arrogant early on in residency will make your life that much more hellish.

5. Life still exists outside the hospital.

While residency is often very difficult, you are still the same person with the same drives, desires, and interests. Sure, you won’t have huge blocks of time to laze about and watch Netflix, but you can still exercise, play music, go out to dinner, and enjoy the company of your friends and family. Expect to work a lot, and realize that getting to do what you want outside the hospital is a blessing. Remember, most of your patients are not going home in great health at the end of the night. You are.

No matter what your level of preparedness for the road ahead, rest assured that you will figure it out. Thousands have come and gone before you and made it through, and there is no reason that you won’t either. Get excited for this amazing opportunity. Work hard and you will excel.