9 Things I Wish I Had Known Before Intern Year

I distinctly remember the feeling of fear in the days leading up to July 1 of my intern year, so I was excited when I was offered the opportunity to write this article. Listed below are 9 of the many things I’ve learned over the last yearI hope they can be helpful to you.
  1.   No one expects you to know everything.
My biggest fear before starting residency was that I wouldn't know what to do, and that my attending/ supervisor/co-interns/patients would realize that I didn't know enough to be a doctor. What I realized is that hard work far outweighs an extensive medical knowledge; we’re not expected to be perfect, but we are expected to put forth our best effort.
  1.   Everyone has different strengths.
My co-interns are rock stars- already independently running codes or easily identifying a left anterior hemifascicular block on EKG. I'm not yet at that level. I’ve learned, though, that we each have our own strengths and weaknesses. It's easy to compare other residents' strengths with our own perceived weaknesses, but this shouldn't make us feel inadequate. Reflect on your own strengths, whether that's reading EKGs or taking a detailed history or having a great bedside manner, and allow those strengths to bolster your confidence. Recognize the areas in which you have room for growth, and allow your co-residents and attendings to help you strengthen those areas.
  1.   Sometimes, the work of medical professionals isn't appreciated.
We’ve all invested huge amounts of time and energy to help our patients. Unfortunately, that investment isn’t always recognized, nor is the crazy schedule that we endure as residents. Instead, we occasionally function as a sort of shock absorber for the painful emotions of patients and families.  When I first experienced this, I was hurt and disappointed. However, I learned that this is often a reflection of someone else’s struggle, rather than a reflection on our skill or knowledge as residents. Accept that some people won’t ever fully appreciate the sacrifices you have made, and continue to make those sacrifices regardless -- other patients will thank you.
  1.   It’s important to make time for the things and people you love.
It's easy to get overwhelmed by clinical responsibilities and give less attention to things (and people) outside of work. But these things will keep life balanced, and it is key to continue to pursue life outside of clinical duties. Make sure you continue to do the things you love, even if it means a little less sleep or studying.
  1.   How to work a pager (and navigate the EMR, and get around the hospital, and, and, and...).
During my first month of residency, it felt like the majority of my time each day was spent trying to find my way through a large hospital system with patients scattered all over multiple towers. I felt frustrated by how long it took me to put in orders (why are there eight different options for potassium supplementation?). It took all my focus to forward a pager, let alone take care of complicated, sick patients. Take the time early on to learn the logistical side of residency, and it will be one less thing that you have to stress about on a busy day.
  1.   Know how to make efficient use of the resources available to you.
I wasted a lot of time trying to find things on Google that I should have searched for on UpToDate, and even more time trying to find things on UpToDate when instead I should have called someone (my supervisor, our team pharmacist, social worker, etc.). Learn what resources are available at your institution, and familiarize yourself with them -- you'll save time down the road when you know where to look the first time.
  1.   It’s important to take a break from medicine.
During my first few vacations, I didn't ask anyone to cover my clinic inbox. I didn't want to bother one of the other residents, and I especially didn't want to seem like I was trying to avoid work. The end result, though, was that I spent hours worrying about my clinical responsibilities and trying to trouble-shoot issues from 700 miles away; I was on vacation physically but mentally I was still working. I missed out on time with my family, and I returned from vacation more emotionally exhausted and stressed than when I had left. Make sure to give yourself a well-deserved break when you have the infrequent opportunity.
  1.   The exhaustion of residency is not solely physical.
This took me some time to realize. I would come home from a day of work and feel drained, even if I had been diligent about sleeping enough. Eventually, I came to recognize that my fatigue wasn't related to a sleep deficit as much as it was due to the exhaustion of being fully involved in patient care. I would argue that it's impossible to tell a patient that they have cancer, or to pronounce a patient, or to discuss end of life care with a patient's family, without being personally affected in some way. And yet this is what we're called to do as physicians -- we're called to interact with sick, dying individuals every day while functioning at a high level under high amounts of pressure. Recognize that this can be emotionally exhausting, and take the time to recharge.

9. Your co-residents are amazing people.
I would have been much less scared if I had known the caliber of the people I would soon be working with. The last 12 months have been a whirlwind of experiences, and I’m so thankful to have been able to share them with the other residents in my program. Make sure to get to know the other residents and enjoy your time with them -- they’re some of the best people you’ll ever meet.

Huge thanks to Dr. Madaiah Lokeshwari, Assistant Professor of Medicine at UMass for her assistance with this article, as well as the UNMC Internal Medicine Residency program for both challenging and supporting me through residency.
Posted by Jessica Rydberg on Jul 24, 2019 9:07 AM America/New_York