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. :)
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. :)
You are writing some Amazing tips. This article really helped me a lot. Thanks for sharing this blog.
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