By AJ Nguyen
It’s your biggest dream and quite possibly your biggest fear at the same time. Your intern year. The year where you are officially called a “doctor” by hospital staff, your colleagues, and your loved ones. This major milestone after medical school is one of the most exciting (and challenging) ones you will ever face in your career as a physician. Regardless of the specialty of your choice, intern year is unanimously considered to be the toughest of your post-graduate training. But it doesn’t have to be all bad. Despite all the trials you will face in your first year as a doctor, there are things you can do to not only survive but thrive during your intern year.
Intern physicians at virtually every program in the US face daunting workloads, long hours, and the intimidating learning curve that comes with intern year training. In addition to the actual medical knowledge, you must learn to negotiate hospital policy, learn EMR systems, manage patients both in the hospital and out in clinic, and make time to teach others and yourself (after all, you still have Step 3 to take and plenty of exams integrated between clinical duties). The aforementioned list isn’t all inclusive, of course, and your individual experiences will differ based on your specialty, the setting wherein you train, and your program goals and objectives. However, certain broad themes apply to all residents with regards to making it through this difficult year of your training.
Here are some points of advice from current interns and residents.
- Always make time for yourself. While intuitive, this is much harder than one often realizes, especially when you’re on a difficult rotation. Personal time is not just time at home with family and friends. It’s time doing things that YOU like. As an intern, you’ll spend an inordinate amount of time thinking about other people. You always need some time just for you. Whether it’s a scheduled massage at the end of the week, 30 minutes a night on Netflix, or having lunch and watching videos online in the call room alone for a few minutes, scheduling time for yourself will pay dividends in the long run. Personal time is not only important for unwinding, it’s also important for your mental health. Mental health can include anything as minor as mental fatigue to something as dangerous as major depression. As an intern, I used to escape to the call room and meditate for 15 minutes every day after lunch. It allowed me to escape the hectic hospital environment, provided needed rest and relaxation time, and gave me something to look forward to during those rough mornings preparing for rounds. A colleague of mine also escaped to the call rooms, but to do 100 sit ups before returning to the floors. Whatever you do to relax and build up energy, give yourself that time and opportunity.
- Don’t forsake your love ones; they help a lot. Medical students are getting older on average and they graduate to become older residents. With the increase in the number of non-traditional students, more and more interns are starting their careers with the added the responsibility of caring for a family or for family members. Almost all residents that I have spoken to have dedicated family time. “As a resident, you’re away from family so much. You miss special events and moments. Dedicating time to be with your family gives you something to look forward to for you and your loved ones.” Loved ones don’t always have to be family members, but can also be your long-time friends, old mentors, or even your furry companions. Anyone who can take the chaos from your mind and replace it with safe, warm, and loving thoughts are going to be important in your life as a physician. Many of my former co-interns have specific special days that they schedule well in advance. Others have dedicated time after work every day. For example, my senior resident set her cut off time for work to be 8pm every night. She would spend time with her daughter at 8pm until 9pm, regardless of how much work she had finished at that point. She realized that it helped her stay on track throughout the day and she had a reason to stay motivated to finish her work more efficiently.
- Be comfortable with your capabilities. Medical people are competitive. It’s that edge that gave us an advantage to get through everything we face. As a result, we often try to one-up each other. However, as a resident, teamwork is much more important than competitiveness. You can be competitive, but don’t let it prevent you from making meaningful working relationships and friendships with your fellow residents. In order to survive the trial that is residency, you will need the help and the mental and emotional support of your fellow residents. Coming off as overly competitive can push people away. Often, coming off as competitive is in response to some self-perceived deficiency. Medicine is a vast field and being an intern, you WILL absolutely have deficiencies. Residency is a time to learn and the fastest way to do so is to learn from one another. I used to feel very self-conscious during rounds when I could not answer a question from our attending, especially when my co-intern was able to answer the question. I would study between patients on rounds and tried to answer the next question about my co-intern’s patients. Over time, I realized that I wasn’t happy and rounds actually made me anxious. Residency became a burden, and I ended up dreading being on service with a stronger resident and co-intern. More importantly, because I wasn’t focused while my co-intern was presenting cases, I had actually missed on a lot of valuable clinical teaching because I was distracted and anxious. Once I accepted my own capabilities, I enjoyed rounding and got more from the teachings during bedside rounds.
- Bond with the people around you. Your fellow house staff and hospital staff are an integral part of your experience as an intern and resident. You will be spending at least 3-7 years with a small group of similar-minded individuals. It’s important to develop good and fun working relationship with the house staff. There are endless instances when the long call nights, the tough emotional times with patients, and similar situations are made so much more tolerable due to the people around you. Sometimes it has even saved lives. During night float shifts, the hospital becomes very lonely. Aside from your patients, the only folks there are a few of your co-residents, a skeleton nursing and ancillary support crew, and maybe one nocturnist attending. Often on night float, you will care for a long list of patients without immediate supervision from a senior resident or attending. I’ve found myself having to reach out to co-interns and residents in the middle of night on occasion. Many were happy to help me because of the bond we’ve built.
- Make sure your efforts are properly recognized. This is not only advice to survive intern year, but to advance your career as well. Don’t be a glory hog and give others credit when it’s due, but don’t let your own efforts go without accolades. If you took initiative to research something about your patient or went out of your way to help your team, make sure it’s recognized. Well earned cheers and accolades really give you strength and confidence to carry on. I did particularly well on my inpatient GI elective during my intern year. Many times, I caught problems that would have delayed the patient from getting their colonoscopy or EGD. I would take steps to mitigate this before the patient’s scheduled procedure. I made sure to report all my efforts to the GI attending and the GI lab staff (in a more factual than self-aggrandizing way). Although I wasn’t going beyond my normal duties, the staff and the attending all appreciated my efforts to make sure no procedures were delayed. My chief resident and my program director received communication commending my efforts. This illustrates two important points: 1) Had I not reported my extra efforts on behalf of my patients, I likely wouldn’t have received accolades for my efforts. Preventative measures are often not recognized because consequences are avoided. You should draw a little more attention to your preventative efforts, without sounding boastful or compliment seeking of course. 2) I had many doubts about my ability to do well during residency. Having recognition from my attending and the hospital really helped to erase those doubts, and I started to grow as a resident and a person.
- Make sure your teammates’ efforts are properly recognized. In a competitive field like medicine, we often feel compelled to focus on our own abilities and efforts. However, it’s equally important to our experiences and success as an intern to recognize and give praise to our fellow residents when they do a good job or when they have your back. As with your own efforts, the efforts of your peers may go unrecognized, even though a job is done exceptionally well. If you notice your fellow house staff taking on additional admits, staying late, or taking time to really look after someone, make time to publicly acknowledge that resident’s efforts. I’ve found that it personally inspires me to improve my own performance and builds healthy working relationships with my co-residents. When you give accolades, your co-residents will feel as though you are looking after them and the work environment will be more supportive and enjoyable for all. Whether it’s a post on the program’s Facebook page or a quick acknowledgement during staff meetings, a little compliment goes a long way.
- Strategically plan your Paid Time Off (PTO). Your PTO is precious “me” time. Most programs will offer you around 3-4 weeks, not including time for continuing medical education and conferences. Use it strategically. A good number of interns misuse these. For example, if you have a family, you may want to take a week off during the summer. Yes, that summer vacation is still possible in residency, if you plan it right. Don’t just use your precious off time on random days when you feel like you need a day off. Try to coordinate with your friends, your family, and for special events that you enjoy. For example, most interns will take a week break in the summer, a week in the winter and a week in the spring in terms of major vacations. Then, they’ll take 5 to 10 individual days scattered throughout the year for birthdays, anniversaries, etc. While the other tidbits of advice above are all important to your overall experience during intern year and residency, planning your PTO well is the most important, in my opinion. Your PTO is the only time (aside from the rare weekend where you aren’t catching up on work) where you can plan to be someone else other than a resident and a doctor. It’s absolutely crucial to your long term health and happiness.
Your intern year doesn’t have to be bad. It actually presents a rare opportunity to push yourself to many different limits. As an intern, you’ll be learning time management, communication, teamwork, team management, managing expectations, mentorship, personal improvement, work-life balance, and navigating bureaucratic policies, in addition learning actual medicine. While the above tips are not inclusive of all things one could or should do, they represent many challenges residents face during their intern year. However, they also represent opportunities for you to challenge yourself. How good or bad of an experience one gets during their first year as a doctor can profoundly change how they address these challenges. Having a road map to tackle these challenges will help you thrive during intern year, build valuable connections, and develop skills to be a better senior resident and attending down the road.
About the Author
AJ Nguyen is a family medicine physician practicing in California. Dr. Nguyen’s interests include academic medicine, preventative care, and healthcare education and leadership.