10 Tips for Surviving Intern Year of Residency
Intern year of residency is a period of adjustment, to say the least. There’s a lot to learn about not just the specialty you’ve chosen, but where you’ll be working, the people you’ll be working with, and how to maintain a work-life balance. It’s no wonder many doctors about to begin residency are excited, but also anxious, about the road ahead. Especially when it feels like there’s nobody to ask for directions.
If you’re feeling some stress over it all, we can help. Here’s some tips to help you navigate the first year of your journey as a resident physician.
Leila Javidi, MD, MPH and Dr. Justine Falcone also contributed to this post.
1. Learn your surroundings.
Figure out where you are! Hospitals are notorious mazes that don’t come with a map. The first step is knowing the best entrance to get to where you’re going fastest. The next step is understanding the layout of the floor you’re working on. Where is the supply closet? What is the code? Where is the bathroom? These are the basics.
The next level is to figure out where everything else is: the lab, the emergency department, radiology, patient registration.
There’s nothing worse than having a patient ask, “Where is the help desk?” and not knowing the answer. Learning the lay of the land will give you much more confidence walking through the halls!
2. Learn the inside scoop from other residents.
Is there another resident who will teach you a ton? One that will give you a hard time? Does one attending prefer a short patient presentation? Is there a question that you are always asked on rounds? What will your schedule be like? What are you expected to do?
These are all things your fellow residents who have been through it will know. I suggest getting the scoop before starting any rotation. Know what you’re walking into. Having that heads up will give you an advantage and make you look so prepared when you know exactly what you’re supposed to be doing.
3. Get organized!
Everyone has a different way to stay organized on rounds. Especially on the medicine rotation, it’s essential for you to figure out how to organize all your patient information.
Most people like to use the patient census and fold it over to write important lab values, consult updates, or imaging results. Some people have a special notebook. Some people have a template they print out. Look at what everyone else is doing and find a way that works for you.
What I highly recommend is getting one of those medical cheat sheet clipboards that folds in half. One thing I advise against is just using random scraps of paper and shoving them into your coat—this is not organized!
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4. Make a great first impression.
In this exciting new time, you’re going to establish a reputation for yourself among co-interns, residents and attendings. These are the people you’re going to be spending up to 80 hours per week with, for about 50 weeks per year. My best advice is to be wonderful to them all.
While it’s nice to think people will give you a chance to show who you really are, you should know by now the first impression is the lasting impression. In fact, if you make an amazing first impression, oftentimes it gives you a lot more leeway in the future if you make a mistake or slack a little bit.
To make a good impression, it’s essential to be courteous to everyone, make an effort to learn, pay attention during rounds, be involved in your patient’s care, and always have a great attitude.
If you start off on the right foot, slipping a little bit later on will be forgiven and forgotten. Those who make a lazy, aggressive, rude, or disinterested first impression will have a difficult time shaking it. Every single one of their indiscretions will be added to the pile to support this reputation. Avoid all that by making a fantastic first impression.
5. Know when to ask for help.
One of the biggest mistakes interns make is being too proud to ask for help. Whether it’s trying to care for a crashing patient on the floor and being too afraid to wake the fellow up at 3 a.m., or feeling incredibly burned out after a stretch of shifts with no days off, it’s always okay to ask for help.
At the very least, even the most brilliant and experienced medical mind will need an extra set of hands. And the burgeoning mind of a new intern will need a set of hands and some extra brain power from those who possess not only the algorithmic thinking, but also the logistical knowledge, to handle situations.
Sure, you know your desatting COPD-er would appreciate some nebulizers and a BiPap, but how do you get respiratory to the bedside? How long can BiPap be offered on a floor bed? How do you transfer a patient to the ICU? It’s paramount to understand there’s no shame in asking a senior for help, even if they’re sleeping, and even when the problem seems trivial.
When I was on call as an intern, if I had to ask an upper level for assistance, I would usually start the conversation with something like, “I’m so sorry to bother you at this hour, I just want to double check the plan,” or “I have a concern about this patient.” If all else fails, the statement “I just want to make sure I’m doing what’s right for the patient” tends to be well accepted.
If you’re feeling physically or emotionally drained after a stretch of shifts without a day off, ask a colleague if they can switch shifts with you.
6. Find enjoyment outside of work.
I’ve also found it helpful to plan something fun to look forward to after a particularly busy week or stretch of shifts, such as entering a 5k race, traveling to see family, or planning to have dinner with a friend.
Planning fun and relaxing events in the future will not only give you something to look forward to, it’ll help prevent burnout in the long run. It’s far too easy to fall into the trap of working all day, ordering in, watching 15 minutes of mindless TV, and going to bed at 8:30 p.m. because you need to be up at 4:30 a.m. This spiral, when it takes place in a new city that’s far from your previous social network, can make for a really hard adjustment.
That’s why it’s necessary to keep part of your life separate from work, even if it’s a small thing. This can be something as simple as a 10-minute jog after work, reading a few pages of a pleasure book, dinner with a friend or lover, or holding your child until bedtime. And don’t think about work while you’re doing it!
Like the zen masters remind us: “When drinking tea, only drink tea.” Pick something to do and do only that. Try not to multitask too much when you’re home. You’ll be doing enough of that during the day.
7. Be a team player.
Someone who’s hardworking and always willing to help is much more enjoyable to work with than someone who coasts along and constantly lets others pick up their slack. Many times when I was on call with other residents, I found it was easier to split the workload and help each other out.
Even if it wasn’t “my day” to be on call, and I had to stay an hour or two later in the afternoon—helping the on-call intern do admissions, see consults, etc., made the process a lot smoother for everyone. Not only are you both more likely to finish your work on time and leave at a reasonable hour but, when it’s your turn to be on call, you’ll find it’s a lot less stressful having someone there to help you out.
Part of being a team player also means arriving on time, or better yet, early. I always arrived several hours before rounds to see all my patients, talk with nurses, review labs, etc. That also made it easier to help with any early morning admissions before rounds.
If you’re able to see a new patient before rounds, take another admission when the on-call resident is getting slammed, or call a consult for a busy co-intern. Not only will it make life easier for everyone, you’ll likely become friends with the people you work with and enjoy the sometimes stressful life of residency a bit more!
8. Be kind to everyone.
From custodial workers, to CNAs, to nurses, to your resident colleagues, everyone on the medical team is working towards a common goal: providing the best care to patients in need. If a nurse keeps paging you about an order or abnormal lab result at 3 a.m. when you have 847,347,653 other pages and patients to attend to, it can be easy to get frustrated.
However, I’ve found that remembering we’re all on the same team, and working towards the same goal, can be very helpful. A nurse frequently paging, the ED calling again for an admission, or a hospitalist calling for yet another consult can all add more stress to your shoulders. But these things all happen because someone is trying to do what’s best for the patient.
I’ve found that kindness is one of the strongest tools to apply in residency. Saying thank you to a colleague who helped you out or telling a nurse how much you appreciate their efforts to draw another set of labs goes a long way. Even on a rough day, try to smile and show appreciation to those around you. Not only will it make for a more pleasant work environment, it’ll probably make you happier too.
9. At times, put yourself first.
You can’t adequately, safely, and emotionally care for other people if you don’t take care of yourself. Although it might sound easy to put yourself first, the demands of residency can make it a lot harder than it seems. Amidst multiple 80-hour work weeks, two-week stretches without a day off, frequent call, and scattered night shifts, it can seem impossible to find time to eat healthy, exercise, and keep in touch with friends/family. And sleep can be hard to come by.
During residency, I learned how truly important it can be to say “no.” Learning not to take on more than you can handle—and saving a little more time for yourself—can be essential. If it’s not something you’re truly passionate about, it’s okay to say no thank you to another research project, serving on a committee, interviewing applicants, etc.
The important thing is to make time for what’s truly important to you. I’ve found that in residency, by taking each day at a time, it’s possible to carve out some time for oneself. Even if it means squeezing in a four-mile run on the hospital treadmill after a 16- hour call shift, choosing a salad for dinner, or picking up the phone to call grandma before collapsing in bed. Those moments and memories in life that are important to you should not (and don’t have to be) lost just because you’re in residency.
10. Don’t forget to call mom.
Your schedule can be tough as a resident, and sometimes it’s hard to find the right work-life balance. I could sit here and tell you all the things you should do to maintain a healthy mind, body and spirit, but until you figure that out for yourself, it just won’t happen. I’m still working on that, myself. So if you do nothing else, make sure to call your mom…and be nice!
The Bottom Line
Intern year is tough. But these seven things can help! Keep them in mind, and you’ll do the best you can for your patients, impress your coworkers, and obtain what every resident desires but few achieve: a healthy work-life balance. Best of luck out there!
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