Everyone goes into their intern year excited for the opportunities ahead. Being on the final trail to becoming an attending. Being called doctor and not med student (with the short coat), and being able to put in orders and write official notes. As exciting as this process is, it also comes with uncertainty and potential fears. Finally having autonomy to make decisions, wanting to do the best job, and working in a new place with new people can be scary and stressful. Some medical students might feel like they don’t know enough medicine or the right steps to becoming a strong intern. Well, hopefully this manual will help answer some common questions for new doctors and make the transition into residency easier. Before we dive in, I want to point out that, at the end of the day, everyone will need to go through their own struggles and experiences of seeing real patients in order to understand how these situations play out. Everyone will develop their own methods and collect tips from people along the way to put in their growing box of skills. To summarize what an attending once told me, residency is for seeing as many patients as possible, being able to recognize normal from abnormal and being able to clinically reason through a problem in a timely manner. It is about filtering out the noise and extracting the crucial information that will lead you to a diagnosis and treatment, while saving you from unnecessary steps. It is important to be accountable for your actions and always see things for yourself. Don’t trust that something was done properly without seeing it with your own eyes.
Accountability: In residency, people will make mistakes or forget things. It is important that you admit to these mistakes. Take the time to listen to someone with experience in this area and learn the process to make sure you don’t repeat the same mistakes. It is important to show growth. Making excuses or blaming things on other people will only hurt your relationships and make you less trustworthy.
Honesty: Don’t make things up. If you forgot to place an order or complete a portion of an exam or simply don’t know the answer, do not lie or make things up. This not only jeopardizes your reputation with your colleagues, but is, most importantly, dangerous for patient care. Just say I don’t know or I forgot or I didn’t ask that, and then make sure you take the immediate initiative and address whatever it is so you will have the information available as soon as possible.
Ownership: Take ownership and pride in your patient care. Think outside the box and don’t be afraid to question information that doesn’t make sense. Don’t assume anything. Always ask the patient and bring ideas up to your team. Have a strong assessment and plan and present it with confidence on rounds. If you are wrong, don’t worry the attending will correct you. The important thing is that you think for yourself and try to contribute valuable information for each patient outside of what is in their chart. But make sure you spend the time to complete an adequate chart review, especially if you can find previous notes from specialists or other providers related to that issue. Compare old imaging with new ones. Check baseline labs to new values and see if this leads to answers.
Confidence: Have your own assessment and plan ready for the big problems, and present it like you are the main provider. Don’t ask your attending or senior for reassurance. Tell them, ‘This is what I think and what I would like to do.’ If you are right, then great; if not, you will learn. Don’t be a follower. Challenge yourself and those around you. At the end of the day, everyone is learning.
Resources: Talk to your seniors. Use your attending for big picture questions and concerns with management that do not make perfect sense. Look up information on all of your patients. If you are busy, just read the things on UpToDate or other trusted resources to get the job done. But when you have time at home or during a break, try to master that concept and then explain it to your team and the patient so it helps you learn as well. If you get tired of reading, YouTube has a lot of good, free videos on just about any topic these days. OnlineMedED intern content is also good. MKSAP is good for quick reference, and obviously UpToDate for those gory details you love (read when alert).
Communication: Very important. Update your seniors, attendings, nursing, patients, families, therapists, case managers, and others to make sure people know what you are doing and know the plan. You wouldn’t want to be left in the dark and a lot of people are wanting to know what is happening with the patient. Take the time to get to know as much staff as you can and work with them to achieve the best patient care.
Follow up: Make sure to check that your orders were completed, specimens collected, labs drawn, orthostatic vitals done and documented. If you need something urgent that you are capable of doing, get it done yourself. The hospital is a busy place so don’t rely on everyone else or try to avoid things that can hurt your patients and your reputation. You will be surprised how many times you will need to make phone calls or fix orders to make sure things are getting done correctly. Do things like putting in IVs, drawing blood gases, and getting vitals yourself if others are busy (as long as you’ve had training). This will make you better and ensure things are getting done. Check for results of things you ordered daily and reach out if something hasn’t been done in a timely manner.
Replete electrolytes: I won’t go into details of how much to give of what, you will learn this, but the big thing is don’t forget to check and replete first thing in the morning when reviewing charts.
Rest: Make sure you make time for nutrition, exercise, sleep, friends, and family. If you had a long day at the hospital and want to relax and do something non-medical after work, it’s okay. This will save you burn out and a lot of time, and make you perform better the next day as you will feel refreshed and ready for new challenges.
Giving a helping hand: Help the medical students, PA and NP students, and your co-interns. If you know how to do something or had a good experience with a similar situation, speak up. We are all here to learn from each other and make each other better. Nobody comes in knowing everything or how to do everything. Help others on your team as your seniors help you.
Don’t complain: Everyone in the hospital experiences stress and long hours. Be positive and bring energy to the room and the team. People will gravitate toward this and will want to work with you. Nobody wants to hear about you being tired all the time or complaining about how much work you have to do. Just take the challenge head on and enjoy it. This is what you love to do.
Priorities: As a new intern, this might be one of the most important. Even if you don’t have the best knowledge, the way you go about your work will make you either shine or be a burden. Always make sure to take care of orders and consults first. Talk to social work first thing in the morning to make sure home health, oxygen, equipment, and so on is being worked on. Replete the electrolytes on time. Follow up on all your orders and treatments. Keep everyone involved in the patient’s care updated, so when noon comes around you are ready to discharge the patient home and not costing them another day in the hospital. Write notes last. Also, you can prewrite and pend your notes before rounds to save time later. Learn to multitask and try to chip away at work when you think you might have free time. Don’t let time go by wasted or you might find yourself in the hospital past sign out.
Be Friendly and Professional:
Don’t lose your cool when things don’t go as planned. Obstacles constantly pop up in the hospital, like orders being delayed or not completed, someone doing something you don’t agree with, or someone not communicating. While it is easy to get angry and burst out, try to stay calm and positive, and find or discuss solutions. More than likely, this will get people to respect you and want to work with you, instead of being scared to approach you in important situations. Listen to the patients and families concerns and try to address them the best you can. If you don’t have all the answers, ask for help so nothing is left out.
Don’t avoid work:
Try not to complain about having more patients or busier patients. This work will only make you stronger and better. The more patients you see, the better you will be and the faster you will grow.
Don’t beat yourself up:
If something doesn’t go as planned or you make a mistake, it is okay to be upset for a short period of time, but don’t let it affect you negatively in the long run. Take the steps to learn and correct your mistakes and know that you aren’t superman and can’t predict everything. Do your best and continue growing and learning.