Lessons of A New Intern

Intern Year: We've all heard the tales, mistakes, lessons learned, tears, victories, and more hours worked than you could possibly imagine. It's a journey they say, but at the end you come out better for it. The transition, as I've experienced it, can be rough at times, but here are some things I've learned the first few months... 

      Be Patient with yourself
You’re new at this, and its tough (or at least that’s what I tell myself). It’s a tough transition going from a 4th year med student, seemingly at the top of their game, 'functioning at the level of an intern', and then becoming an intern and barely being able to function. However, Rome wasn’t built in a day, and there’s a reason we are residents, to learn. There’s also a reason residency is, in my case 4 years, because it takes time to learn all the things. I can be so hard on myself when I don’t know something, but then I remind myself that I’m an intern and I’m here to learn. If I knew all the answers, I wouldn’t be a resident! Its ok to say you don’t know, look things up, and you’ll know for next time. I know even as I say this though, I will have to keep reminding myself to do the same.

2    Comparison is the thief of joy
When you’re in a residency class of its hard to not compare yourself to others in your cohort. Especially when it feels like you’re constantly being compared to others. However I’ve found its more helpful to focus on meeting objective milestones (knot tying, suturing, mgmt. of common scenarios). Each of your co-interns is unique with a unique set of strength and weaknesses that brought them to this program, as are you. Focus on what you can learn from your co-residents. If you like how efficient they are with a particular EMR, ask for tips, if you think someone ties beautiful knots, ask them to show you how they do it. As a group you all have things to learn from each other to be a collectively strong group, embrace it!

3    If you need help, ask.
As we are learning, we must remember that at the end of the day the patient is the priority. As their doctor its our job to ensure they not only get proper treatment and interventions, but also safe ones. So if you’re unclear on something, not sure, or have never done something before, speak up! When it comes to medications, it’s always ok to give the clinical pharmacist a call before placing the order, to prevent delays if you put in the wrong order. If you need to do a procedure, and haven’t done it before, or haven’t done it enough to feel comfortable, it’s perfectly fine to ask your upper level for help. I’ve found they appreciate it so much more when they walk you through it, versus having to retroactively fix it after it’s done incorrectly. It can be tough, because you feel like you’re constantly asking people for help, and they have other things they need to do. I tend to feel like I’m bugging people when I ask for help, so I try not to ask the same questions twice, and ask about things after I’ve attempted to read about it or find a solution on my own, and still need clarity, but sometimes there isn’t always time for this.

          Confidence comes with time
I have found that as an intern, I typically lack confidence, particularly in things I’m unfamiliar with or am doing for the first time (so like everything). I honestly felt more sure of myself as a medical student. Somehow being the decision maker and knowing that there are less safety nets under you, makes you really second guess some of your decisions. However, as the old saying goes, you have to fake it til you make it, within reason obviously. My biggest fear as a new intern was being asked a question by a patient I didn’t know the answer to. In my mind (and I guess in real life, too) I’m the patient's doctor and should have all the answers. I felt like not knowing the answer eroded their confidence in me as a doctor. I’ve learned you should appear confident to patients, but know that it's ok to not know. Patients understand that we are human and do not know everything, I’ve learned it is ok to tell them that I would like to discuss their questions further with the team and circle back with an answer. They are often so grateful when you circle back, and feel that they are receiving the most accurate information AND high quality care because their doctor is attentive.

5        Use your resources
When I was on internal medicine we had huge team, and I had a lot of sick patients all with questions and concerns that needed to be addressed. I made it a point, to answer the questions I could while pre-rounding, jot down the ones that should be addressed during rounds (i.e. they needed to be discussed with an attending/upper level). If I got medication related questions, I would be sure to send in the pharmacy student to counsel the patient. This freed me up, and allowed the pharm student to practice counseling patients on medications. Based on the level of training of my medical students, I would have them circle back with their patients and check on them, and answer any lingering questions they had about the plan (after I made sure the students were clear on the plan, of course). It also gives the medical student a chance to review some of the pathophysiology they’ve been studying for their shelf, and gets them comfortable talking to patients in a way that patients understand. If a non-emergent patient issue arose I would often give them a 5 minute headstart to go and get the scoop while I got to a good stopping point.  This helps your students feel included and frees you up to check off a few more of your more urgent tasks. Of course you should ALWAYS go and see the patient, but your students can help streamline the process, and if its urgent, you should go together with the student. 

6    Prioritize survival
When you begin intern year there will be this intense pressure to read as much as possible in addition to all of your clinical duties. The advice I was given was to prioritize adjusting and surviving. Intern year is a great deal of on the job training and active learning. Don’t be too hard on yourself if you can’t find the time to read a practice bulletin/article. Adjusting to life as an intern, learning your clinical responsibilities, learning HOW to do said clinical responsibilities, navigating the EMR, it’s all so tough. Its specialty dependent, but in my opinion it was more useful to focus on learning the tasks, becoming efficient, and then perhaps once I’ve mastered these I can build by reading a little each day on top of the things I read in the moment throughout the day.

Also prioritize your tasks! - Arguably the most important lesson of early intern life
As an intern there are endless lists of things to do for each patient, all of which are important, but some of which are non-urgent. The most important thing I’ve learned in terms of intern work-flow, is to figure out what’s urgent, somewhat urgent, and non-urgent, and prioritize my list of to dos accordingly. That way I can get the ball rolling on the more time-sensitive things earlier in the day. I also try to anticipate urgent tasks to come, if you know tomorrow your patient will need some procedure early in the morning, try to get as much of the leg work done the prior evening.

Overall, so far intern year has been TOUGH, and I by no means have it all figured out. These are just the things I repeat to myself in my head to get through the day. :)


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