Four Pearls For Intern Year

Four Pearls for Intern Year
Ryan Nelson, MD

I pulled the prescription off the printer. At the bottom was a blank line, awaiting my signature. I wasn’t delivering a script to a resident or attending anymore. For the first time in my life, I felt self-doubt while signing my own name. I also felt an immense amount of privilege to care for another person directly and make my own medical decision. Three years later, I still vividly remember this moment: writing my first prescription as an intern. I was both excited and nervous. The new role of “doctor” is humbling but immensely gratifying.

When I was given the prompt for this article, ‘Tips for New Interns,’ I admit my first thought was to describe my methods for data organization, prioritizing tasks, and time management. While these are important skills, I felt that providing advice here would be somewhat trivial. As I continued to reflect, I settled on four principles that helped me find fulfillment during residency.

1. Embrace the unknown.
I remember the night before my first wards call thinking: “I don’t know how to admit or discharge a patient. What if I don’t know the diagnosis?” I was anxious, and I tossed and turned all night. There is no way to prevent anxious anticipation, but you must realize that medicine is dynamic and difficult. The only way to change or control a situation is to first experience it. After the initial exposure, the first shock, it only gets better because you adapt. The unknown is always scary, but eventually it becomes an old friend as your clinical arsenal builds up. I encourage you to embrace the unknown. As a new intern, it’s easy to feel overwhelmed by the sudden increase in autonomy and responsibility. Instead, focus on one new challenge at a time and solidify what you’ve learned by teaching a fellow intern. Never be afraid to ask questions, and always remember that your team has your back.  

2. Be humble and resilient.
Intern year is a learning experience, and you are going to make mistakes. Often, with mistakes comes feedback. In medical school, we are conditioned to believe that receiving feedback translates into a lower evaluation. This mentality puts you on the defensive and hinders personal growth. I remember my first piece of feedback as an intern: “You need to work on your organization for rounds.” Initially, it felt personal, and I was embarrassed. Then, I thought about it more, and realized it was true. I hadn’t optimized my system yet. I swallowed my pride and vowed to improve for the next day. From then on, I began to look forward to feedback, seeing it as an opportunity to improve my clinical care. Your residents and attendings want you to succeed, and accepting constructive feedback is key to that success. Don’t be defensive. Instead, be proactive and strive to be better with every patient, every call cycle, and every rotation. Be humble and resilient throughout intern year. It’s no longer about the grade; it’s about patient care and personal growth.

3. Preserve your passions.
Twice a week, no matter what, I sat behind my drum set and played. I’ve been a drummer since high school, and I vowed early on in residency that I would not lose this skill. Each week, set aside time to paint, run, write, cook a nice meal, or rock out. It’s so important to preserve your passions during residency. Creativity and medicine are complementary, and personal interests stave off burnout. Also, chances are, your passion will annoy your neighbors a lot less than mine does.

4. Celebrate your victories.
One of the best traditions in my residency is for all of the night team interns and residents to go to brunch the Friday morning after their final night shift. It was motivational and exciting to know that a team meal was on the horizon… along with a few cocktails. I highly recommend you celebrate each victory throughout intern year, no matter how small. It is important to always have something to look forward to.

In New Orleans, it’s customary to end with a “Lagniappe,” which means a bonus or extra. Here are three books that were key to my personal growth throughout residency:

1. The Seven Habits of Highly Effective People – Stephen Covey
2. Essentialism – Greg McKewon
3. Make Your Bed – Admiral William H. McRaven

The next time you sit there, faced with signing your name to a prescription, preparing for rounds or finishing up a long week on the night shift, I hope you remember some of these tips to keep you focused on the end game: being the doctor you always dreamed you could be.
Posted by Ryan Nelson on Oct 1, 2018 7:50 PM America/New_York