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Reflections on Intern Year: Tips for Incoming Interns.

I’m going to be blunt. Intern year was hard. There were days this past year when I left work after a hard shift and found myself unexpectedly in a variety of positions — tearful on the stair climber at the gym or exhausted eating leftovers over my kitchen sink. Sometimes you don’t even know why you feel this way. Patient acuity, the draining hours, sometimes it all adds up. All of the stressors of medical school compound with increased responsibility, even more hours, and boom, you have intern year.

But, there are so many wonderful moments, too. Waking my husband up at 3am to celebrate after getting my first successful intubation was priceless. Seeing your patient get downgraded from the ICU and eventually stepping out the front doors of the hospital made the long hours worth it. Sharing cookies with the nursing staff on holidays makes you feel like you have a family-away-from-family. Looking back, I learned SO much in just a short period of time. I almost can’t believe I did it, or am doing it, I should say. Intern year is time for growth and it’s well known for having its challenges.

But that is why I felt so compelled to write this article. Because intern year repeats. Every year, a new generation of sparkling new interns will join us. Often, the weeks leading up to July 1 are filled with the fear of the unknown, wondering how you can prepare, if you’ll succeed, or how’ll you’ll even survive. At least that’s what I found myself thinking just 12 brief months ago.

I am by no means an expert. I’m technically still an intern for the next few weeks. But in each of these tired, post-shift intern year moments, after letting all of my emotions release and coming to terms with myself, I felt empowered to share some insightful tidbits with the world. Feeling like I’d conquered some unsolved mystery, I’d pull out my phone and draft some catchy prose. Something that the medical community would appreciate, something to normalize the ups and downs of medicine. I never pressed send, publish, or tweet. With more than 90 percent of intern year complete, and PGY2 within my sights, I’m left with a rather nice memoir of the year that is notoriously known as the hardest in residency.

Below is a summary of lessons learned, taken directly from my dearest diary… that is, Apple Notes on my cellphone. To my new colleagues who will be the 2021 interns, welcome. We are so excited to have you by our sides.

From intern to intern, here’s my tips:

The Hospital is a Machine. Some days you will feel like a cog. Be the cog...

It’s just a fact that residents are crucial to a functioning academic medical center. But the importance of our presence is to learn, to grow as physicians, and care for our patients. There are days when the waiting room never empties, the consults keep coming, and the phone never stops ringing. It’s hard after the 100 clicks on Cerner/Epic/CRPS that it takes just to go through the VTE Prophylaxis Manager and order Lovenox, not to feel like your job is less than what it is. But try your hardest not to forget about the reason you went into this career. Linger on the moments that reinforce that desire and remember that you’re a doctor.

You will see and do some cool things. Don’t let those moments slip by without recognition.

Celebrate your wins. I placed a traumatic chest tube on my first day of residency and that high carried me through that first, scary month of intern year. Depending on your speciality or interests, your “wins” may be different, but use that momentum to get you through some of the harder moments. You will not like every task that you have to do. But at the end of the day, you will have made a difference in patient care. There’s more daily work than what I realized as a medical student. Coordinating with medical supply companies, completing paperwork, calling insurance companies, the list goes on. But these small things add up and improve patient care. All of these tasks you do daily matter. You matter.

Don’t forget to have some fun along the way.

We have a soccer league between residents and nurses. There’s monthly book clubs, game nights, barbecues, and baseball games. Don’t be afraid to take some time for yourself and bond with your colleagues. Forming those connections helps you, not only in the wards but also for out-of-work friendships. We are all on the same team. When it comes time for vacation, I highly recommend hosteling or camping if you are looking for cheap, fun get-away options.

Find your comforts.

For me, those cafeteria breakfast potatoes at 5am were the key to surviving ICU. You may need to promise yourself a Starbucks cake pop at midnight to get through a call night. Whatever it is that makes your day a little easier or brighter, make sure you do it. I found this to be extra important before 24-hour shifts. I always brought a “go bag” with a toothbrush, some Tums, and some small make-up essentials. It made me feel like I was prepared for the long days. Before a new rotation, check out where the work room is, pop in and say hi to the team. Maybe even find the sacred single bathroom — anything that makes the first day a bit less scary.

It takes time to find your groove, observe your seniors, recognize what you know and what you do not know.

In EM, we sign out a lot of patients at once. Struggling to keep all the details straight, I listened to an upper level resident who suggested I “chart check” the board 20-30 min before shift started. This helps to review why a patient is here, what their ED course has been so far and what tasks are pending. Now, I show up a bit early but my shift runs smoothly. Many shifts were spent struggling over a lack of organization when I simply could have asked for advice early on. You will find your process. Every resident has a preferred way to pre-round or organize their patient lists. Try something and stick with it for a week or so. If it’s not working, change it up.

In line with this, if you’re unsure about something, just ask. Not sure how to order that heparin drip? Call your friendly pharmacist. Don’t know what is expected of you? Clarify with your senior. When it comes to medical decision making and disease processes, pick a topic from the day and read about it after shift. This way you start forming good self-directed learning habits early.

The evaluations are constant, do your best to evaluate yourself fairly.

The feeling of imposter syndrome is real, and it only compounds with the constant pressure to succeed. Some days I felt this more than others. In residency, you are being watched by everyone. Your attendings, co-residents, and medical students give you evaluations at the end of rotations. Patients get sent surveys. Your out-of-work life can also easily be questioned for professionalism (a huge thing in times of COVID social distancing and traveling). All of this can feel like feedback overload. Take a deep breath, you are here to learn and it is the expectation that you will not know everything from day one, or else why would we be in residency? Try your best to pull feedback from your evaluations that is constructive and work to integrate the appropriate changes into your shifts.

Recognize that the list of things COVID-19 took from us is long, but we got through this together.

We lost a lot this year. Just like the interns of 2020, your class is also entering a career field in the middle of a pandemic. We were all forced to find each other through Zoom calls and Group Me’s. As individuals, we lost loved ones and even lost the opportunity for funerals to celebrate their lives. Many of us also lost patients. Medicine comes with the expectation of loss; some patients die. It is okay to feel the pain of losing something but one of the hardest things, for me, was to step back and grieve. If you feel overwhelmed, don’t be afraid to vocalize that you need a minute. Check in with your seniors, your chiefs, your team members. If intern year is giving you heartburn, you’re not alone. Everyone wants you to succeed.

You made it through 2020, and you’re going to make such an amazing doctor. You can do this.

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